eMedicine Specialties > Neurology > Neuro-oncology
Benign Skull Tumors: Treatment & Medication
Updated: Oct 13, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
Medical Care
- Administer aspirin or NSAIDs for osteoid osteoma.
- Provide pain control symptomatically.
- No treatment is required for asymptomatic lesions unless diagnostic concerns exist.
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.7
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
Medication
The goals of pharmacotherapy are to reduce morbidity and prevent complications.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Have analgesic, anti-inflammatory, and antipyretic activities. Their mechanism of action is not known but may inhibit cyclooxygenase activity and prostaglandin synthesis. Other mechanisms may exist as well, such as inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell membrane functions.
Ibuprofen (Motrin, Advil, Haltran, Nuprin)
DOC for mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.
Adult
200-800 mg PO q6-8h while symptoms persist; not to exceed 3.2 g/d
Pediatric
<6 months: Not established
6 months to 12 years: 20-70 mg/kg/d PO divided tid/qid; start at lower end of dosing range and titrate; not to exceed 2.4 g/d
>12 years: Administer as in adults
May decrease effects of loop diuretics; may increase PT in patients taking anticoagulants (monitor PT carefully and watch patient for signs of bleeding); may increase serum lithium levels and risk of methotrexate toxicity (eg, stomatitis, bone marrow suppression, nephrotoxicity); probenecid may increase concentrations and probably toxicity of NSAIDs; consider effects on platelet function and gastric mucosa
Documented hypersensitivity; peptic ulcer disease; recent GI bleeding or perforation; renal insufficiency; high risk of bleeding
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Caution in congestive heart failure, hypertension, and decreased renal or hepatic function; caution in anticoagulation abnormalities or during anticoagulant therapy (monitor PT); acute renal insufficiency, interstitial nephritis, hyperkalemia, hyponatremia, and renal papillary necrosis may occur; patients with preexisting renal disease or compromised renal perfusion are at greatest risk of acute renal failure; low WBCs are rare and transient (usually return to normal as therapy continues); persistent leukopenia, granulocytopenia, or thrombocytopenia warrants further evaluation and may require discontinuing drug
Narcotics
Pain control is essential to quality patient care. These agents ensure patient comfort, promote pulmonary toilet, and have sedating properties, which are beneficial for patients who have moderate to severe pain.
Acetaminophen with codeine (Tylenol #3)
Indicated for treatment of mild to moderate pain.
Adult
15-60 mg PO q4h prn pain
Pediatric
0.5-1 mg/kg/dose PO q4-6h prn pain
Toxicity increases with CNS depressants or TCAs
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Significant abuse potential; may cause withdrawal headaches; may result in acute opiate withdrawal symptoms in patients dependent on opiates; caution in severe renal or hepatic dysfunction; babies born to mothers using narcotics regularly may show signs of withdrawal; be aware of total daily dose of acetaminophen; do not exceed 4000 mg/24h of acetaminophen; higher doses may cause liver toxicity
Oxycodone and acetaminophen (Percocet)
Drug combination indicated for relief of moderate to severe pain; DOC for aspirin-hypersensitive patients.
Adult
1-2 tab or cap PO q4-6h prn pain
Pediatric
0.05-0.15 mg/kg/dose oxycodone PO q4-6h prn; not to exceed 5 mg/dose oxycodone
Phenothiazines may decrease analgesic effects; toxicity increases with coadministration of either CNS depressants or TCAs
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Duration of action may increase in elderly patients; be aware of total daily dose of acetaminophen; do not exceed 4000 mg/24h of acetaminophen; higher doses may cause liver toxicity
Hydrocodone bitartrate and acetaminophen (Vicodin ES)
Drug combination indicated for moderate to severe pain.
Adult
1-2 tab or cap PO q4-6h prn pain
Pediatric
<12 years: 10-15 mg/kg/dose acetaminophen q4-6h prn; not to exceed 2.6 g/d acetaminophen
>12 years: 750 mg acetaminophen q4h; not to exceed 10 mg hydrocodone bitartrate per dose or 5 doses/24h
Coadministration with phenothiazines may decrease analgesic effects; toxicity increases with CNS depressants or TCAs
Documented hypersensitivity; elevated intracranial pressure
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Tablets contain metabisulfite, which may cause allergic reactions; caution in severe renal or hepatic dysfunction; be aware of total daily dose of acetaminophen; do not exceed 4000 mg/24h of acetaminophen; higher doses may cause liver toxicity
Salicylates
Can reduce inflammation and pain symptoms.
Aspirin (Anacin, Ascriptin, Bayer Aspirin)
Treats mild to moderate pain and headache. Inhibits prostaglandin synthesis, which prevents formation of platelet-aggregating thromboxane A2.
Adult
325-650 mg PO q4-6h for osteoid osteoma
Pediatric
Not established
Effects may decrease with antacids and urinary alkalinizers; corticosteroids decrease salicylate serum levels; additive hypoprothrombinemic effects and increased bleeding time may occur with coadministration of anticoagulants; may antagonize uricosuric effects of probenecid and increase toxicity of phenytoin and valproic acid; doses > 2 g/d may potentiate glucose-lowering effect of sulfonylurea drugs
Documented hypersensitivity; liver damage; hypoprothrombinemia; vitamin K deficiency; bleeding disorders; asthma; use in children ( <16 y) with flu because of association of aspirin with Reye syndrome
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
May cause transient decrease in renal function and aggravate chronic kidney disease; avoid use in patients with severe anemia, with history of blood coagulation defects, or who are taking anticoagulants
More on Benign Skull Tumors |
| Overview: Benign Skull Tumors |
| Differential Diagnoses & Workup: Benign Skull Tumors |
 Treatment & Medication: Benign Skull Tumors |
| Follow-up: Benign Skull Tumors |
| Multimedia: Benign Skull Tumors |
| References |
| Further Reading |
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References
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Further Reading
Related eMedicine topics
Skull Base, Benign Tumors
Skull Base Tumors
Skull Base, Reconstruction
Primary Malignant Skull Tumors
Keywords
skull, tumor, aneurysmal bone cyst, bone-forming tumor, chondroma, chondroblastoma, chondromyxoid fibroma, connective tissue tumor, desmoplastic fibroma, dermoid, encephalocele, eosinophilic granuloma, epidermoid, fibrous dysplasia, giant cell granuloma, Gardner's syndrome, Hand-Schüller-Christian disease, hemangioma, lymphangioma, Maffucci's syndrome, McCune-Albright's syndrome, meningoencephalocele, nonossifying fibroma, Ollier's syndrome, ossifying fibroma, osteoblastoma, osteoid osteoma, osteoma, pacchionian depression, venous lakes of the skull, xanthoma
