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Differential diagnosis of tumors at the base of the skull

Differential diagnosis of tumors at the base of the skull
Site of lesion Associated tumors Clinical findings
Anterior parts Carcinoma invasive from frontal and ethmoid sinuses; meningioma Unilateral anosmia, frontal lobe syndrome, seizures
Superior orbital fissure Meningioma, carcinoma of nasopharynx III, IV, V, VI cranial nerve lesions with ophthalmoplegia; pain and hypesthesia in distribution of V
Cavernous sinus Chordoma, chondrosarcoma, meningioma, sellar, and parasellar tumors III, IV, VI, and sometimes V nerve involvement with ophthalmoplegia
Apex of the petrous temporal bone Cholesteatoma, chordoma, chondrosarcoma, meningioma, neurinoma V and VI nerve involvement with sensory and motor findings and diplopia
Sphenoid and petrous bone Meningioma, chordoma, chondrosarcoma, nasopharyngeal carcinoma, metastasis III, IV, VI nerve lesions result in ophthalmoplegia; V may be associated with trigeminal neuralgia syndrome
Jugular foramen Glomus jugulare tumor, neurinoma, chordoma, chondrosarcoma, cholesteatoma, meningioma, nasopharyngeal carcinoma IX, X, XI nerves producing difficulty with swallowing, speaking, and weakness of strap muscles of neck
Cerebellopontine angle Neurinoma, meningioma, cholesteatoma, metastasis, cerebellar tumors VIII nerve lesions causing loss of hearing, vertigo, and nystagmus; cerebellar lesions producing ataxia of limbs and gait; V, VII, and occasionally IX and XII nerve lesions; brainstem symptoms and signs of increased intracranial pressure
Adapted from: Bingas B. Tumors of the base of the skull. In: Handbook of Clinical Neurology: Tumors of the Brain and Skull, Vinken PJ, Bruyn GW (Eds), Amsterdam, North Holland 1974. Vol 17, p.136.
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