title: Metastatic Liposarcoma of the Skull Base: A Case Report and Review of Literature.
abstract: Myxoid liposarcoma is not an uncommon form of sarcoma. However, it usually affects the lower extremity long bones. Scapular involvement is extremely rare, as is a metastasis to the parasellar region. We present a case of liposarcoma of the skull base originating in the scapular region and metastasizing to the sellar and parasellar regions and provide a review of the pertinent literature.
  
  
  
  A 43-year-old female patient diagnosed with left scapular myxoid liposarcoma was treated with surgical resection. She had clear resection margins and was treated pre- and postoperatively with radiotherapy to the region. She remained asymptomatic for 2 years following surgery, after which she abruptly developed diplopia with right lateral gaze. There were no symptoms of raised intracranial pressure or impaired vision. Her examination was normal apart from complete right sixth nerve palsy. Imaging studies of the brain showed a large mass in the clivus eroding into the floor of the sella, encircling the right internal carotid artery in the cavernous sinus. The mass also displaced the sellar contents superiorly. An endonasal, endoscopic skull base approach was undertaken, and a subtotal resection was performed in an effort to avoid multiple cranial nerve pareses.
  
  
  
  Our literature search revealed that this case report is the first to document liposarcoma metastasis to the skull base originating from the scapular region. Subtotal surgical resection resulted in minimal improvement of the patient's sixth nerve palsy. Postoperative radiation was undertaken. A multidisciplinary approach on an individual patient basis is recommended.
authors.affiliation: Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Nirmeen
authors.initials: N
authors.lastname: Zagzoog
authors.affiliation: Mount Sinai Hospital Centre for Inflammatory Bowel Disease, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Greta
authors.initials: G
authors.lastname: Ra
authors.affiliation: Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Alex
authors.initials: A
authors.lastname: Koziarz
authors.affiliation: Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Provias
authors.affiliation: Division of Otolaryngology Head and Neck Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Doron
authors.initials: D
authors.lastname: Sommer
authors.affiliation: Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Saleh A
authors.initials: SA
authors.lastname: Almenawer
authors.affiliation: Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Kesava
authors.initials: K
authors.lastname: Reddy
mesh_terms: D000328:Adult; D001859:Bone Neoplasms / Q000473:pathology / Q000601:surgery*; D003388:Cranial Fossa, Posterior / Q000601:surgery; D005260:Female; D006801:Humans; D008080:Liposarcoma / Q000556:secondary / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D012540:Scapula / Q000473:pathology / Q000601:surgery*; D019292:Skull Base Neoplasms / Q000556:secondary / Q000601:surgery*; D016896:Treatment Outcome
keywords: Brain; Liposarcoma; Metastases; Myxoid; Parasellar; Skull base