title: Neo-adjuvant chemotherapy followed by surgery for extensive calvarial metastases of a neuroblastoma.
abstract: Neuroblastoma is a common tumor of children. We report a patient with extensive calvarial metastases of a neuroblastoma as an initial presentation. A 2-year-old girl presented with a history of gradually increasing head size and fever. A brain CT showed a multilobulated, large, extra-axial tumor involving both frontotemporoparietal areas with a sunray-spiculated hyperostosis of the skull and marked contrast enhancement. A brain MRI demonstrated extensive calvarial lesions with simultaneous involvement of the orbits. A biopsy was performed and a ganglioneuroblastoma was diagnosed. On systemic evaluation, an enlarged abdominal mass was detected. After neo-adjuvant chemotherapy, most of the tumors disappeared except for a tumor in the left parietal area; there was a corresponding decrease in the circumference of the head. We performed surgery for the remnant mass. Intensive chemotherapy was administered and a bone marrow transplantation was performed. Adequate neo-adjuvant chemotherapy followed by surgery to the neuroblatoma with extensive metastases to the skull and orbit may be helpful.
authors.affiliation: Department of Neurosurgery, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hwasun Hospital & Medical School, Gwangju, Korea.
authors.forename: Sang-Deok
authors.initials: SD
authors.lastname: Kim
authors.forename: Tae-Young
authors.initials: TY
authors.lastname: Jung
authors.forename: Shin
authors.initials: S
authors.lastname: Jung
authors.forename: Hee-Jo
authors.initials: HJ
authors.lastname: Baek