Surgical Management of Skull Base Breast Metastasis

Objective: To evaluate surgical management of skull base breast metastasis. Study Design: Case presentation. Patient and Methods: A 68 years old right-handed female with history of breast cancer and sacrum metastasis since 2003 with previous radiation treatment, hormone therapy, and chemotherapy with lower extremities weakness and bedridden in past 2years. In 2011, had a left temporal fossa lesion biopsy with pathology result of fibrolipoma, and gradual enlargement of painless left temporal lesion with proptosis, and diplopia, worse in the past 2months. Her neurological examination showed limited left eye abduction, otherwise normal cranial nerves, and baseline lower extremities weakness due to sacral tumor. Brain CT scan and MRI showed left lytic extradural lesion extending in temporal fossa, infratemporal fossa, orbit with optic nerve compression, middle and anterior fossa with major diameter of 6.5 × 6.1 × 6cm. Cerebral angiogram showed hypervascular lesion supplied by proximal branches of the internal maxillary artery. Results: Performed preoperative embolization and left-sided peritumoral craniectomy and orbital decompression for invasive tumor resection followed by cranioplasty. The lesion was invading temporalis muscle, temporal bone, greater sphenoid wing, infratemporal fossa, middle fossa, anterior fossa, and orbit. Even with preoperative embolization the tumor was highly vascular and the estimated blood loss was of 800mL. No neurological deficits were found after resection. The pathology confirmed metastatic adenocarcinoma. Conclusions: Even with overall poor prognosis for skull base metastasis, surgical resection is still a treatment option for adequate candidates with preserved neurological conditions, and large skull base metastasis with significant mass effect.