Anterior skull base
- Squamous cell carcinoma
- Sarcoma
- Olfactory neuroblastoma
- Adenocarcinoma
- Adenoid cystic carcinoma
- Sinonasal undifferentiated carcinoma
Middle skull base
- Sarcoma
- Squamous cell carcinoma
- Adenoid cystic carcinoma
- Cavernous sinus lesion/mass
- Meningioma
- Orbital apical inflammation with cavernous sinus involvement (Tolosa-Hunt syndrome)
- Infection
- Schwannoma
- CN5 is the most common
- Any of the cranial nerves traversing the cavernous sinus: III, IV, V (V1 and V2) and VI
- Cavernous haemangioma
- Lymphoma/ neurolymphomatosis
- Metastatic disease (i.e. perineural spread of tumour through neural foramina)
- Aneurysm
- Haemangiopericytoma
- Neurosarcoidosis:
- Rarely involves the cavernous sinus
- Pituitary macroadenoma
- Base of skull tumour
- Chondrosarcoma
- Osteosarcoma
- Chordoma (usually midline)
- Juvenile angiofibroma
- Nasopharyngeal carcinoma with intracranial extension (especially in Southeast Asia)
Posterior skull base
- Chordoma
- Basal cell carcinoma
Malignant tumours skull base
- Trojani grading, 1984
- Differentiation
- Cellularity
- Mitosis
- Necrosis
- Vascular emboli
- Systemic staging
- CT chest
- CT PET whole body
- Most sarcoma involved the chest first
- Decision making:
- Understand role of chemotherapy and radiotherapy
- Biopsy - know the histology if possible
- Early multidisciplinary team discussion
- Completeness of excision is important
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