Benign Skull Tumors Treatment & Management

  • Author: Draga Jichici, MD, FRCP, FAHA; Chief Editor: Tarakad S Ramachandran, MBBS, FRCP(C), FACP   more...
 
Updated: Feb 3, 2012
 

Medical Care

  • Administer aspirin or NSAIDs for osteoid osteoma.
  • Provide pain control symptomatically.
  • No treatment is required for asymptomatic lesions unless diagnostic concerns exist.
  • Stereotactic radiosurgery should be considered as an alternative to surgical resection for benign meningiomas.[10]
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Surgical Care

  • Complete surgical excision is possible for symptomatic relief, cosmetic reasons, or cranial nerve decompression.
  • En bloc resection is the preferred intervention.
  • Curettage is also performed for lesions that cannot be resected completely. Careful removal of the cyst wall is critical in epidermoids and dermoids. Gamma Knife and CyberKnife are possible new ways of treating unresectable symptomatic lesions.[11]
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Consultations

  • Neurosurgeon
  • Plastic surgeon
  • Neurologist
  • Radiation oncologist: Radiation therapy is acceptable as a second form of treatment in some partially resected lesions such as ossifying fibroma, hemangioma, and aneurysmal bone cyst because of their high recurrence rate. In addition, the Gamma Knife and the CyberKnife are under investigation.
  • Ophthalmologist
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Contributor Information and Disclosures
Author

Draga Jichici, MD, FRCP, FAHA  Associate Clinical Professor, Department of Neurology and Critical Care Medicine, McMaster University School of Medicine, Canada

Draga Jichici, MD, FRCP, FAHA is a member of the following medical societies: American Academy of Neurology, Canadian Congress of Neurological Sciences, Canadian Congress of Neurological Sciences, Canadian Congress of Neurological Sciences, Canadian Critical Care Society, Canadian Medical Protective Association, Canadian Neurocritical Care Society, Neurocritical Care Society, Royal College of Physicians and Surgeons of Canada, and Society of Critical Care Medicine (USA)

Disclosure: Nothing to disclose.

Specialty Editor Board

Spiros Manolidis, MD  Associate Professor of Otolaryngology and Neurological Surgery, Columbia University

Spiros Manolidis, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Auditory Society, American Head and Neck Society, American Medical Association, Canadian Society of Otolaryngology-Head & Neck Surgery, Society of University Otolaryngologists-Head and Neck Surgeons, and Texas Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Jorge C Kattah, MD  Head, Associate Program Director, Professor, Department of Neurology, University of Illinois College of Medicine at Peoria

Jorge C Kattah, MD is a member of the following medical societies: American Academy of Neurology, American Neurological Association, and New York Academy of Sciences

Disclosure: Biogen Honoraria Consulting; Bayer Corporation Honoraria Consulting

Chief Editor

Tarakad S Ramachandran, MBBS, FRCP(C), FACP  Professor of Neurology, Clinical Professor of Medicine, Clinical Professor of Family Medicine, Clinical Professor of Neurosurgery, State University of New York Upstate Medical University; Chair, Department of Neurology, Crouse Irving Memorial Hospital

Tarakad S Ramachandran, MBBS, FRCP(C), FACP is a member of the following medical societies: American Academy of Neurology, American Academy of Pain Medicine, American College of Forensic Examiners, American College of International Physicians, American College of Managed Care Medicine, American College of Physicians, American Heart Association, American Stroke Association, Royal College of Physicians, Royal College of Physicians and Surgeons of Canada, Royal College of Surgeons of England, and Royal Society of Medicine

Disclosure: Abbott Labs None None; Teva Marion None None; Boeringer-Ingelheim Honoraria Speaking and teaching

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Efstathios Papavassiliou, MD to the development and writing of this article.

References

  1. Wilkins RH, Rengachary SS. 2nd ed. Neurosurgery. New York, NY: McGraw-Hill; 1996:1503-1528.

  2. Huvos AG. Bone Tumors: Diagnosis, Treatment and Prognosis. Philadelphia, Pa: WB Saunders Company; 1979.

  3. Yuca K, Kiris M, Avcu S, Bayram I, Cankaya H, Kiroglu AF. A giant paediatric mandibular aneurysmal bone cyst and reconstruction with bilateral iliac bone graft. B-ENT. 2009;5(1):39-42. [Medline].

