Skull cancer predominantly develops as an initial lesion.

Reasons

The etiology of the disease is unknown. Among the risk factors, doctors consider:

• presence of concomitant cancer;
• genetic predisposition;
• exposure to ionizing radiation;
• systemic decrease in immunity.

Skull bone cancer: types of tumors

Malignant neoplasms in this area are formed in the following variants:

1. Chondrosarcoma is a tumor that consists of mutated elements of cartilage tissue.
2. Osteosarcoma is an oncological formation that is predominantly localized in the temporal, occipital and frontal regions. This pathology is characterized by rapid and aggressive growth with early formation of metastases. Most patients are people of a younger age category, which is explained by the development of mutations during the period of bone tissue growth.
3. Chordoma is cancer of the base of the skull. It is dangerous due to the spread of oncology into the nasopharyngeal space and damage to the nerve bundles. Due to these topographic features, a high mortality rate is observed among cancer patients with chordoma.
4. Myeloma is a cancerous pathology that is located in the area of ​​the cranial vault.
5. Ewing's sarcoma - in most cases, this tumor affects the bones of the extremities, and in the cranial tissues the sarcoma is identified as a metastasis.

Symptoms and signs

The clinical picture is based on the following principles:

• The early stages of the oncological process are predominantly asymptomatic.
• For Ewing's sarcoma, typical manifestations are: migraine attacks, low-grade body temperature, increased concentration of leukocytes and anemia.
• Myeloma is accompanied by malaise and intense muscle pain.
• Symptoms of osteosarcoma include the formation of a fixed hard tissue mass and localized pain.
• Metastatic processes in the skull are manifested by symptoms of intoxication of the body.

Modern diagnostics

The determination of an oncological diagnosis is based on an X-ray of the head. A cancerous lump, in particular, requires a radiological examination in a lateral projection.

The radiologist identifies the tumor by atypical fusion of bone tissue, which may have clear or jagged edges. Depending on the form of the pathology, foci of mutation can be either single or multiple.

The final diagnosis is made in the laboratory, by microscopic examination of a small area of ​​modified tissue (biopsy). This technique is called a biopsy.

After determining the final diagnosis, specialists prescribe the patient to undergo computed tomography and magnetic resonance imaging. Such examinations are necessary to clarify the extent and location of the tumor.

Skull bone cancer: how is it treated today?

The method of anticancer treatment for cranial cancer depends on the stage of malignant growth and the location of the painful focus.

At the initial stage, the most effective method of treatment is surgery, during which the tumor is radically excised for the cancer patient. After resection, the patient often undergoes a course of rehabilitation. He undergoes plastic surgery of the bone defect and endoprosthetics to restore cosmetics.

In later phases of oncology development and in case of inoperability of the tumor, the patient is recommended to undergo the following treatment:

Systemic use of cytostatic agents causes the disintegration of the neoplasm in the first and second stages. Oncologists prescribe this therapy in several courses, the dosage being determined individually for each cancer patient.

Radiation irradiation of the tumor focus is indicated for Ewing's sarcoma as the only anticancer technique. And in the case of myeloma, ionizing radiation contributes to a significant improvement in the quality of life.

The bottom line is surgical removal and subsequent radiation therapy. This sequence of procedures minimizes the risk of postoperative complications and relapses of the disease.

Metastatic cancer and end-stage skull cancer are treated symptomatically. Medical care in such cases focuses on relieving pain attacks and maintaining vital body functions.

Video: Gorodnichev versus CANCER 1 episode (craniotomy)

Prognosis and how long do they live?

To assess the consequences of such a diagnosis as “cancer of the skull bones”, in oncological practice the 5-year survival rate is used. This index includes the total number of patients surviving to the five-year mark from the time of final diagnosis.

Video: BATTLE OF LOCKS Skull and Cancer. Evolution 1 and 2.

The life prognosis of patients with stage 1 cancer is usually favorable. About 80% of cancer patients survive 5 or more years. Further development of oncology and the spread of mutated cells beyond the tumor aggravates the prognosis. The postoperative survival rate for stage 3 cancer is 60%. The terminal phase and metastasized neoplasm of cranial tissue has a negative treatment outcome. The high mortality rate of patients is explained by the aggressiveness of oncology and damage to nearby nerve centers.

Skull cancer, like many other malignant oncological formations, requires detailed and timely diagnosis. Only adequate therapy at an early stage of the oncological process contributes to a complete cure and protects the patient from postoperative relapse. Such patients also additionally need to undergo annual preventive examinations with an oncologist.

Skull bone tumors

Most often, tumors affect the facial skull, especially the upper and lower jaws and paranasal sinuses. The bones of the arch and base are affected much less frequently than all other parts of the skeletal system (L. M. Goldstein 1954).

Tumors of the skull bones are divided into primary and secondary. Each of these groups is in turn divided into benign tumors and malignant tumors.

Primary benign tumors include: osteoma, osteochondroma, hemangioma, epidermoid. Primary malignant ones, which are relatively rare, include primary bone sarcoma, Ewing's tumor, single myelomas and chloromas.

Of the groups of primary benign tumors of the skull bones, osteoma is the most common.

Osteoma is often located closer to the cranial sutures, sits either on a broad base, or less often on a pedicle. It can develop from the outer or inner bone plates, in which case a compact osteoma is formed, or from the diploic substance - a spongy osteoma. Osteomas are very often localized in the paranasal sinuses, especially in the frontal and ethmoid sinuses. Protruding into the orbital cavity, osteomas can displace the eyeball, causing exophthalmos; growing into the nasal cavity - lead to blockage of the nasal passages. If osteoma grows into the cranial cavity, compression of the brain may occur. However, most often, even with very large tumors, the disease is asymptomatic.

Radiologically, osteoma appears as a formation of bone density with clear, smooth contours. Compact osteomas give a very intense structureless shadow; the more rare spongy osteomas retain the trabecular structure characteristic of bone tissue in the image.

S., 31 years old. Complaints of double vision, dizziness and headache. Right-sided exophthalmos is clinically determined. Radiographs revealed a pea-sized osteoma emanating from the anterior cells of the right half of the ethmoid bone, protruding into the orbital cavity (Fig. 13).

Osteochondromas are less common than osteomas and are more often localized in the bones of the base of the skull - in the basal, ethmoid and occipital bones, i.e. in those bones that go through the phase of cartilaginous development. Osteochondromas consist of bone and cartilage tissue and sit on a wide stalk. Radiographically, they appear as a heterogeneous dense shadow with randomly scattered foci of clearing and islands of lime, which gives their pattern a speckled appearance. Osteochondromas can, with their pressure, destroy the bones of the base of the skull - the small wings, the apices of the pyramids and the bottom of the anterior cranial fossa. Depending on the location, differential diagnosis should be made with arachnoidendothelioma, craniopharyngioma, and acoustic neuroma.

Another primary benign tumor of the skull bones, hemangioma, is much less common. This tumor is of vascular origin, most often affecting the frontal and parietal bones.

Hemangioma is observed in two anatomical forms: cavernous (cavernous) and diffuse. In the cavernous form, the tumor is first localized in the diploic layer, then, as it grows, it destroys one or another bone plate. The tumor consists of large, blood-filled vascular lacunae, the inner surface of which is lined with large flat endothelial cells. Lacunae develop from one or more diploic veins. Tangential images reveal a cyst-like swelling of the bone. Bone trabeculae, located between the vascular lacunae, on a tangential image have the appearance of sun rays emanating from a common center. When describing the bone structure of hemangiomas, they usually compare it to a honeycomb.

A., 44 years old. Neurotic complaints. Images of the skull revealed a local swelling of the parietal bone with scalloped contours and a honeycomb (“honeycomb”) pattern typical of hemangioma. The bone plates are preserved. There is no local pain. Soft tissues are not changed (Fig. 14).

With the diffuse form of hemangioma, the number of blood vessels increases significantly and their caliber expands. The vessels of the meninges are involved. A non-painful pulsating swelling appears on the head, sometimes with softening in the center. The images reveal a rounded lesion with a cellular pattern and smooth semi-oval edges. There are no phenomena of hyperostosis and reactive sclerosis. Dilated channels of the diploic veins entering the tumor area are often visible. When a hemangioma is localized in the bones of the base of the skull, their destruction occurs (for example, the petrous part of the pyramid), and with angioma of the soft tissues of the skull, an ulcer may occur in the bone.

