Further Outpatient Care

See the list below:

Postoperative care
Radiation therapy

Further Inpatient Care

Inpatient care is not usually required unless skull-base surgery is needed for nerve decompression.

Complications

See the list below:

Cranial nerve palsy
Recurrence
- Desmoplastic fibroma - 20-30%
- Giant cell granuloma - 12-16%
- Aneurysmal bone cyst - 40-50%
Wound infection
Malignant transformation

Prognosis

See the list below:

Prognosis is good if tumor is resected completely.
In malignant transformation of fibrous dysplasia and Paget disease, the prognosis depends on the malignant tumor that is finally diagnosed.

Patient Education

See the list below:

Reassure patients regarding the benign nature of the tumor.
Educate patients with Paget disease and fibrous dysplasia about the malignant potential of their disease.

Wilkins RH, Rengachary SS. 2nd ed. Neurosurgery. New York, NY: McGraw-Hill; 1996. 1503-1528.
Huvos AG. Bone Tumors: Diagnosis, Treatment and Prognosis. Philadelphia, Pa: WB Saunders Company; 1979.
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. [QxMD MEDLINE Link].
Nasser MJ. Psammomatoid ossifying fibroma with secondary aneurysmal bone cyst of frontal sinus. Childs Nerv Syst. 2009 May 30. [QxMD MEDLINE Link]. [Full Text].
Docquier PL, Delloye C, Galant C. Histology can be predictive of the clinical course of a primary aneurysmal bone cyst. Arch Orthop Trauma Surg. 2009 May 9. [QxMD MEDLINE Link].
Konishi E, Okubo T, Itoi M, Katsumi Y, Murata H, Yanagisawa A. Chondroblastoma of trapezium with metacarpal involvement. Orthopedics. 2008 Apr. 31(4):395. [QxMD MEDLINE Link].
Schmitz-Feuerhake I, Pflugbeil S, Pflugbeil C. Radiation Risks from Diagnostic Radiology: Meningiomas and other Late Effects after Exposure of the Skull. Gesundheitswesen. 2009 Jun 23. [QxMD MEDLINE Link].
Wootton-Gorges SL. MR imaging of primary bone tumors and tumor-like conditions in children. Magn Reson Imaging Clin N Am. 2009 Aug. 17(3):469-87, vi. [QxMD MEDLINE Link].
Yucel E, Akkaya H, Gürkanlar D, Ergun T. Congenital cavernous hemangioma of the skull. Turk Neurosurg. 2011. 21(4):645-7. [QxMD MEDLINE Link].
Bloch O, Kaur G, Jian BJ, Parsa AT, Barani IJ. Stereotactic radiosurgery for benign meningiomas. J Neurooncol. 2011 Oct 18. [QxMD MEDLINE Link].
Dassoulas K, Schlesinger D, Yen CP, Sheehan J. The role of Gamma Knife surgery in the treatment of skull base chordomas. J Neurooncol. 2009 Mar 11. [QxMD MEDLINE Link].
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.
Keyserling H, Peterson K, Camacho D, Castillo M. Giant cell angiofibroma of the orbit. AJNR Am J Neuroradiol. 2004 Aug. 25(7):1266-8. [QxMD MEDLINE Link].
Mirra JM. Bone Tumors: Clinical, Radiological and Pathological Correlations. Philadelphia, Pa: Lea and Febiger; 1989.
Morris JM, Lane JI, Witte RJ, Thompson DM. Giant cell reparative granuloma of the nasal cavity. AJNR Am J Neuroradiol. 2004 Aug. 25(7):1263-5. [QxMD MEDLINE Link].
Thomas JE, Baker HL Jr. Assessment of roentgenographic lucencies of the skull: a systematic approach. Neurology. 1975 Feb. 25(2):99-106. [QxMD MEDLINE Link].
Unni KK. 5th ed. Dahlin's Bone Tumors: General Aspects and Data on 11,087 Cases. Philadelphia, Pa: Lippincott Williams & Wilkins; 1996.
Youmans JR. 5th ed. Neurological Surgery. Philadelphia, Pa: WB Saunders Company; 2004. 3227-3268.

Media Gallery

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.
A well-preserved 90-year-old female patient with a mass in the occiput with an inability to sleep and rapid atrial fibrillation related to hyperthyroidism due to a solitary thyroid metastasis. This sagittal CT scan demonstrates a lytic lesion.
Same patient as above with mixed attenuation calvarial and epidural mass on MRI; lesion was resected.
A 49-year-old male patient with occipital headache and no deficits. A CT scan demonstrates an expansile lesion involving the diploe. This was demonstrated to be a dermoid tumor at histopathology.
Same patient as above with an expansile lesion involving the diploe on MRI.
A 56-year-old female patient with a small bump on her forehead which slowly increased in size over a 5-year period. A CT scan revealed a lesion which was resected with endoscopic assistance so the incision would be in the hairline. Histopathological examination confirmed an osteoid osteoma.
Axial and coronal CT scan images of a 40-year-old female patient with progressive visual decline in the left eye for >2 years. Patient was blind at presentation. A cranial resection was done with resulting return of light perception. Histopathological examination confirmed an intraosseous meningioma.
Coronal T1 and axial T2 images for same patient as above.
MRI images of a 40-year-old patient with a visual field defect in the left temporal (Ollier disease). Both lesions were resected and shown to be osteochondromas on histopathological examination.
CT scan images for same patient as above.
Axial and coronal T1 MRI images of a 65-year-old patient with a chronically large jaw who presented with h/a and left visual worsening due to fibrous dysplasia. Transnasal surgery combined with an eyelid approach was completed to open up the frontal sinus ostium and decompress the orbit.
Coronal and sagittal CT bone window images of same patient as above.

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Author

Draga Jichici, MD, FRCPC, FAHA Associate Clinical Professor, Division of Medicine, Department of Critical Care Medicine and Neurology, Co-Director, Neurosurgical Intensive Care Unit, Co-Director, Transcranial Doppler Ultrasound, Hamilton Health Sciences, McMaster University School of Medicine, Canada

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

Disclosure: Nothing to disclose.

Coauthor(s)

Kesava KV Reddy, MBBS Head of Service-Neurosurgery, St Joseph’s Hospital; Chief of Surgery, Hamilton General Site, Hamilton Health Sciences; Clinical Professor, Department of Surgery, McMaster University School of Medicine, Canada

Kesava KV Reddy, MBBS is a member of the following medical societies: American Association of Neurological Surgeons, American College of Surgeons, Canadian Consortium on Adult Hydrocephalus, Canadian Neurosurgical Society, College of Physicians and Surgeons of Ontario, Congress of Neurological Surgeons, Hamilton Academy of Medicine, North American Skull Base Society, Ontario Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

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, New York Academy of Sciences

Disclosure: Nothing to disclose.

Chief Editor

Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS † Professor Emeritus of Neurology and Psychiatry, Clinical Professor of Medicine, Clinical Professor of Family Medicine, Clinical Professor of Neurosurgery, State University of New York Upstate Medical University; Neuroscience Director, Department of Neurology, Crouse Irving Memorial Hospital

Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS is a member of the following medical societies: American Academy of Neurology, American Academy of Pain Medicine, American College of Forensic Examiners Institute, American College of International Physicians, American College of Physicians, American Heart Association, American Stroke Association, National Association of Managed Care Physicians, Royal College of Physicians, Royal College of Physicians and Surgeons of Canada, Royal College of Surgeons of England, Royal Society of Medicine

Disclosure: Nothing to disclose.

Additional Contributors

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, Texas Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

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