Surgical Decompression of Skull Base and Orbital Prostate Metastasis

Background: Prostate cancer is the most frequently diagnosed cancer in men, and hormonal therapy has limitations, with prostate cancer cells becoming resistant after several years. Skull metastases from prostate are rare (around 6%), and even less frequent in the skull base.

Case Report: A 57-year-old man with history of prostate cancer had a minor head injury 2 months prior to our evaluation, was admitted to an outside institution and diagnosed with a right-sided subdural hematoma based on brain CT scan. The patient was managed with observation only and developed progressive visual loss for a week (right > left). He was found with bilateral papilledema. The brain MRI showed an extra-axial subdural mass with bone involvement and orbit extension. The patient underwent a right frontotemporal craniotomy with orbital decompression and exploration. He later underwent radiation treatment with 3750 cGy in 15 fractions with four fields prescribed to 95% IDL.

Conclusion: Prostate cancer frequently causes metastases to bone, but uncommonly to skull and the skull base. Any neurological symptoms or cranial nerve deficits in a patient with history of prostate cancer will require further workup for prostate metastasis, given the fact that early detection can improve medical and surgical treatment, as well as provide functional recovery.