Primary benign tumors of the skull bones also include dermoid cysts and epidermoids. Both of these formations represent a malformation of embryonic development. Most often they are localized in the soft tissues of the head, including galea aponeurotica. Thus, typical places for dermoid cysts are the corners of the eye, places near the sagittal and coronal sutures, the area of ​​the temporal and occipital bones and the mastoid process. Dermoid cysts are small, elastic tumors. When pressure is applied to the bone, they can produce an uzuru - a small bone defect with a sclerotic edge. Dermoid cysts can also be localized in the cranial cavity and put pressure on the bones from the inside, giving a clearly limited focus of bone destruction. Dermoids can also develop in the thickness of the skull bone, swelling it, destroying first the diploe and then the bone plates.

Epidermoids consist of epidermal cells and accumulations of cholesterol; they are most often localized in the cranial cavity, but can also be located deep in the bones. Epidermoids localized in the diploe region are surrounded by a dense capsule. They grow very slowly and over time destroy either the outer or inner bone plate. In the latter case, by penetrating into the cranial cavity, the tumor can perforate the dura mater and cause symptoms of brain compression. When the outer bone plate is destroyed, a swelling with a doughy consistency is palpable.

X-rays reveal single or multiple bone defects, limited by clear scalloped or jagged edges. With other tumors, such defined edges of the defect are never observed.

A., 28 years old. 6 years ago I first discovered a pea-sized “tumor” in the upper part of my forehead. Education is slowly increasing. The skin is not changed. A dense small swelling is palpable. The photographs show a defect in the outer bone plate, delimited from the surrounding unchanged bone by a very clear, even edge (Fig. 15).

Primary malignant tumors of the skull are rare.

Primary bone sarcoma develops at a young age, is very malignant, metastasizes to the bones and internal organs, and quickly grows into the skull and brain matter. The tumor is initially very dense, has a developed vascular network, and later softens and suppurates. There are two forms of osteogenic sarcoma of the skull - osteoclastic and osteoblastic. In the osteoblastic form, in the first stage of the disease there may be needle-like growths in a limited area. Subsequently, with both forms, the bone structure becomes uneven, with areas of rarefaction, with uneven, corroded contours, without a clear boundary with the surrounding unchanged bone. There may be local development of vascular grooves.

Much more often, sarcomas of the skull primarily arise not from the bone, but from the periosteum (periosteal sarcomas), from the aponeurosis, nuchal ligaments and from the dura mater.

The predominant localization of sarcomas is the jaws, walls of the paranasal cavities and temporal bones.

N., 24 years old. Complaints of deafness in the right ear, hoarse voice, slight asymmetry of the facial muscles. A neurological examination revealed a syndrome of damage to the cerebellopontine angle on the right. The images revealed extensive destruction of the right pyramid with a sclerotic edge. The back of the sella turcica is inclined anteriorly (Fig. 16). During the operation, a large tumor was discovered associated with the bones of the base of the skull. A biopsy was taken. Histological examination revealed angioreticular sarcoma. 2 courses of radiotherapy were performed.

This group of diseases also includes the very rare Jupiter tumor, solitary myelomas and chloromas.

Ewing's tumor occurs in the bones of the skull either as a primary lesion or as a metastasis from other bones, usually occurs at a young age, is a soft fluctuating formation, sharply painful, with local skin changes. X-rays reveal large, undefined foci of destruction. The tumor responds well to radiotherapy.

Chloroma (or chloromyeloma) occurs in children, mainly in the area of ​​the temporal bone or orbit. When localized in the orbit, bulging eyes and a sharp drop in vision are noted. There are many mononuclear cells in the blood, increasing leukocytosis.

Single primary myeloma of the skull bones is very rare; much more often it is a metastasis from other bones.

Secondary tumors of the skull bones are much more common than primary ones. They are also divided into benign and malignant. Benign ones include arachnoidepdothelioma (meningioma) and cholestatomy of the middle ear, malignant ones include soft tissue sarcoma and integumentary cancer growing into the bones, and metastases of cancer and myeloma, as well as neuroblastoma in children, chordoma and craniopharyngioma.

Rice. 17. Scheme of bone changes in arachnoidendothelioma (according to Cushing).

Arachnoidendothelioma is a tumor arising from the membranes of the brain, which only in some cases, when growing through the Haversian canals, produces changes in the corresponding area of ​​the bone, manifested either by destruction (usura) or local hyperostosis (Fig. 17).

In the differential diagnosis when reading radiographs, it is necessary to take into account neurological symptoms, which appear earlier in time than changes in the bones of the skull. There are favorite localization sites for arachnoid endothelioma - the falciform process, the small and large wings of the sphenoid bone, the tubercle of the sella turcica, the olfactory fossa.

P., 40 years old. Complaints of a dense swelling in the parietal region along the midline, which appeared 3 years ago, headache and general seizures. Left-sided hemiparesis and congestion of the fundus are detected. An X-ray examination revealed pronounced hyperostosis of the parietal bones with a sharp restructuring of the bone structure corresponding to the palpable swelling. Diploid channels are strengthened. Hypertensive changes in the bones of the arch and sella turcica are pronounced (Fig. 18). During the operation, an arachnoidendothelioma was discovered emanating from the falciform process of the dura mater.

N„ 36 years old. Complaints of headache, pain in the right eye socket, double vision, decreased vision in the right eye. On the right side, ptosis, swelling of the soft tissues around the orbit, exophthalmos, and hypoesthesia in the area of ​​the superior branch of the trigeminal nerve are detected. The right eyeball does not move to extreme positions. The photographs show hyperostosis of the lesser and greater wings of the sphenoid bone, spreading along the bottom of the anterior cranial fossa. The superior orbital fissure is significantly narrowed (Fig. -19). During the operation, a large lumpy tumor was discovered - arachnoidendothelioma.

Destructive changes in the area of ​​the temporal bone can also be detected with cholesteatoma. Cholesteatoma is not a true tumor, but is an epithelial formation that occurs when the epithelium of the external auditory canal grows into the tympanic cavity during chronic epitympanitis. Gradually, cholesteatoma grows into the cave, into the cavity system of the mastoid process, and sometimes into the inner ear, leading to pronounced destruction of the temporal bone. On radiographs, the destructive focus appears delimited from the unchanged bone by a clear bone plate.

The overwhelming number of secondary malignant tumors of the skull are metastases from other organs and tissues. In terms of frequency, cancer metastases are in first place. Most often, cancer of the breast, prostate, kidney, adrenal gland, lung, and thyroid gland metastasizes to the skull bones. There may be relatively early metastases in the bones of the skull, at a time when the primary tumor does not yet attract the attention of the patient. Sometimes such metastases in the skull occur several years after removal of the primary tumor. Metastases are often multiple, but sometimes single and, apparently, the only metastases of a cancerous tumor in the body are found in the skull.

Metastases can be osteoclastic or osteoblastic in nature. The latter can be observed in prostate cancer and, less commonly, in breast cancer. Osteoclastic metastases in the image appear as round bone defects of varying size and outline. Most often such defects are visible in the arch area. Osteoblastic metastases, on the contrary, appear as separate areas of compaction that gradually transform into unchanged bone. Sometimes there is a combination of osteoclastic and osteoblastic metastases. A spotted pattern of the skull bones appears, sometimes similar to Paget's disease.

M., 25 years old. Spinal cord compression syndrome with conus lesion. Primary diagnosis: spinal cord tumor. Sick for 3 months. Paraplegia1 and pelvic disorders developed quickly. Later, a dense, painless swelling appeared in the right parietal region. The images revealed a large focus of destruction in the right parietal bone and destruction of the arches and processes of the L2, partially L3 vertebrae (Fig. 20). Further examination revealed a malignant tumor of the left ovary with metastases to the bones, lymph nodes and internal organs.

U., 44 years old. 4 years ago I was operated on for breast cancer. Images of the skull reveal multiple foci of destruction (metastases) in the scales of the frontal bone (Fig. 21).

