Medical Care

See the list below:

Analgesic medications can be used for painful lesions.
Aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) are used for osteoid osteoma.

Surgical Care

See the list below:

Whenever possible, complete surgical excision is the treatment of choice for primary tumors (except multiple myeloma).
Preoperative embolization is recommended for angiosarcomas to reduce intraoperative blood loss. If other means cannot control tumor expansion, surgery is still an option in metastatic disease.

Consultations

See the list below:

Neurosurgeon
Neurologist
Radiation oncologist
Hematologist/oncologist
Radiation therapist
Radiosurgery, including Gamma Knife and CyberKnife, can be useful for some tumors.
- Osteosarcomas - Primary form of treatment for secondary osteosarcoma, especially in elderly patients
- Ewing sarcoma
- Giant cell tumor
- Multiple myeloma, if chemotherapy fails
- Chordoma
- Radiosensitive metastatic tumors
- Not indicated for angiosarcoma and fibrosarcoma
- Use in chondrosarcoma controversial
Chemotherapy also may be indicated. Chemotherapy should be administered under the direction of a hematologist and/or oncologist. Combinations of various drugs are used, including cisplatin, cyclophosphamide, carmustine (BCNU), and lomustine (CCNU).
- Osteosarcomas
- Fibrosarcomas
- Multiple myeloma (first choice of treatment)
- Efficacy in chondrosarcoma unknown

Medication

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Media Gallery

Head CT scan of a 60-year-old man with a history of multiple myeloma for 2 years, showing multiple lytic lesions that involve both the inner and outer tables as well as the diploë.
This head CT scan shows multiple lytic lesions of the skull involving both the inner and outer tables.

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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.

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

Stephen L Nelson, Jr, MD, PhD, FAACPDM, FAAN, FAAP, FANA Professor of Pediatrics, Neurology, Neurosurgery, and Psychiatry, Medical Director, Tulane Center for Autism and Related Disorders, Tulane University School of Medicine; Pediatric Neurologist and Epileptologist, Ochsner Hospital for Children; Professor of Neurology, Louisiana State University School of Medicine

Stephen L Nelson, Jr, MD, PhD, FAACPDM, FAAN, FAAP, FANA is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine, American Academy of Neurology, American Academy of Pediatrics, American Epilepsy Society, American Medical Association, American Neurological Association, The Society of Federal Health Professionals (AMSUS), Child Neurology Society, Southern Pediatric Neurology Society

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.