Skull metastases: clinical features, differential diagnosis, and review of the literature.

BACKGROUND: Most metastatic skull lesions are asymptomatic, although they can cause severe disability due to compression of dural sinuses and cranial nerves. The authors present current cases of calvarial and skull base metastases. Clinical features are compared to those of primary skull tumors and tumor-like lesions.
METHODS: We retrospectively reviewed the charts and radiographic images of 38 patients who underwent surgery for a skull lesion at our department between 1991 and 2001. The literature on skull metastases was reviewed.
RESULTS: In 12 cases, histologic examination revealed skull metastases. Eleven patients were known to suffer from cancer at the time of presentation. However, in 5 cases metastatic lesions were the first evidence of disseminated disease. Radical resection was possible in 9 cases. Removal and reconstruction of the infiltrated dura mater was necessary in 5 patients, whereas reconstruction of the bone was required in 8 patients. In comparison to 18 cases with primary skull tumors, patients with skull metastases presented less frequently with a neurologic deficit (3/12 vs. 9/18), reported a shorter history of symptoms (median 2 months vs. 24 months), and were older (median 70 years vs. 51 years).
CONCLUSION: Patients presenting with skull metastases are often in an advanced stage of disease, although surgery can relieve symptoms quickly and effectively with low morbidity. In particular, patients with signs of dura infiltration and related neurologic deficit should be offered neurosurgical therapy.