In addition to cancer metastases, myeloma metastases can occur in the bones of the skull. The tumor develops from bone marrow cells. The disease occurs as a subacute infection with general weakness, fever, and bone pain. Often accompanied by nephritis, Beps-Jones protein is found in the urine, and in the late period - severe secondary anemia. The tumor metastasizes mainly to flat bones: skull, pelvis, ribs. In the late period, there may be metastases to internal organs, lymph nodes and skin. X-ray images of the skull reveal through small round defects, sharply outlined, without reaction of the surrounding bone. The process begins with dip 1, and when the internal bone plate is destroyed, it can spread to the membranes of the brain. Larger single defects in the bone may also occur. It is not always possible to differentiate from cancer metastases based on radiological data.

G., 52 years old. The fall caused a fracture of the left clavicle. X-ray examination revealed extensive destruction of its sternal end. Clinical examination diagnosed myeloma. A year later, a non-painful swelling appeared in the parietal region. The images revealed a rounded, clearly demarcated area of ​​destruction - metastasis of myeloma to the right parietal bone (Fig. 22).

Secondary changes in the bones of the base of the skull can occur with craniopharyngioma and chordoma - tumors associated with embryonic developmental defects. These tumors often have a benign course, but can undergo infiltrating growth and metastasize.

Craniopharyngiomas arise from the embryonic epithelium of the oral cavity and pharynx, from the remnants of the so-called Rathke's pouch. Developing in the cavity of the main sinus and in the area of ​​the sella turcica, they can cause significant destruction of the bones of the base of the skull. A distinctive feature of this tumor is its tendency to calcify (see Fig. 49), so its X-ray diagnosis does not present any particular difficulties. In rare cases, criopharyngioma may undergo cancerous transformation.

Chordomas develop from the remnants of the dorsal chord. Normally, the dorsal chord disappears at the end of the period of embryonic development; its remnants are preserved only in the intervertebral discs and in the lig. apicis dentis. However, elements of the dorsal chord may remain in other places throughout the skeleton from the sella turcica to the coccyx; from them chordomas develop. More often they are localized at the base of the skull and in the sacrococcygeal region (see Fig. 113). Small benign chordomas can occur in the area of ​​the clivus of the occipital bone and the basal occipital synchondrosis. Malignant chordomas reach a large size and can affect the entire base of the skull, grow into the orbit and nasal cavity, causing extensive bone destruction. The tumor is sensitive to X-rays.

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Skull bone tumors

What are Skull Bone Tumors -

A brain abscess is a localized accumulation of pus in the brain. Most often, abscesses are intracerebral, less often - epidural or subdural.

What provokes / Causes of Swelling of the skull bones:

The cause of a brain abscess is the spread of infection caused by streptococci, staphylococci, pneumococci, and meningococci. E. coli, Proteus, and mixed flora are often found. The ways in which infection penetrates into the brain matter are different. In accordance with the etiology and pathogenesis, brain abscesses are divided into: 1) contact (associated with a nearby purulent focus); 2) metastatic; 3) traumatic.

Pathogenesis (what happens?) during tumors of the skull bones:

The most common are contact abscesses caused by mastoiditis, otitis, purulent processes in the bones of the skull, paranasal sinuses, orbit, and meninges. About half of all brain abscesses are of otogenic origin. Chronic purulent otitis is much more often complicated by an abscess than acute inflammatory processes in the ear. Infection in otitis media penetrates from the temporal bone through the roof of the tympanic cavity and the cavernous sinuses percontinuitate into the middle cranial fossa, causing an abscess of the temporal lobe of the brain. Otogenic infection can also spread into the posterior cranial fossa through the labyrinth and sigmoid sinus, leading to a cerebellar abscess. Rhinogenic abscesses are localized in the frontal lobes of the brain. First, local pachymeningitis develops, then adhesive limited meningitis, and finally the inflammatory process spreads to the brain substance with the formation of limited purulent encephalitis. In more rare cases, oto- and rhinogenic abscesses can occur hematogenously due to thrombosis of veins, sinuses, and septic arteritis. Abscesses are localized in the deep parts of the brain, far from the primary focus.

Metastatic brain abscesses are most often associated with lung diseases: pneumonia, bronchiectasis, abscess, empyema. Metastatic abscesses can also complicate septic ulcerative endocarditis, osteomyelitis, and abscesses of internal organs. The mechanism of infection entering the brain is septic embolism. In 25–30% of cases, metastatic abscesses are multiple and are usually localized in the deep parts of the white matter of the brain.

Traumatic abscesses arise as a result of open (extremely rarely closed) skull injuries. When the dura mater is damaged, the infection penetrates through the perivascular fissures into the brain tissue, which is preceded by the development of limited or diffuse inflammation of the membranes. In cases of foreign body penetration into the brain, the infection enters along with it. An abscess forms along the wound canal or directly in the area of ​​a foreign body. Peacetime traumatic abscesses account for up to 15% of all brain abscesses; their percentage increases sharply during the war and in the post-war period.

Pathomorphology. The formation of a brain abscess goes through a number of stages. Initially, the reaction to the introduction of infection is expressed in the picture of limited inflammation of the brain tissue - purulent encephalitis. In the future, healing through scarring is possible. In other cases, as a result of the melting of brain tissue, a cavity filled with pus appears - the stage of a limited abscess. A rather dense connective tissue capsule forms around the cavity - the stage of an encapsulated abscess. It is believed that capsule formation begins after 2–3 weeks and ends after 4–6 weeks. With a decrease in the body's immune reactivity, encapsulation occurs extremely slowly, and sometimes the purulent focus in the brain remains in the stage of melting of the brain tissue.

Symptoms of Skull Tumors:

In the clinical picture of a brain abscess, 3 groups of symptoms can be distinguished:

1) general infectious – fever (sometimes intermittent), chills, leukocytosis in the blood, increased ESR, signs of a chronic infectious process (pallor, weakness, weight loss); 2) cerebral, appearing as a result of increased intracranial pressure caused by the formation of an abscess. The most consistent symptom is headaches. Cerebral vomiting, fundus changes (congestive discs or optic neuritis), periodic (orthostatic) bradycardia up to 40–50 beats/min, and mental disorders are often observed. The inertia, lethargy of the patient, and the slowness of his thinking are noteworthy. Stupefaction, drowsiness, and in severe cases without treatment, coma may gradually develop. As a consequence of intracranial hypertension, general epileptic seizures may occur; 3) focal, depending on the location of the abscess in the frontal, temporal lobes, and cerebellum. Abscesses located deep in the hemispheres outside the motor zone can occur without local symptoms. Otogenic abscesses sometimes form not on the side of otitis media, but on the opposite side, giving the corresponding clinical picture. Along with focal symptoms, symptoms associated with swelling and compression of brain tissue may be observed. When the abscess is close to the membranes and with a cerebellar abscess, meningeal symptoms are detected.

In the cerebrospinal fluid, pleocytosis consisting of lymphocytes and polynuclear cells, increased protein levels (0.75–3 g/l) and pressure are noted. However, often no changes are found in the cerebrospinal fluid.

Flow. The onset of the disease is usually acute, with rapid manifestation of hypertension and focal symptoms against a background of rising temperature. In other cases, the onset of the disease is less defined, then the clinical picture resembles the course of a general infection or meningitis. Rarely, the initial stage of an abscess occurs latently, with minimal symptoms and low fever. After the initial manifestations, after 5–30 days, the disease enters the latent stage, corresponding to the encystation of the abscess. This stage is asymptomatic or manifests itself with moderately severe symptoms of intracranial hypertension - frequent headache, vomiting, mental retardation. The latent stage can last from several days to several years. Subsequently, under the influence of some external factor (infection), and more often without obvious reasons, cerebral and focal symptoms begin to progress rapidly. A lethal outcome with a brain abscess occurs due to its swelling and a sharp increase in intracranial pressure. An extremely serious complication of an abscess, possible at any stage, is its rupture into the ventricular system or subarachnoid space, which also usually ends in death.

Diagnosis of tumors of the skull bones:

Recognition of a brain abscess is based on medical history (chronic otitis media, bronchiectasis, other foci of purulent infection, trauma), the presence of focal, cerebral symptoms, signs of increased intracranial pressure, the onset of the disease with elevated temperature and its characteristic progressive course. To make a diagnosis, repeated echoencephalography is important, revealing displacement of the midline structures of the brain during abscesses of the hemispheres. X-rays of the skull (signs of increased intracranial pressure), X-rays of the paranasal sinuses, temporal bones, fundus examination (congestive discs or a picture of optic neuritis), and lumbar puncture are also necessary.

