Management of skull base metastases.

Skull base metastases (SBM) are rare among all tumors affecting the base of the skull. Because of their rarity, they have received limited attention in the published medical literature. Several clinical syndromes associated with SBM have been described. Knowledge of these syndromes and maintenance of a high index of suspicion are important for an early diagnosis. The majority of patients are best managed by radiotherapy. Other therapeutic options include stereotactic radiosurgery, chemotherapy, and surgery. Surgical resection is reserved for a minority of well-selected patients. The decision to intervene surgically is based on patients' clinical status, the degree of control of systemic disease, the accessibility of the lesion, and the potential morbidity of the procedure. Well-designed trials and evidence-based practice guidelines are not available. The management of these patients largely depends of the experience of the treating medical team.