Metastatic skull tumors: MRI features and a new conventional classification

ABSTR AC TBackground Although a wide range of processes along the neurocranium are of a benign nature, there are often difficulties in the differential diagnosis.Method In the review CT/MRI scans of the head were evaluated retrospectively regarding solitary lesions along the neurocranium. The majority of the lesions were histologically proven.Results The purpose of the review is to present typical pathologies of the neurocranium and provide a systematic overview based on 12 entities, their locations, prevalence and radiological characteristics.Conclusion Processes, which primarily originate from the neurocranium have to be differentiated from secondary processes infiltrating the neurocranium. For this important diagnostic feature, MRI is typically essential, while the definitive diagnosis is often made on the basis of the medical history and the typical appearance on computer tomography. Key Points▪ There are often difficulties in the precise differential diagnosis of solitary lesions along the neurocranium. Typical solitary pathologies of the neurocranium based on 12 entities were presented. Both magnetic resonance imaging and computed tomography are often essential for an exact differential diagnosis. Schlussfolgerung Unterschieden werden müssen Prozesse, die primär vom Neurokranium ausgehen, von sekundären Prozessen, die das Neurokranium infiltrieren. Für dieses wichtige diagnostische Merkmal ist die MRT meistens unverzichtbar, während die definitive Diagnose dann unter Berücksichti-gung der Anamnese mit dem typischen Erscheinungsbild in der CT häufig gestellt werden kann.

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“…Metastases are the most common malignant bone lesions in adults [42]. Almost any malignant tumor can cause metastases in the calvaria.…”

Section: Definition and Locationmentioning

confidence: 99%

Cross Sectional Imaging of Solitary Lesions of the Neurocranium

Schäfer

Koch

Streitparth

et al. 2017

Fortschr Röntgenstr

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“…Metastatic skull tumors are mostly calvarial circumscribed intraosseous tumors (14). Radionuclide bone studies are a valuable screening test to detect bone metastases.…”

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confidence: 99%

“…Primary sites were breast cancer (55%), lung cancer (14%), prostate cancer (6%), malignant lymphoma (5%), and others (20%). Calvarial metastases were most frequently circumscribed and intraosseous (27%) (14).…”

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confidence: 99%

Management of calvarial tumors - a retrospective analysis and literature review

Özgiray¹,

Perumal²,

Çınar³

et al. 2015

Turkish Neurosurgery

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Hematogenous metastases to the calvarium can be caused by nearly all types of tumors (8). Most metastatic skull lesions being asymptomatic and less important clinically than intraparenchymal metastatic lesions, they are rarely diagnosed clinically but are frequently found in autopsies. Literature on the skull tumors consists mostly of individual case reports and a scarce number of case series. Only a few articles are available on skull metastases, especially calvarial metastases (3,4,13,15,16). Calvarial metastases signify an advanced stage of disease (16). █ INTRODUCTIONT umors of various organs and tissues that tend to metastasize to bony structures do not neglect the skull vault as a target. There are autopsy series of carcinoma breast cases reporting occasional skull metastases even from the end of 18 th century. Today and in the near future, we may expect more cases with skull metastasis as a result of advanced radiological imaging and prolonged survival of cancer patients. AIM:Tumors of various organs that metastasize to bone do not neglect calvarium as a target. The aim of this study was to characterize the calvarial tumors. MATERIAL and METhODS:We retrospectively reviewed 45 consecutive patients operated for calvarial masses from January 2002 till May 2012 at our hospital. Skull base tumors and patients ≤18 years were excluded. RESULTS:Three groups of lesions were found -calvarial metastases (15/45), primary tumors (5/45) and tumor-like lesions (25/45). Malignant lesions were equitable by gender distribution, higher age of onset (median age of primary =55; secondary = 60 years) and benign lesions by younger age (median = 35) and female bias (18/25). Calvarial metastases mostly presented with local swelling (10/15), local pain (6/15) and rarely neurologic deficit. There was associated dural sinus thrombosis (4/20 of malignant; 1/25 of benign lesions) and osteolysis (3/5 primary malignant, 13/15 secondary and 18/25 of benign lesions). Complete surgical excision was possible with minimal morbidity in all except one patient and nil mortality. CONCLUSION:Nearly half (20/45) of the calvarial lesions tend to be malignant with most of them presenting as silent painless masses. Surgical excision should be considered only after suitable investigation and appropriate neurosurgical set-up.

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“…Calvarial metastases can be diffuse or circumscribed. 1 Dural metastases can appear at several sites ( Fig. 1) and are often asymptomatic or have unspecific symptoms.…”

Section: Symptoms and Signsmentioning

confidence: 99%

“…Classically, 5 typical syndromes have been described by Greenberg 3 and were recently updated by Mitusuya. 1 The inclusion of the controversial anatomical concept of angiosoma 6 may prove to be helpful in diagnosis and treatment. Angiosomas divide the tissue compartments of the head and skull according to their vascularization in contrast to the more traditional way of viewing the skull by the distribution of CN nerve trunks and vessels.…”

Section: Symptoms and Signsmentioning

confidence: 99%

Cancer around the brain

Grisold

2014

Neuro-Oncology Practice

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Background Neuro-oncologists are familiar with primary brain tumors, intracerebral metastases meningeal carcinomatosis and extracerebral intracranial tumors as meningeoma. For these conditions, and also some other rare tumor entities several treatment options exist. Cancer can also involve structures around the brain as the dura, the base of the skull, the cavities of the skull and tissue around the bony skull, the skin, the tissue of the neck. and either compress, invade or spread in the central or peripheral nervous system. Methods A systematic literature research was conducted determining symptoms and signs, tumor sites of nerve invasion, tumor types, diagnostic techniques, mechanisms of nerve invasion, and important differential diagnosis. Additional cases from own experience were added for illustration. Results The mechanisms of tumor invasion of cranial nerves is heterogenous and not only involves several types of invasion, but also spread along the cranial nerves in antero- and retrograde fashion and even spread into different nerve territories via anastomosis. In addition the concept of angiosomas may have an influence on the spread of metastases. Conclusion In addition to the well described tumor spread in meningeal carcinomatosis and base of the skull metastases, dural spread, lesions of the bony skull, the cavities of the skull and skin of the face and tissue of the neck region need to be considered, and have an impact on therapeutic decisions.

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Metastatic skull tumors: MRI features and a new conventional classification

Cited by 130 publications

References 13 publications

Cross Sectional Imaging of Solitary Lesions of the Neurocranium

Cross Sectional Imaging of Solitary Lesions of the Neurocranium

Management of calvarial tumors - a retrospective analysis and literature review

Cancer around the brain

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