The decisive role in recognizing abscesses, especially multiple ones, belongs to computed tomography and magnetic resonance imaging, which reveals a characteristic round formation, usually limited to the capsule.

When conducting a study at the stage of abscess formation, the capsule may be absent, and around the formed cavity there are signs of inflammation of the brain tissue and accompanying edema.

In the presence of hypertension syndrome, lumbar puncture should be performed carefully, and if the patient’s condition is serious, refrain from it, since with increasing intracranial hypertension, extraction of cerebrospinal fluid can cause pinching of the cerebellar tonsils in the foramen magnum (with cerebellar abscess) or the medial part in the temporal lobes in the foramen of the tentorium cerebellum (with an abscess of the temporal lobe) with compression of the trunk, which can lead to the death of the patient.

Differential diagnosis depends on the stage of the abscess. In the initial acute period of the disease, an abscess should be distinguished from purulent meningitis, the cause of which may be the same as the abscess. One should take into account the greater severity of rigidity of the neck muscles and Kernig's symptom in purulent meningitis, the persistence of high temperature (with an abscess the temperature is often hectic), large neutrophilic pleocytosis in the cerebrospinal fluid, and the absence of focal symptoms.

The course and symptoms of an abscess and a brain tumor have much in common. Differential diagnosis is difficult, since a malignant tumor may cause leukocytosis in the blood and an increase in body temperature. In these cases, the anamnesis data is of particular importance, i.e. the presence of factors that cause the development of an abscess. It should be borne in mind that by the time the abscess forms, the primary purulent focus may have already been eliminated.

Treatment of Skull Tumors:

With a brain abscess, the prognosis is always serious. With untimely and inadequate treatment, primarily surgical, mortality reaches 40–60%. The worst prognosis is for patients with multiple metastatic abscesses. In 30% of those who recover, residual neurological symptoms persist, most often focal seizures.

Which doctors should you contact if you have a tumor of the skull bones:

Is something bothering you? Do you want to know more detailed information about Tumors of the skull bones, its causes, symptoms, methods of treatment and prevention, the course of the disease and diet after it? Or do you need an inspection? You can make an appointment with a doctor - the Eurolab clinic is always at your service! The best doctors will examine you, study external signs and help you identify the disease by symptoms, advise you and provide the necessary assistance and make a diagnosis. You can also call a doctor at home. The Eurolab clinic is open for you around the clock.

The telephone number of our clinic in Kyiv: (+3 (multi-channel). The clinic secretary will select a convenient day and time for you to visit the doctor. Our coordinates and directions are listed here. Look in more detail about all the clinic’s services on its personal page.

If you have previously performed any tests, be sure to take their results to a consultation with your doctor. If the studies have not been performed, we will do everything necessary in our clinic or with our colleagues in other clinics.

At yours? It is necessary to take a very careful approach to your overall health. People do not pay enough attention to the symptoms of diseases and do not realize that these diseases can be life-threatening. There are many diseases that at first do not manifest themselves in our body, but in the end it turns out that, unfortunately, it is too late to treat them. Each disease has its own specific signs, characteristic external manifestations - the so-called symptoms of the disease. Identifying symptoms is the first step in diagnosing diseases in general. To do this, you simply need to be examined by a doctor several times a year in order not only to prevent a terrible disease, but also to maintain a healthy spirit in the body and the body as a whole.

If you want to ask a doctor a question, use the online consultation section, perhaps you will find answers to your questions there and read tips on caring for yourself. If you are interested in reviews about clinics and doctors, try to find the information you need in the All Medicine section. Also register on the Eurolab medical portal to be constantly aware of the latest news and information updates on the site, which will be automatically sent to you by email.

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Malignant tumors of the skull bones

Among them, primary tumors of the flat bones of the skull are more common. These are different types and types of sarcoma. Since there are no epithelial cells in the bones of the skull, there are no primary cancerous tumors in the skull. Osteosarcoma, myeloma, Ewing's sarcoma, chordoma belong to the group of primary malignant tumors of the skull bones. Along with the listed primary forms, there are various metastatic forms of malignant tumors. Tumors from various organs, sometimes very distant ones, such as the prostate gland, adrenal gland, and uterus, can metastasize into the bones of the skull. Finally, cancer of the face, mucous membranes and scalp can spread directly to the bone, causing cancerous caries, which is not a true metastasis.

These tumors are observed more often at a young age. They grow very quickly in the temporal, parietal or occipital bone from a single focus. They reach very large sizes, at first they are very dense, and then areas of softening appear. “Spicules” form in the bone, as with meningiomas. Tumor cells are polymorphic, but spindle-shaped cells predominate. Usually it is possible to establish a connection between this disease and the trauma suffered. Very strong local pain is constant. The skin over the tumor is rich in blood vessels. The tumor is painful to the touch. Metastasizes early. Neither radiotherapy nor surgery for this form gives reliable results.

Isolated relatively recently. Unlike osteosarcoma, the bulk here consists of uniform, round, large cells containing small nuclei. The tumor spreads through the bone marrow. Necrosis and hemorrhage are observed in its syncytial eosinophilic mass. Already in the first months the tumor gives many metastases. With this tumor, the temperature rises, high leukocytosis (up to 15,000) and secondary anemia are detected. Pain is also characteristic of this tumor, but not as intense as with osteosarcomas. An X-ray examination reveals loosening and separation of the bone substance, resembling an onion, which initially simulates an inflammatory focus. The tumor very rarely begins initially in the bones of the skull; its usual place is in long tubular bones. Apart from pain, it does not produce any special cerebral or meningeal effects. The tumor responds well to radiotherapy. There are cases where patients lived 9 years after radiotherapy. Treatment with sarcolysine is also effective.

Multiple myeloma (myelomatosis)

Among all primary malignant tumors of the cranial bones, it is relatively more common than others. X-ray examination of the skull, pelvic bones, and ribs gives a characteristic picture of punched round holes. Typical plasma myeloma cells are obtained from the bone marrow by puncturing the sternum. Urine examination often reveals a special protein that indicates kidney damage (Bence Jones bodies). S. Reinberg considers this disease to be a true bone marrow sarcoma with a large number of individual nodes. Clinically, excruciating pain in the pelvis and sacrum is observed; spontaneous fractures of bones, especially ribs, are often observed. General weakness sets in and secondary anemia increases due to sudden changes in the hematopoietic system. The disease relatively quickly leads to cachexia, but sometimes the process lasts 2-3 years. The prognosis for this disease has improved significantly due to the use of radiation therapy and new drugs.

Multiple myeloma is a severe primary malignant disease of the bone marrow, one of those that a neurologist often encounters. In the described group of primary bone malignant neoplasms of the skull, myeloma occupies a central place.

They develop from the remnants of the primitive embryonic dorsal cord, most often in the sacral region and in a small percentage of cases at the base of the skull. This is a large tumor of soft consistency, growing in the cranial cavity on the Blumenbach clivus. It infiltrates the nasopharynx, the nerves of the base of the brain, its membranes and quickly leads to death.

These secondary tumors appear in men with prostate cancer, with hypernephroma, and in women with breast and uterine cancer. The X-ray picture of metastases in the cranial bones can be very bright and is similar to the picture of myelomatosis.

However, the holes here do not have a clear roundness and sometimes large areas of the skull are destroyed.

Metastases to the cranial bones are not yet available to either X-ray therapy or surgical treatment. The clinical picture of metastases is determined by those that are located in the substance and membranes of the brain; metastases to the bone do not produce any special symptoms. Facial cancer or flat scalp cancer can grow into the bone. In this case, the cancerous caries beetle continues for a long time, going from the surface of the bone to the depth, in contrast to true metastases.

For metastatic prostate or breast cancer, hypophysectomy may provide temporary improvement. The technique of destroying the pituitary gland using radioactive isotopes is promising, but is still under development.

