Signs and Symptoms

Progressive, dull, continuous pain in the supraorbital area over the affected eye, diplopia, proptosis of the involved eye, external ophthalmoplegia, first-division trigeminal sensory loss

Ipsilateral frontal headache, oculomotor or abducens palsies without associated proptosis or visual loss

Facial pain or numbness referable to the second or third divisions of trigeminal nerve

Paralysis of cranial nerves IX through Xl

Unilateral occipital pain and unilateral tongue paralysis

Data from Greenberg HS, Deck MDF, Vikram B, et al: Metastasis to the base of the skull: Clinical filldings in 43 patients. Neurology 1981;31:53s537.

most commonly involve the middle cranial fossa. Other sites include the jugular foramen, occipital condyle, parasellar region, and orbit. Metastases to the skull base entrap the cranial nerves and vessels at their exit foramina. Often the cancer appears en plaque as a thin skein of tumor cells. Greenberg has identified five clinical syndromes: orbital, parasellar, middle fossa, jugular foramen, and occipital condyle. y

Owing to their insidious subacute onset, skull-based metastases are difficult to identify on MRI or CT where masses may coalesce with changes of prior irradiation or surgical extirpation. Often the T2-weighted changes in contiguous bone after radiotherapy may be confused with tumor. Treatment depends on the nature of the underlying tumor and is typically confined to irradiation as previously described.

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