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prominent, facial pain and numbness (trigeminal), abducens, and other cranial nerve palsies may occur Diagnosis depends on inspection and biopsy of a nasopharyngeal mass or an involved cervical lymph node and radiologic evidence of erosion of the base of the skull Bone and CT scans are helpful in diagnosis (Fig 47-5, page 1188) The treatment is surgical resection (in some cases) and radiation Carcinoma of the ethmoid or sphenoid sinuses and postradiation neuropathy, coming on years after the treatment of a nasopharyngeal tumor, may produce similar clinical pictures and are dif cult to differentiate Special imaging techniques, such as the diffusion-weighted MRI sequence, may be useful in separating them The several syndromes resulting from nasopharyngeal tumors are discussed in Chap 47, under Diseases of the Cranial Nerves Other Tumors of the Base of the Skull In addition to meningioma, nasopharyngeal tumors, and the other tumors enumerated above, there are a large variety of tumors, rare to be sure, that derive from tissues at the base of the skull and paranasal sinuses, ears, etc, and give rise to distinctive syndromes Included in this category are osteomas, chondromas, ossifying bromas, giant-cell tumors of bone, lipomas, epidermoids, teratomas, mixed tumors of the parotid gland, and hemangiomas and cylindromas (adenoid cystic carcinomas of salivary gland origin) of the sinuses and orbit; sarcoid produces the same effect Most of these tumors are benign, but some have a potential for malignant change To the group must be added the esthesioneuroblastoma (of the nasal cavity) with anterior fossa extension and, perhaps most common of all of these, the systemic malignant tumors that metastasize to basal skull bones (prostate, lung, and breast being the most common sources) or involve them as part of a multicentric neoplastic process, eg, primary lymphoma, multiple myeloma, plasmacytoma, and lymphocytic leukemia Suprasellar arachnoid cysts also occur in this region CSF ows upward from the interpeduncular cistern but is trapped above the sella by thickened arachnoid (membrane of Liliequist) As the CSF accumulates, it forms a cyst that invaginates the third ventricle; the dome of the cyst may intermittently block the foramina of Monro and cause hydrocephalus (Fox and Al-Mefty) Children with this condition exhibit a curious to-and-fro bobbing and nodding of the head, like a doll with a weighted head resting on a coiled spring This has been referred to as the bobble-headed doll syndrome by Benton and colleagues; it can be cured by emptying the cyst See-saw and other pendular and jerk types of nystagmus may also result from these suprasellar lesions Details of the pathology, embryogenesis, and symptomatology of these rare tumors are far too varied to include in a textbook devoted to principles of neurology Table 31-4, and Table 47-1 on page 1180, adapted from Bingas s large neurosurgical service in Berlin, summarizes the known facts about the focal syndromes of the skull base; his authoritative article and the more recent one by Morita and Piepgras, both in the Handbook of Clinical Neurology, are recommended references Modern imaging techniques now serve to clarify many of the diagnostic problems posed by these tumors MRI is particularly helpful in delineating structures at the base of the brain and in the upper cervical region CT is also capable of determining the absorptive values of the tumor itself and the sites of bone erosion When the lesion is analyzed in this way, an etiologic diagnosis often becomes possible For example, the absorptive value of lipomatous tissue is different from that of brain tissue, glioma, blood, and calcium Bone scans (technetium and gallium) display active. free barcode add-in excel 2007 Excel QR -Code, DataMatrix & PDF417 2D Font - IDAutomation
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