IX RUSSIAN ONCOLOGY CONGRESS

CLINICAL, DIAGNOSIS AND TREATMENT OF SKULL BASE TUMORS

A.M. Mudunov, E.G. Matyakin
State Institution Russian Research Center named after N.N. Blokhin RAMS, Moscow

The term “tumors of the skull base,” being a collective term, unites a variety of tumor processes characterized by damage to a very specific anatomical formation. The base of the skull is an anatomical and topographic complex consisting of many dissimilar organs and tissues, as a result of which tumors of this localization usually cause combined damage to several anatomical zones and lead to the development of pronounced clinical symptoms.

The anatomical boundaries of the base of the skull are considered to be a complex of bone structures located below the line connecting the intersection of the frontonasal suture and the midline (nasion) with the external occipital protrusion (inion). It should be noted that there is an external and internal base of the skull. Considering this circumstance, we classify as tumors of the skull base not only those that manifest themselves as lesions of the internal base, but also tumors localized in the structures that make up the external base, such as cells of the ethmoidal labyrinth, orbit, infratemporal and pterygopalatine fossa, cervico-occipital joint.

It is clinically impossible to determine damage directly to the base of the skull without diagnostic procedures such as computed x-ray and magnetic resonance imaging. This is due to the fact that even small tumors with minimal clinical manifestations, often having a generally silent course, can immediately affect the base of the skull and, conversely, tumors with extensive damage to anatomical formations adjacent to the base of the skull, which have pronounced clinical symptoms, may not spread directly to the base, which greatly facilitates the technical performance of surgical intervention and improves life prognosis. Therefore, the birth of such an extraordinary nosological entity as “tumor of the skull base” and the main advances in its treatment are associated precisely with the advent of these revolutionary tumor imaging techniques.

What is the clinical significance of tumor damage to the base of the skull? As is known, the base of the skull performs a very specific physiological function as a link between the brain skeleton and the facial structure and the skull as a whole with the spinal column. Despite the successes of modern chemoradiotherapy, when some types of tumors, for example, nasopharyngeal cancer, are successfully treated conservatively, the main method of treating tumors of the skull base is surgical. When determining the scope of surgical intervention, it is necessary to take into account the fact that during interventions on the base of the skull for oncological diseases, too extensive combined defects arise, which themselves can lead to the development of complications incompatible with life, among which the most dangerous are meningoencephalitis, stroke, thrombosis cerebral sinuses, air embolism, traumatic spinal cord injury.

The experimental foundations of skull base surgery were laid at the end of the 19th century by the famous neurosurgeons Victor Horsley and Harvey Cushing. However, the impetus for the rapid development of this direction was the results of a study by the American surgeon A.S. Ketcham, published in the early 60s. last century, in which for the first time in patients with recurrent tumors of the paranasal sinuses affecting the base of the skull, previously considered doomed, it was possible to achieve a 3-year survival rate of 61%, thanks to the use of combined craniofacial resections.

Currently, the most appropriate treatment for patients with lesions of the base of the skull is considered to be a complex method combining chemoradiotherapy with surgery. Combined damage to both orbits, optic chiasm, damage to the brain stem, transverse and sigmoid sinuses, extended damage to the internal carotid artery are factors that greatly limit the radicalism of the intervention performed. Most authors in such cases are inclined to the need for preoperative chemoradiation therapy in order to reduce the size of the tumor focus to the point where it is possible to perform a functionally preserved surgical intervention without compromising radicalism. Perhaps the only limitation in carrying out such a treatment technique is the resistance of the tumor to chemoradiotherapy (osteogenic sarcomas, chondrosarcomas, meningiomas, etc.). In such cases, as well as when after the chemoradiotherapy stage it is not possible to achieve pronounced tumor regression, it is advisable to conduct a course of postoperative radiation therapy in order to devitalize microscopic residual foci - areas of development of potential relapses. The main criterion in this case is the morphologically confirmed presence of tumor cells in the resection margin.

Today there is no universal classification of tumors of the skull base, because in most cases, the base is involved in the tumor process secondarily by locally advanced tumors in neighboring locations, or by metastases of malignant tumors from distant organs. Optimal, in our opinion, is the conditional division of tumors affecting the base of the skull according to the projection of the three cranial fossae, since it is very convenient in planning the scope of surgical intervention, which plays a major role in the treatment of this pathology. For example, in the projection of the anterior cranial fossa there are tumors emanating from the maxillary and frontal sinuses, cells of the ethmoidal labyrinth, and orbits; middle - tumors of the main sinus, nasopharynx, infratemporal and pterygopalatine fossae, middle ear; posterior - tissues that make up the cervical-occipital joint.

Clinical manifestations of tumors affecting the base of the skull are varied and nonspecific and mainly depend on the primary localization of the tumor and the involvement of neighboring structures in the process: cranial nerves, great vessels, brain and spinal cord tissues. The first place in the frequency of damage to the base of the skull is occupied by tumors of the paranasal sinuses, which in approximately 15% of cases spread to the area of ​​the anterior cranial fossa. Most often these are epithelial tumors, among which squamous cell carcinoma occurs in the majority of cases (50-80%). Often, tumors of the paranasal sinuses are mistaken for various inflammatory processes (sinusitis, sinusitis, etc.), which is why most patients (70-90%) enter the clinic with an already widespread tumor process. Among the main symptoms in this case are congestion and periodic bloody discharge from the nose, decreased hearing on the affected side, often with infiltrative tumors of the nasopharynx - a combined lesion of n. abducens (VI) and n. facialis (VII), manifested by adductor strabismus and paresis of facial muscles, decreased sensitivity of the facial skin, neuralgia, exophthalmos. Tumors of the infratemporal fossa clinically occur as parapharyngeal and most often manifest as displacement of the lateral wall of the pharynx to the midline, dysphagia, and difficulty breathing; in case of malignant tumors with infiltrative growth, progressive headaches associated with involvement of the internal carotid artery, laryngeal paresis due to damage to the vagus nerve, Horner's syndrome due to damage to the sympathetic trunk may occur. In cases where the tumors are located in the projection of the posterior cranial fossa, the clinical picture resembles cervical osteochondrosis - pain in the cervical spine, periodic headaches, dizziness, vestibular disorders. When the tumor spreads into the cranial cavity, manifestations of focal neurological symptoms, which depend on the location of the lesion, come to the fore.

Since 1980, 366 patients with various pathological processes in the area of ​​the base of the skull have been treated in the clinic of tumors of the upper respiratory-digestive tract of the State Scientific Research Center named after N.N. Blokhin of the Russian Academy of Medical Sciences. Among them, 140 (38.2%) patients with tumors localized in the area of ​​the paranasal sinuses and nasal cavity, 176 (48.1%) with tumors of the infratemporal fossa, 40 (10.9%) patients with common pathological processes arising from from the bones of the skull base, 8 (2.2%) - with primary or secondary metastatic lesions of the orbit, 2 (0.5%) - with locally advanced skin tumors affecting the base of the skull. The variety of tumors affecting the base of the skull requires careful morphological verification before treatment; Often the final diagnosis can be obtained only after an immunomorphological study. In the study group, 196 (53.6%) patients had malignant neoplasms, among which epithelial tumors predominated: squamous cell carcinoma - in 65 (33.2%), adenoid cystic cancer - in 16 (8.2%), adenocarcinoma - in 8 ( 4.1%), esthesioneuroblastoma - in 18 (9.2%), affecting mainly (54.1%), the paranasal sinuses and nasal cavity; There were also various types of sarcomas (55 patients - 28.1%), emanating from the bone structures of the base of the skull; in addition, tumors such as malignant schwannoma (6 patients - 3.1%), melanoma (3 patients - 1.5%), basal cell carcinoma (2 patients - 1%), etc. were encountered.

170 (46.4%) patients had benign tumors. In this group, tumors of the infratemporal fossa predominated (75.9%), among which the most common were benign schwannomas (34 patients - 20%), emanating from the sheaths of the cranial nerves and sensory roots of the cervical plexus, pleomorphic adenoma of the pharyngeal process of the parotid gland ( 30 patients - 17.6%), vagal paragangliomas (28 patients - 16.5%), neuromas (14 patients - 8.2%), meningioma (7 patients - 4.1%); in addition, angiofibromas of the nasopharynx (8 patients - 8.2%), fibrous dysplasia of the upper jaw (5 patients - 2.9%).

