Neuroblastoma (craniocerebral metastases)

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Craniocerebral neuroblastoma metastases usually involve the calvaria, orbits, skull base and the dura.

Please refer to the article neuroblastoma for a general discussion on this entity.

Epidemiology

In children, neuroblastoma is the most common cause of orbital metastases ⁴.

Clinical presentation

proptosis
periorbital ecchymosis ~~" racoon~~("racoon eyes")
palpable calvarial masses

Radiographic features

CT

spiculated periorbital bone mass, typically involving the roof or lateral wall/sphenoid wings
"hair on end" spiculated periostitis of orbits and skull usually associated with bone destruction
sutural separation: non-uniform sutural separation with indistinct suture margins
cranial metastasis nearly always extradural (may mimic epidural or subdural haematoma)

MRI

T1: hypointense to muscles
T2: heterogeneous usually hyperintense to muscles
T1 C+ (Gd): vigorously enhances, may be heterogeneous
MRV: may narrow or invade adjacent dural sinuses

Nuclear medicine

MIBG (meta-iodo benzyl guanidine): avid uptake by neural crest tumours
TC-99-m-MDP: shows increased uptake due to the calcium metabolism of the tumour
PET: shows high sensitivity and specificity for recurrent tumours

Differential diagnosis

Imaging differential considerations include:

consider intracranial metastases from
- leukaemia
- dural or calvarial based masses
- usually associated with intraparenchymal masses
- Ewing sarcoma
- osteosarcoma
skeletal involvement with Langerhans cell histiocytosis: lytic bone lesions without periosteal bone formation
extra-axial intracranial haematoma

~~-<li>periorbital ecchymosis " racoon eyes"</li>~~
+<li>periorbital ecchymosis ("racoon eyes")</li>
~~-<a title="Sutural diastasis" href="/articles/sutural-diastasis">sutural separation</a>: non-uniform sutural separation with indistinct suture margins</li>~~
+<a href="/articles/sutural-diastasis">sutural separation</a>: non-uniform sutural separation with indistinct suture margins</li>

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