  4. Nasser MJ. Psammomatoid ossifying fibroma with secondary aneurysmal bone cyst of frontal sinus. Childs Nerv Syst. May 30 2009;[Medline].

  5. Docquier PL, Delloye C, Galant C. Histology can be predictive of the clinical course of a primary aneurysmal bone cyst. Arch Orthop Trauma Surg. May 9 2009;[Medline].

  6. Konishi E, Okubo T, Itoi M, Katsumi Y, Murata H, Yanagisawa A. Chondroblastoma of trapezium with metacarpal involvement. Orthopedics. Apr 2008;31(4):395. [Medline].

  7. Schmitz-Feuerhake I, Pflugbeil S, Pflugbeil C. Radiation Risks from Diagnostic Radiology: Meningiomas and other Late Effects after Exposure of the Skull. Gesundheitswesen. Jun 23 2009;[Medline].

  8. Wootton-Gorges SL. MR imaging of primary bone tumors and tumor-like conditions in children. Magn Reson Imaging Clin N Am. Aug 2009;17(3):469-87, vi. [Medline].

  9. Yucel E, Akkaya H, Gürkanlar D, Ergun T. Congenital cavernous hemangioma of the skull. Turk Neurosurg. 2011;21(4):645-7. [Medline].

  10. Bloch O, Kaur G, Jian BJ, Parsa AT, Barani IJ. Stereotactic radiosurgery for benign meningiomas. J Neurooncol. Oct 18 2011;[Medline].

  11. Dassoulas K, Schlesinger D, Yen CP, Sheehan J. The role of Gamma Knife surgery in the treatment of skull base chordomas. J Neurooncol. Mar 11 2009;[Medline].

  12. Burger PC, Scheithauer BW, Vogel FS. 4th ed. Surgical Pathology of the Nervous System and its Coverings. New York, NY: Churchill Livingstone; 2002:1-66.

  13. Keyserling H, Peterson K, Camacho D, Castillo M. Giant cell angiofibroma of the orbit. AJNR Am J Neuroradiol. Aug 2004;25(7):1266-8. [Medline].

  14. Mirra JM. Bone Tumors: Clinical, Radiological and Pathological Correlations. Philadelphia, Pa: Lea and Febiger; 1989.

  15. Morris JM, Lane JI, Witte RJ, Thompson DM. Giant cell reparative granuloma of the nasal cavity. AJNR Am J Neuroradiol. Aug 2004;25(7):1263-5. [Medline].

  16. Thomas JE, Baker HL Jr. Assessment of roentgenographic lucencies of the skull: a systematic approach. Neurology. Feb 1975;25(2):99-106. [Medline].

  17. Unni KK. 5th ed. Dahlin's Bone Tumors: General Aspects and Data on 11,087 Cases. Philadelphia, Pa: Lippincott Williams & Wilkins; 1996.

  18. Youmans JR. 5th ed. Neurological Surgery. Philadelphia, Pa: WB Saunders Company; 2004:3227-3268.

 
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Composite CT scan, MRI, and angiogram of a symptomatic ossifying fibroma with extensive involvement of the skull base in a 12-year-old girl whose primary symptom was exophthalmos and loss of vision bilaterally.
Lateral skull radiograph of a 73-year-old patient with a slow-growing nontender skull lesion. Note the typical honeycomb appearance.
Head CT scan of a 73-year-old patient with a slow-growing nontender skull lesion shows a well-defined nonenhancing lytic lesion with calcification and honeycomb appearance.
Sagittal magnetic resonance imaging (MRI) section of the brain of a 73-year-old patient with a slow-growing nontender skull lesion showing a nonenhancing soft tissue mass. This lesion proved to be a hemangioma.
Lateral skull radiograph of a 17-year-old adolescent male with a painless slow-growing mass. The single round lytic lesion was found to be an epidermoid.
Fibrous dysplasia involving the sphenoid sinus and pterygoid plates as well as the sella. This is an asymptomatic lesion; observation was recommended.
Head CT scan of a 78-year-old woman with Paget disease. Note the cotton wool appearance of the lesion, with varying degrees of bone formation and no clear edges. Observation was recommended.
 
 
 
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