Skull and Dural Metastases

Metastases of the skull base, dura, and calvarium are common complications of systemic cancer. In many patients, the tumors can remain asymptomatic until enlargement causes symptoms such as headache, lethargy, cranial nerve palsies, and focal deficits. Skull base metastases can present with specific clinical syndromes, including the orbital, parasellar, middle fossa, jugular foramen, occipital condyle, temporal bone, and sellar varieties. MRI is the most sensitive neuroimaging technique for the diagnosis of skull and dural metastases. The most common form of treatment is conventional radiation therapy, with doses ranging from 30 to 35 Gy. Surgical resection is appropriate for selected patients with accessible, solitary lesions, especially if there is mass effect. Chemotherapy may be beneficial, alone or in combination with irradiation, for patients with chemosensitive tumors.