A Young Adolescent Case of Secondary Skull Neuroblastoma presenting with Intracranial Hypertension

Abstract

Neuroblastoma presenting after the infantile is rare. Ordinarily the skull tumor is initially found as the scalp mass before the intracranial symptoms. We report a young adolescent case of secondary skull neuroblastoma presenting with the intracranial hypertension before forming the scalp mass. A 15-year-old boy was admitted complaining of headache and diplopia. On admission, he had bilateral abducens nerve palsies and papilledema. CT scans and MR images showed the multiple epidural and subperiosteal masses with the contrast enhancement. Cerebral angiograms revealed the occipital epidural mass compressing the superior sagittal sinus. After admission, these multiple masses were enlarged progressively and his neurological symptoms got worse. The largest tumor on the right parietal region were removed. They developed out of the bone into the epidural and subperiosteal spaces but not infiltrating over the adjacent sutural edge, periosteum and dura mater. The histological diagnosis was neuroblastoma. Later a small primary focus was revealed in the retroperitoneum. The skull tumor involving the multiple epidural spaces, compressing the brain substance and the venous sinus, can initially produce the clinical evidence of the intracranial hypertension before forming the scalp mass. Neuroblastoma should be considered as multiple skull tumors in adolescence.