Management of Skull Base Metastases

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Management of Skull Base Metastases Roukoz B. Chamoun, MD, Franco DeMonte, MD, FRCSC Neurosurgery Clinics Volume 22, Issue 1, Pages 61-66 (January 2011) DOI: 10.1016/j.nec.2010.08.005 Copyright © 2011 Elsevier Inc. Terms and Conditions

Fig. 1 Coronal, postcontrast, T1-weighted MRI of a 72-year-old man with severe pain and progressive proptosis. An orbitectomy and free-flap reconstruction was uneventful and resulted in a marked reduction in pain. The tumor was initially thought to represent a primary lacrimal carcinoma, but a small lung primary, obscured by underlying pulmonary fibrosis, was ultimately identified. (Courtesy of The Department of Neurosurgery, M.D. Anderson Cancer Center; with permission.) Neurosurgery Clinics 2011 22, 61-66DOI: (10.1016/j.nec.2010.08.005) Copyright © 2011 Elsevier Inc. Terms and Conditions

Fig. 2 Coronal, postcontrast, T1-weighted MRI of a 47-year-old woman with progressive visual decline and remote history of breast carcinoma. Imaging suggested the presence of an optic nerve sheath/anterior clinoidal meningioma. Surgical biopsy was performed for diagnostic purposes. Metastatic carcinoma of breast origin was confirmed. (Courtesy of The Department of Neurosurgery, M.D. Anderson Cancer Center; with permission.) Neurosurgery Clinics 2011 22, 61-66DOI: (10.1016/j.nec.2010.08.005) Copyright © 2011 Elsevier Inc. Terms and Conditions

Fig. 3 (A) Axial, postcontrast preoperative CT scan. This 54-year-old woman with known metastatic mesenchymal chondrosarcoma presented with progressive optic neuropathy. Preoperative visual acuity was no light perception. (B) Axial, postcontrast, postoperative MRI. A left orbito-cranial approach was used to completely resect the metastasis to the greater sphenoid wing and decompress the left optic nerve. Vision had improved to 20/400 by the sixth postoperative day. (Courtesy of The Department of Neurosurgery, M.D. Anderson Cancer Center; with permission.) Neurosurgery Clinics 2011 22, 61-66DOI: (10.1016/j.nec.2010.08.005) Copyright © 2011 Elsevier Inc. Terms and Conditions

Fig. 4 Preoperative (A) and postoperative (B) sagittal postcontrast MRI of a 64-year-old woman with progressive left optic neuropathy. A bifrontal biorbital approach allowed complete tumor resection and a return to normal vision. The patient ultimately died of progressive systemic disease 26 months later. (Courtesy of The Department of Neurosurgery, M.D. Anderson Cancer Center; with permission.) Neurosurgery Clinics 2011 22, 61-66DOI: (10.1016/j.nec.2010.08.005) Copyright © 2011 Elsevier Inc. Terms and Conditions