Treatment tactics for patients with locally advanced tumors of the skull base depend on the histological type, location, and extent of the tumor process. Thanks to the development of active chemoradiation treatment regimens, which make it possible to achieve significant tumor regression at the preoperative stage, it is often possible to transfer the process to a resectable state in patients who were previously considered unpromising. In this regard, 54 (27.6%) patients with tumors such as squamous cell carcinoma, esthesioneuroblastoma, and embryonal rhabdomyosarcoma underwent chemoradiation treatment at the first stage, and in 20% of cases complete clinical regression was achieved. 74 (37.7%) patients, mainly with squamous cell/adenocystic cancer of the maxillary sinuses and various types of sarcomas, in terms of combined treatment at the first stage received only radiation therapy with lower rates of immediate treatment effectiveness - 3.5%.

Surgical interventions were performed in 267 (73%) patients. Of these, in 170 (63.4%) cases with benign processes, when the scope of the operation was limited mainly to tumor removal without damaging adjacent structures. Some benign processes are accompanied by pronounced bone-destructive changes, making correct diagnosis difficult and often requiring extensive combined resections. Similar manifestations were present in 26 (15.3%) cases, mainly with angiofibromas of the nasopharynx and fibrous dysplasia of the bones of the facial skeleton.

In most cases, the diagnosis of a benign process is not difficult at the preoperative stage, but technical difficulties associated with the removal of extensive tumors force the use of combined approaches to adequately perform the surgical procedure. An example of this is giant pleomorphic adenomas arising from the pharyngeal process of the parotid salivary gland, which in our observations occurred in 30 (17.6%) cases. External cervical access in most cases (176 patients) was sufficient to remove tumors of the infratemporal fossa. However, in more common tumor processes, especially such malignant ones as sarcomas, this type of access has to be combined with various types of osteotomies, resection of the mandibular branch and/or zygomatic arch, which were performed in 23 (13.1%) patients.

In patients with common tumors of the paranasal sinuses, nasal cavity and bone structures of the skull base, extensive combined operations were performed (71 cases), consisting of removal of the upper jaw on one or both sides, exenteration and various types of resection of the orbital walls, resection of the ethmoidal labyrinth cells, walls frontal and sphenoid sinuses, dura mater. The main type of access for removing such tumors was transfacial.

Often, with advanced tumors, it is necessary to perform resections directly of the bony structures of the skull base. At the same time, defects formed during such operations must be immediately restored in order to prevent various complications, mainly basal liquorrhea. Small defects can be replaced with local plastic material. For example, with limited-volume orbitofacial resections, the temporalis muscle can serve as a good plastic material for restoring a skull base defect in the orbital area. Such operations were performed in 11 (4.1%) patients.

In 35 (9.6%) patients, the tumor spread into the cranial cavity. In this case, the main gates of tumor invasion are natural openings at the base (reticular plate, optic nerve canal, inferior orbital fissure, jugular foramen) or direct destruction of the bone barrier by the tumor with spread to the dura mater and brain tissue. It is known that patients with damage to the dura mater have a worse prognosis due to the high risk of distant metastasis; According to various authors, 2-year survival rate in such cases after treatment drops from 56% to 40%. But still, in such cases, it is possible to perform radical intervention using a combined craniofacial approach. Departure from this principle leads to a sharp increase in the frequency of relapses.

When performing such extensive resections, the question arises of using reliable plastic material to close the skull base defect. It should be noted that in this case, restoration of the dural mater defect carries the task of preventing not only basal liquorrhea, but also such a complication as meningoencephalitis, limiting the cranial cavity from the paranasal sinuses contaminated with pathogenic flora. In our group, 15 (42.9%) patients with intracranial tumor spread underwent simultaneous surgical interventions with plastic restoration of skull base defects. Moreover, in 5 (33.3%) cases, we used a pericranial periosteal flap to restore defects of the base of the skull and dura mater, in other cases (10 patients - 66.7%) with less common defects - the temporal muscle.

Complications after operations in the area of ​​the base of the skull developed in 27 (9.9%) patients, with the main types being meningitis (2 patients - 0.7%), paresis of half the larynx due to resection of the vagus nerve (5 patients - 1.9% ), various neurological disorders in the form of paresis and paralysis of the caudal group of cranial nerves (IX, X, XI, XII), as well as Horner's syndrome (15 patients - 5.6%), liquorrhea (3 patients - 1.1%) , acute cerebrovascular accident (2 patients - 0.7%). Most often, neurological symptoms of this kind occurred during the removal of vagal chemodectomas (60%), which is associated with the close proximity of the listed structures to large vessels in the area of ​​the infratemporal fossa, along with the small size of this area and insufficient visualization of its proximal parts.

109 (55.6%) patients with malignant neoplasms affecting the base of the skull are alive more than 5 years after treatment.

References:

1. Sdvizhkov A.M. “Surgical aspects of the treatment of common malignant tumors of the nose, paranasal sinuses and upper jaw”, Dr. diss., Moscow, 1997.

2. Konovalov A.N. “Surgery of skull base tumors”, M.: 2004.

3. Jatin Shah “HEAD & NECK, SURGERY & ONCOLOGY”, THIRD EDITION, Mosby, 2003.

4. J.Shah, Narayan S., Joseph G. “Craniofacial Resections for Tumors Involving the Base of the Skull,” The American Journal of Surgery, Vol.154, Oct.1987.

5. Matias C., Carlos C., Julio A., Carlos N., Santiago O. “Repair of large orbito-cutaneous defects by combining two classical flaps.” Journal of Cranio-Maxillofacial Surgery, (2004) 32, p.21-27.

6. Paul J.Donald “Surgery of the Skull Base”, Lippincott-Raven Publishers, Philadelphia, 1998.

Skull bone tumors

What are Skull Bone Tumors -

Brain abscess- limited accumulation of pus in the brain matter. The most common abscesses are intracerebral, less often - epidural or subdural.

What provokes / Causes of Swelling of the skull bones:

The cause of a brain abscess is the spread of infection caused by streptococci, staphylococci, pneumococci, and meningococci. E. coli, Proteus, and mixed flora are often found. The ways in which infection penetrates into the brain matter are different. In accordance with the etiology and pathogenesis, brain abscesses are divided into: 1) contact (associated with a nearby purulent focus); 2) metastatic; 3) traumatic.

Pathogenesis (what happens?) during tumors of the skull bones:

Most common contact abscesses caused by mastoiditis, otitis, purulent processes in the bones of the skull, paranasal sinuses, orbit, and meninges. About half of all brain abscesses are of otogenic origin. Chronic purulent otitis is much more often complicated by an abscess than acute inflammatory processes in the ear. Infection in otitis media penetrates from the temporal bone through the roof of the tympanic cavity and the cavernous sinuses percontinuitate into the middle cranial fossa, causing an abscess of the temporal lobe of the brain. Otogenic infection can also spread into the posterior cranial fossa through the labyrinth and sigmoid sinus, leading to a cerebellar abscess. Rhinogenic abscesses are localized in the frontal lobes of the brain. First, local pachymeningitis develops, then adhesive limited meningitis, and finally the inflammatory process spreads to the brain substance with the formation of limited purulent encephalitis. In more rare cases, oto- and rhinogenic abscesses can occur hematogenously due to thrombosis of veins, sinuses, and septic arteritis. Abscesses are localized in the deep parts of the brain, far from the primary focus.

Metastatic abscesses brain diseases are most often associated with lung diseases: pneumonia, bronchiectasis, abscess, empyema. Metastatic abscesses can also complicate septic ulcerative endocarditis, osteomyelitis, and abscesses of internal organs. The mechanism of infection entering the brain is septic embolism. In 25-30% of cases, metastatic abscesses are multiple and are usually localized in the deep parts of the white matter of the brain.

Traumatic abscesses arise as a result of open (extremely rarely closed) skull injuries. When the dura mater is damaged, the infection penetrates through the perivascular fissures into the brain tissue, which is preceded by the development of limited or diffuse inflammation of the membranes. In cases of foreign body penetration into the brain, the infection enters along with it. An abscess forms along the wound canal or directly in the area of ​​a foreign body. Peacetime traumatic abscesses account for up to 15% of all brain abscesses; their percentage increases sharply during the war and in the post-war period.

