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]
Surgical Care
Complete surgical excision when feasible is ideal for benign skull tumors for symptomatic relief, cosmetic reasons, or cranial nerve/neural decompression.
En bloc resection is the preferred intervention though this may not be possible for skull base lesions, especially those of a chondroid nature.
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]
Extended endonasal approaches to skull base lesions are now accepted methods of accessing hitherto difficult-to-access lesions. Endoscopy is also being used in simple osteoid osteomas of the forehead for cosmetic purposes.
Consultations
See the list below:
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Neurosurgeon
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Plastic surgeon
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Neurologist
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Radiation oncologist: Radiation therapy is acceptable as an adjuvant treatment in some partially resected lesions, such as ossifying fibroma, hemangioma, and aneurysmal bone cyst because of their high recurrence rate. In addition, stereotactic neurosurical modalities such as the Gamma Knife and the CyberKnife are widely used now for inaccessible/ incompletely resected skull base lesions.
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Ophthalmologist
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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.
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Lateral skull radiograph of a 73-year-old patient with a slow-growing, nontender skull lesion. Note the typical honeycomb appearance.
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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.
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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.
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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.
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Fibrous dysplasia involving the sphenoid sinus and pterygoid plates as well as the sella. This is an asymptomatic lesion; observation was recommended.
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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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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.
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Same patient as above with mixed attenuation calvarial and epidural mass on MRI; lesion was resected.
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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.
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Same patient as above with an expansile lesion involving the diploe on MRI.
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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.
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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.
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Coronal T1 and axial T2 images for same patient as above.
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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.
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CT scan images for same patient as above.
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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.
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Coronal and sagittal CT bone window images of same patient as above.
