Abstract
Skull base petroclival metastases cause diplopia due to abducens nerve palsy. Diplopia is visually disabling, and skull base metastasis is extremely difficult to treat even with microscopic surgery. However, stereotactic radiotherapy with CyberKnife (Accuray Incorporated, Sunnyvale, California) has been very successful in 10 cases. As the abducens nerve runs through Dorello’s canal in the skull base, the radiation dose and fraction were adjusted to avoid damage to the nerve. Since these metastases are not located inside the brain but in the skull base, contrast magnetic resonance imaging (MRI) combined with fluorodeoxyglucose-positron emission tomography (FDG-PET) was essential to detect the cancers.
Highlights
Skull base metastasis causes pain or cranial nerve palsy, which are disturbing symptoms for patients
As the abducens nerve runs through Dorello’s canal in the skull base, the radiation dose and fraction were adjusted to avoid damage to the nerve. Since these metastases are not located inside the brain but in the skull base, contrast magnetic resonance imaging (MRI) combined with fluorodeoxyglucose-positron emission tomography (FDG-PET) was essential to detect the cancers
In 1981, Greenberg et al classified the neurological findings of skull base metastases into five syndromes: orbital, parasellar, middle fossa, jugular foramen, and occipital condyle [1]. in 2018, Hayashi et al reported metastatic tumors in the clivus or petrous, which presented diplopia due to abducens palsy
Summary
Skull base metastasis causes pain or cranial nerve palsy, which are disturbing symptoms for patients. In 2018, Hayashi et al reported metastatic tumors in the clivus or petrous, which presented diplopia due to abducens palsy These tumors comprised 20% of skull base metastases [2] We treated 10 patients with diplopia who presented with petroclival metastases, which falls into the category of parasellar syndrome or middle fossa syndrome by Greenberg. The treatment required some adjustment to decrease the compression pressure to the abducens nerve in Dorello’s canal without damaging the nerve. This is the first report to treat diplopia by treating petroclival metastasis with multi-fractionated SRT, presuming that the tumor is compressing the abducens nerve in Dorello’s canal
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