Pathomorphology. The formation of a brain abscess goes through a number of stages. Initially, the reaction to the introduction of infection is expressed in a picture of limited inflammation of the brain tissue - purulent encephalitis. In the future, healing through scarring is possible. In other cases, as a result of the melting of brain tissue, a cavity filled with pus appears - the stage of a limited abscess. A rather dense connective tissue capsule forms around the cavity - the stage of an encapsulated abscess. It is believed that capsule formation begins after 2-3 weeks and ends after 4-6 weeks. With a decrease in the body's immune reactivity, encapsulation occurs extremely slowly, and sometimes the purulent focus in the brain remains in the stage of melting of the brain tissue.

Symptoms of Skull Tumors:

In the clinical picture of a brain abscess, 3 groups of symptoms can be distinguished:

1) general infectious diseases- increased temperature (sometimes intermittent), chills, leukocytosis in the blood, increased ESR, signs of a chronic infectious process (pallor, weakness, weight loss); 2) cerebral, appearing as a result of increased intracranial pressure caused by the formation of an abscess. The most consistent symptom is headaches. Cerebral vomiting, fundus changes (congestive discs or optic neuritis), periodic (orthostatic) bradycardia up to 40-50 beats/min, and mental disorders are often observed. The inertia, lethargy of the patient, and the slowness of his thinking are noteworthy. Stupefaction, drowsiness, and in severe cases without treatment, coma may gradually develop. As a consequence of intracranial hypertension, general epileptic seizures may occur; 3) focal, depending on the location of the abscess in the frontal, temporal lobes, and cerebellum. Abscesses located deep in the hemispheres outside the motor zone can occur without local symptoms. Otogenic abscesses sometimes form not on the side of otitis media, but on the opposite side, giving the corresponding clinical picture. Along with focal symptoms, symptoms associated with swelling and compression of brain tissue may be observed. When the abscess is close to the membranes and with a cerebellar abscess, meningeal symptoms are detected.

In the cerebrospinal fluid, pleocytosis is observed, consisting of lymphocytes and polynuclear cells, an increase in protein levels (0.75-3 g/l) and pressure. However, often no changes are found in the cerebrospinal fluid.

Flow. The onset of the disease is usually acute, with rapid manifestation of hypertension and focal symptoms against a background of rising temperature. In other cases, the onset of the disease is less defined, then the clinical picture resembles the course of a general infection or meningitis. Rarely, the initial stage of an abscess occurs latently, with minimal symptoms and low fever. After the initial manifestations, after 5-30 days the disease enters the latent stage, corresponding to the encystation of the abscess. This stage is asymptomatic or manifests itself with moderate symptoms of intracranial hypertension - frequent headache, vomiting, mental retardation. The latent stage can last from several days to several years. Subsequently, under the influence of some external factor (infection), and more often without obvious reasons, cerebral and focal symptoms begin to progress rapidly. A lethal outcome with a brain abscess occurs due to its swelling and a sharp increase in intracranial pressure. An extremely serious complication of an abscess, possible at any stage, is its rupture into the ventricular system or subarachnoid space, which also usually ends in death.

Diagnosis of tumors of the skull bones:

Recognition of a brain abscess is based on medical history (chronic otitis media, bronchiectasis, other foci of purulent infection, trauma), the presence of focal, cerebral symptoms, signs of increased intracranial pressure, the onset of the disease with elevated temperature and its characteristic progressive course. To make a diagnosis, repeated echoencephalography is important, revealing displacement of the midline structures of the brain during abscesses of the hemispheres. X-rays of the skull (signs of increased intracranial pressure), X-rays of the paranasal sinuses, temporal bones, fundus examination (congestive discs or a picture of optic neuritis), and lumbar puncture are also necessary.

The decisive role in recognizing abscesses, especially multiple ones, belongs to computed tomography and magnetic resonance imaging, which reveals a characteristic round formation, usually limited to the capsule.

When conducting a study at the stage of abscess formation, the capsule may be absent, and around the formed cavity there are signs of inflammation of the brain tissue and accompanying edema.

In the presence of hypertensive syndrome, lumbar puncture should be performed carefully, and if the patient’s condition is serious, it should be abstained from it, since with increasing intracranial hypertension, extraction of cerebrospinal fluid can cause pinching of the cerebellar tonsils in the foramen magnum (with cerebellar abscess) or the medial part in the temporal lobes in the foramen of the tentorium cerebellum (with an abscess of the temporal lobe) with compression of the trunk, which can lead to the death of the patient.

Differential diagnosis depends on the stage of the abscess. In the initial acute period of the disease, an abscess should be distinguished from purulent meningitis, the cause of which may be the same as the abscess. One should take into account the greater severity of rigidity of the neck muscles and Kernig's symptom in purulent meningitis, the persistence of high temperature (with an abscess the temperature is often hectic), large neutrophilic pleocytosis in the cerebrospinal fluid, and the absence of focal symptoms.

The course and symptoms of an abscess and a brain tumor have much in common. Differential diagnosis is difficult, since a malignant tumor may cause leukocytosis in the blood and an increase in body temperature. In these cases, the anamnesis data is of particular importance, i.e. the presence of factors that cause the development of an abscess. It should be borne in mind that by the time the abscess forms, the primary purulent focus may have already been eliminated.

Treatment of Skull Tumors:

With a brain abscess, the prognosis is always serious. With untimely and inadequate treatment, primarily surgical, mortality reaches 40-60%. The worst prognosis is for patients with multiple metastatic abscesses. In 30% of those who recover, residual neurological symptoms persist, most often focal seizures.

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Other diseases from the group Diseases of the nervous system:

Of the benign tumors of the skull, the most common are atheromas, somewhat less frequently angiomas and dercoids, and very rarely fibromas, lipomas and neurofibromas.

Atheromas of the head more common in adulthood.

Clinically, atheroma (retention cyst of the sebaceous gland) is a slowly growing, painless tumor with a smooth surface, soft or tightly elastic to the touch. Large atheromas fluctuate. The size ranges from a pea to a potato. The tumor is covered with unchanged or somewhat thinned skin, with which it, as a skin derivative, is closely connected and with which it easily moves in relation to the underlying tissues.

Atheromas are often single, less often multiple. They are located mainly in the scalp, especially often in the parietal region. The course of the disease is sometimes complicated by suppuration or malignant degeneration. The tumor must be removed carefully; not a single piece of the membrane should be left, otherwise a relapse is inevitable.

Dermoids represent cysts formed from particles of the ectodermal layer included in the underlying tissue in the embryonic period of life. The wall of the cyst is lined with skin containing sebaceous and sweat glands and hair follicles. The contents of the cyst consist of a pasty mass formed from discharged skin glands and exfoliated epithelium, often mixed with hair.

Clinically, a dermoid is a slowly growing, painless, round, smooth, tight-elastic tumor ranging in size from a pea to a tangerine or larger. Dermoids, usually buried deep, are loosely connected to the skin. Unlike atheromas, the skin easily moves over the tumor. In the bone under the tumor, due to prolonged pressure, a depression is sometimes formed, the edges of which can be felt around the circumference of the tumor in the form of a hard ridge.

The depression in the bone sometimes turns into a hole, and the tumor comes into contact with the dura mater. Typical locations of dermoids: the median canthus, the temporal and occipital region, the mastoid region and the lateral end of the eyebrow. Clinically, dermoids are detected in childhood and adolescence.

Dermoids located at the inner canthus can be mistaken for a cerebral hernia. Distinctive features of the latter are greater softness, compressibility (not always) and a defect in the cranial bone, ascertained by x-ray. Lipomas are distinguished by their lobulation and great softness.

Dermoids are removed surgically. To avoid relapse, the cyst shell should be bluntly isolated or completely cut out. During surgery, one must keep in mind the possibility of skull distortion and, consequently, damage to the dura mater.

Hemangioma of the skull found in all its characteristic forms.

Superficial capillary hemangioma looks like a more or less extensive spot with a smooth or slightly bumpy surface and is usually located on one side of the head. Capillary hemangioma involves only the skin and does not extend to the subcutaneous tissue. If arterial capillaries predominate, the spot is bright red; if venous capillaries are developed, it is blue-red. Superficial hemangioma is a congenital formation, therefore it is also called a vascular birthmark (naevus vasculosus).

