Skull Base Metastasis Revealed by Bone Scintigraphy in a Patient With Hypoglossal Nerve Palsy

Trans-oral approach for occipital condyle biopsy: Case report and review of literature

Isolated occipital condyle lesions are commonly treated with empirical radiation, with the sole aim of relieving symptoms. Patients rarely undergo surgical biopsy, considering the morbidity associated with open surgery approaches and the importance of surrounding structures limiting the application of computed tomography (CT) scan or fluoroscopic percutaneous needle biopsies. We describe the case of a 66-year-old woman who was admitted on an emergency basis. Her clinical presentation included unilateral occipital headache and ipsilateral hypoglossal nerve palsy. Imaging revealed findings consistent with an isolated right occipital condyle lesion. In order to pursue a tissue diagnosis, essential to dictate medical management accurately, a minimally invasive biopsy of the occipital condyle through the trans-oral route was performed. Combined fluoroscopy, cone-bean CT and angiography allowed safe access to the lesion.

Cranial nerve palsy caused by metastasis to the skull base in patients with castration-resistant prostate cancer: Three case reports

INTRODUCTION

Skull base metastasis of prostate cancer associated with cranial nerve palsy is rare. We observed three patients with aggressive prostate cancer who experienced cranial nerve palsy.

CASE PRESENTATION

Case 1 was a 53-year-old patient who was treated with carboplatin and etoposide. He noticed sensory abnormalities on his left mouth edge. Head magnetic resonance imaging revealed skull base metastasis. Case 2 was a 50-year-old patient who received docetaxel. This patient exhibited ptosis of the left eye. Skull base metastasis was detected by magnetic resonance imaging. External beam radiation therapy was performed. Case 3 was a 64-year-old patient who was treated with docetaxel. He experienced ptosis of the right eye and diplopia. He was also treated with external beam radiation therapy.

CONCLUSION

External beam radiation therapy exhibited some efficacy against the symptoms, but skull base metastasis of treatment-resistant prostate cancer has poor prognosis. Three patients died within 3 months after symptoms occurred with or without external beam radiation therapy.

Minimally Invasive Tubular Approach for Occipital Condylar Biopsy and Resection: Case Report and Review of Literature

BACKGROUND

Patients with isolated occipital condyle lesions concerning for metastases rarely undergo surgical biopsies and are more commonly treated with empirical radiation with or without chemotherapy. This is likely related to the morbidity associated with open condylar approaches and the importance of surrounding structures. We present a minimally invasive technique to approach the occipital condyle using a tubular dilating retractor system.

CASE DESCRIPTION

A 38-year-old woman with medical history of breast cancer presented with a 2-month history of headache localizing to the right occipital area and right tongue deviation. Magnetic resonance imaging revealed a heterogeneously enhancing mass within the right occipital condyle. The patient was brought into the operating room and placed in prone position. A 2-cm paramedian incision was made on the right approximately 2.5 cm off midline at the level of C1. Sequential dilation using a tubular retractor system was performed under fluoroscopic guidance. Once the condylar cortex was identified and entered, the tumor was immediately visualized and resected. Operative time was 65 minutes and estimated blood loss was 5 mL. The patient was discharged to home on postoperative day 1.

CONCLUSIONS

This report, to our knowledge, presents the first case of a minimally invasive tubular retractor system-based approach for biopsy and resection of an occipital condylar metastasis causing occipital condyle syndrome. This approach allows for tissue diagnosis to precisely dictate medical management and minimizes the morbidity associated with traditional open surgical approaches.