Dural and Skull Base Metastases

Silva, Arnaldo Neves Da; Schiff, David

doi:10.1007/978-0-387-69222-7_7

Cited by 11 publications

(4 citation statements)

References 124 publications

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“…Other intracranial deposits are usually present, with only 4% of patients having isolated dural intracranial disease [28]. The incidence of intracranial metastasis is currently increasing due to improving treatments for systemic cancer [30].…”

Section: Introductionmentioning

confidence: 99%

Dural masses: meningiomas and their mimics

et al. 2019

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Meningiomas are the most common dural tumour. They are regularly being seen as an incidental finding on brain imaging and treated conservatively. However, there are many other dural masses which mimic their appearances, including primary neoplastic processes, metastases, granulomatous diseases and infection. While some of these are rare, others such as metastases and tuberculosis arise relatively frequently in practice. Although not pathognomonic, key features which increase the probability of a lesion being a meningioma include intralesional calcifications, skull hyperostosis, local dural enhancement and increased perfusion. It is important to have an awareness of these entities as well as their main imaging findings, as they have a wide range of prognoses and differing management strategies. This review outlines several of the most important mimics along with their imaging findings on both standard and advanced techniques with key features which may be used to help differentiate them from meningiomas.

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Section: Introductionmentioning

confidence: 99%

Dural masses: meningiomas and their mimics

et al. 2019

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“…Cranial nerve palsies can occur when the DM is located at the base of the skull (10,20). Compression of the cavernous sinus is associated with multiple cranial neuropathies, and focal weakness can result from compression or invasion of the underlying brain parenchyma by the DM (20). In this study, most symptoms disappeared after WBRT and did not worsen or reappear until death or the end of the study.…”

Section: Discussionmentioning

confidence: 56%

“…Subdural hematoma should be considered when evaluating headache symptoms. Cranial nerve palsies can occur when the DM is located at the base of the skull (10,20). Compression of the cavernous sinus is associated with multiple cranial neuropathies, and focal weakness can result from compression or invasion of the underlying brain parenchyma by the DM (20).…”

Section: Discussionmentioning

confidence: 99%

Whole-brain Radiation Therapy for Breast Cancer Patients with Dural Metastasis Without Concomitant Brain Metastasis and Leptomeningeal Metastasis

et al. 2018

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Aim: To evaluate outcomes of breast cancer patients with confirmed dural metastasis (DM) alone who received whole-brain radiation therapy (WBRT). Patients and Methods: The medical records of thirty-three breast cancer patients who received WBRT to treat intracranial metastasis were retrospectively reviewed. The clinical presentation of DM-only was compared with that of brain metastasis (BM)/leptomeningeal metastasis (LM). Results: Eight patients had DM and 25 patients had BM/LM. Median survival was 12 months in patients with DM and 7 months in those with BM/LM. Multivariate analysis found that only a Karnofsky performance status of ≥70 was significantly associated with improved OS. DM did not cause the death of any patient. Symptoms did not worsen in any DM patient. Conclusion: WBRT can be considered for patients with DM alone for symptom improvement and preventing DM-related death.

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“…20 Therefore, for patients with a good long-term prognosis (controlled primary cancer, good performance status, limited concurrent medical conditions, and long life expectancy), higher doses up to 50 Gy are also reasonable. 3 Of note, approximately 80% of patients who received radiation therapy have sustained improvement until their last follow-up visit or time of death. 20 In addition to dose escalation, the timing of treatment initiation might also affect effectiveness of treatment.…”

Section: Discussionmentioning

confidence: 99%

Calvarial and skull base metastases: expanding the clinical utility of Gamma Knife surgery

Kotecha¹,

Angelov

Barnett

et al. 2014

JNS

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ObjectTraditionally, the treatment of choice for patients with metastases to the calvaria or skull base has been conventional radiation therapy. Because patients with systemic malignancies are also at risk for intracranial metastases, the utility of Gamma Knife surgery (GKS) for these patients has been explored to reduce excess radiation exposure to the perilesional brain parenchyma. The purpose of this study was to report the efficacy of GKS for the treatment of calvarial metastases and skull base lesions.MethodsThe authors performed a retrospective chart review of 21 patients with at least 1 calvarial or skull base metastatic lesion treated with GKS during 2001–2013. For 7 calvarial lesions, a novel technique, in which a bolus was placed over the treatment site, was used. For determination of local control or disease progression, radiation therapy data were examined and posttreatment MR images and oncology records were reviewed. Survival times from the date of procedure were estimated by using Kaplan-Meier analyses.ResultsThe median patient age at treatment was 57 years (range 29–84 years). A total of 19 (90%) patients received treatment for single lesions, 1 patient received treatment for 3 lesions, and 1 patient received treatment for 4 lesions. The most common primary tumor was breast cancer (24% of patients). Per lesion, the median clinical and radiographic follow-up times were 10.3 months (range 0–71.9 months) and 7.1 months (range 0–61.3 months), respectively. Of the 26 lesions analyzed, 14 (54%) were located in calvarial bones and 12 (46%) were located in the skull base. The median lesion volume was 5.3 cm3 (range 0.3–55.6 cm3), and the median prescription margin dose was 15 Gy (range 13–24 Gy). The median overall survival time for all patients was 35.9 months, and the 1-year local control rate was 88.9% (95% CI 74.4%–100%). Local control rates did not differ between lesions treated with the bolus technique and those treated with traditional methods or between calvarial lesions and skull base lesions (p > 0.05). Of the 3 patients for whom local treatment failed, 1 patient received no further treatment and 2 patients responded to salvage chemotherapy. Subsequent brain parenchymal metastases developed in 2 patients, who then underwent GKS.ConclusionsGKS is an effective treatment modality for patients with metastases to the calvarial bones or skull base. For patients with superficial calvarial lesions, a novel approach with bolus application resulted in excellent rates of local control. GKS provides an effective therapeutic alternative to conventional radiation therapy and should be considered for patients at risk for calvarial metastases and brain parenchymal metastases.

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Dural and Skull Base Metastases

Cited by 11 publications

References 124 publications

Dural masses: meningiomas and their mimics

Dural masses: meningiomas and their mimics

Whole-brain Radiation Therapy for Breast Cancer Patients with Dural Metastasis Without Concomitant Brain Metastasis and Leptomeningeal Metastasis

Calvarial and skull base metastases: expanding the clinical utility of Gamma Knife surgery

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