For therapeutic purposes, electrocoagulation, cauterization with a hot needle, x-ray therapy, radiotherapy, surgical removal of hemangioma are used, followed by closing a significant defect with large epithelial flaps obtained using a dermatome, or a lattice flap.

Cavernous cavernous hemangioma (haeman-gioma cavernosum) is a cluster of blood-filled cavities communicating with each other and with small blood vessels. The most common are cavernous hemangiomas, located in the subcutaneous tissue.

Clinically, cavernous hemangioma appears as a red spot or soft nodule that appears through thin skin or protrudes onto its surface. With pressure, the angiomatous node collapses.

The tumor may be congenital or may appear in early childhood, developing from an initially imperceptible congenital rudiment. Small cavernous hemangiomas sometimes disappear spontaneously, but more often they slowly enlarge. Often, the growth of a hemangioma is greatly accelerated, and the tumor in a short time engulfs a significant area of ​​neighboring tissues, growing over a long distance and even usurizing the bone.

Once ulcerated, the hemangioma can become a source of heavy bleeding. Rarely, cranial hemangiomas, especially those located in the midline, communicate with intracranial blood vessels, for example, with venous sinuses.

Due to the usually rapid growth and sometimes observed malignant degeneration, cavernous hemangiomas must be surgically removed. Bleeding during surgery is perfectly prevented, as the experience of our clinic has shown, by preliminary application around the tumor of a looped hemostatic suture used during craniotomy. Small superficial cavernous hemangiomas can also be successfully treated with electrocoagulation or radium rays.

Branched hemangioma (haemangioma racemosum), also called serpentine aneurysm (aneurysma cirsoides), is rare and is a flat, irregularly shaped, pulsating tumor consisting of elongated, tortuous and highly dilated vessels.

The essence of the disease is a wide connection between the arterial system and the vein. The veins are arterialized. The number and caliber of capillaries are extremely increased. On the tumor, a constant noise is heard that increases with systole, caused by numerous anastomoses between arteries and veins.

Anastomosis is sometimes single. Its presence and location are determined by arteriography. Most often, a serpentine aneurysm is observed in the area of ​​branches of the temporal artery, less often in the area of ​​other branches of the external carotid artery. Sometimes it spreads to the entire half of the head. The disease develops in connection with a head injury or from a cavernous hemangioma and tends to progress.

Radical cure is achieved only by complete removal of the tumor. To limit bleeding, which is sometimes dangerous, a preliminary ligation of the adductor artery is performed and the tumor is cut around the circumference with a hemostatic suture, and an elastic tourniquet is applied around the skull. In the case of a single anastomosis, the communication between the artery and vein is first closed.

Neurofibromas are very rare. These are multiple small, dense, painless tumors in the thickness of the skull, congenital or detected in early childhood. The starting point for the formation of tumors is the nerve sheath. Neurofibromas of the head can also be a manifestation of general neurofibromatosis. Surgical intervention is indicated for large single nodes or when there is a threat of malignant degeneration.

Malignant tumors of the skull

Of the malignant tumors of the skull, cancer is often encountered and sarcoma is much less common.

Cancer of the skin covering the skull originates from the dermal epithelium or from the epithelium of the sebaceous or sweat glands and hair follicles and is observed almost exclusively in the more benign superficial basocellular form. The more malignant spinocellular form, which tends to spread early and metastasize to the lymph nodes, is rare. Treatment of skin cancer of the skull area is carried out according to the same rules as the treatment of facial skin cancer.

Sarcoma of the skull in the initial stage is a dense skin nodule, which quickly enlarges and soon ulcerates. Growing deeper, the tumor often grows into the underlying cranial bone. Surgical treatment gives better results in combination with x-ray or radiotherapy.

Malignant neoplasms of the skeletal system in the head region occur as both primary and secondary tumors. This disease is characterized by rapid and aggressive growth of mutated tissues. Skull cancer, predominantly develops in the form of an initial lesion.

Reasons

The etiology of the disease is unknown. Among the risk factors, doctors consider:

• presence of concomitant cancer;
• genetic predisposition;
• exposure to ionizing radiation;
• systemic decrease in immunity.

Skull bone cancer: types of tumors

Malignant neoplasms in this area are formed in the following variants:

1. – a tumor that contains mutated elements of cartilage tissue.
2. – oncological formation, which is predominantly localized in the temporal, occipital and frontal regions. This pathology is characterized by rapid and aggressive growth with early formation of metastases. Most patients are people of a younger age category, which is explained by the development of mutations during the period of bone tissue growth.
3. – cancer of the base of the skull. It is dangerous due to the spread of oncology into the nasopharyngeal space and damage to the nerve bundles. Due to these topographic features, a high mortality rate is observed among cancer patients with chordoma.
4. – cancer pathology, which is located in the area of ​​the cranial vault.
5. – in most cases, this tumor affects the bones of the extremities, and in the cranial tissues the sarcoma is identified as a metastasis.

Symptoms and signs

The clinical picture is based on the following principles:

• The early stages of the oncological process are predominantly asymptomatic.
• For Ewing's sarcoma, typical manifestations are: migraine attacks, low-grade body temperature, increased concentration of leukocytes and anemia.
• Myeloma is accompanied by malaise and intense muscle pain.
• Symptoms of osteosarcoma include the formation of a fixed hard tissue mass and localized pain.
• Metastatic processes in the skull are manifested by symptoms of intoxication of the body.

Modern diagnostics

The determination of an oncological diagnosis is based on an X-ray of the head. A cancerous lump, in particular, requires a radiological examination in a lateral projection.

The radiologist identifies the tumor by atypical fusion of bone tissue, which may have clear or jagged edges. Depending on the form of the pathology, foci of mutation can be either single or multiple.

The final diagnosis is made in the laboratory, by microscopic examination of a small area of ​​modified tissue (biopsy). This technique is called.

After determining the final diagnosis, specialists prescribe the patient to undergo computed tomography and magnetic resonance imaging. Such examinations are necessary to clarify the extent and location of the tumor.

Skull bone cancer: how is it treated today?

The method of anticancer treatment for cranial cancer depends on the stage of malignant growth and the location of the painful focus.

At the initial stage, the most effective method of treatment is surgery, during which the tumor is radically excised for the cancer patient. After resection, the patient often undergoes a course of rehabilitation. He undergoes plastic surgery of the bone defect and endoprosthetics to restore cosmetics.

In later phases of oncology development and in case of inoperability of the tumor, the patient is recommended to undergo the following treatment:

Chemotherapy

Systemic use of cytostatic agents causes the disintegration of the neoplasm in the first and second stages. Oncologists prescribe this therapy in several courses, the dosage being determined individually for each cancer patient.

Radiotherapy

Radiation irradiation of the tumor focus is indicated for Ewing's sarcoma as the only anticancer technique. And in the case of myeloma, ionizing radiation contributes to a significant improvement in the quality of life.

Combined treatment

The bottom line is surgical removal and subsequent radiation therapy. This sequence of procedures minimizes the risk of postoperative complications and relapses of the disease.

Palliative care

Metastatic cancer and end-stage skull cancer are treated symptomatically. Medical care in such cases focuses on relieving pain attacks and maintaining vital body functions.

Sarcoma of the skull bones

Prognosis and how long do they live?

To assess the consequences of such a diagnosis as “ skull bone cancer", in oncological practice the 5-year survival rate is used. This index includes the total number of patients surviving to the five-year mark from the time of final diagnosis.

The life prognosis of patients is usually favorable. About 80% of cancer patients survive 5 or more years. Further development of oncology and the spread of mutated cells beyond the tumor aggravates the prognosis. The postoperative survival rate is 60%. The terminal phase and metastasized neoplasm of cranial tissue has a negative treatment outcome. The high mortality rate of patients is explained by the aggressiveness of oncology and damage to nearby nerve centers.

Skull cancer, like many other malignant oncological formations, requires detailed and timely diagnosis. Only adequate therapy at an early stage of the oncological process contributes to a complete cure and protects the patient from postoperative relapse. Such patients also additionally need to undergo annual preventive examinations with an oncologist.