Neuroblastoma skull metastasis

Case contributed by Hidayatullah Hamidi


Headache, skull bulging, ill looking.

Patient Data

Age: 4 years
Gender: Female

Multiple osteolytic lesions featuring hair-on-end appearance and sun-ray spiculation involving most of the cranial bones and right mandible. The largest left parieto-occipital region lesion causes significant mass effect over the underlying brain parenchyma.


Transabdominal ultrasound shows a soft tissue echogenicity, solid lesion with lobulated outlines mostly in the right suprarenal location enhcasing the abdominal aorta and adjacent great vessels.

Case Discussion

Neuroblastoma craniocerebral metastases mainly involve the calvaria, orbits, skull base, and the dura. CT can reveal a spiculated periorbital bone mass, typically involving the roof or lateral wall/sphenoid wing. A "hair on end" periosteal reaction may be seen in association with bone destruction.

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