Bony calvarial and skull base tumors: Pandora's box

The calvaria or skull vault, in general, has a limited spectrum of oncological disorders which are both unique to it and ubiquitous throughout the body. Lesions of the calvarium may originate from the bony structures or may be secondary to an invasion of scalp-based lesions or brain-based lesions into the skull vault.A PubMed/Medline search was conducted using the MESH keywords “Calvarial tumors”, “Bony tumors”, “Skull base bony lesions” and all reported cases and series were collected, and relevant details extracted from the same. Data were extracted concerning the type of study, the number of cases, follow-up duration, the primary treatment offered, details of adjuvant therapy, overall survival, and recurrence rates where relevant. All data were then tabulated and reviewed. Cases showing relevant information on treatment modalities and their effect on outcomes and survival were only included. A total of 1020 results were found on the PubMed database (until March 2021) and after duplicates removal, a total of 9 studies were found to be relevant for calvarial tumors with 1 case series and 4 retrospective reviews of intraosseous meningiomas which included 2 review papers as well. Most of these results were either retrospective case series or case reports along with a single systematic review of intraosseous meningioma. The primary treatment modality in almost all cases was either surgery or biopsy followed by adjuvant radiotherapy. The skull base and cranial vault is a Pandora's box of malignancies with varied shapes and appearances. Presentation is either due to pressure symptoms or swellings, and whenever accessible, complete excision offers the best management. Imaging findings are of germinal importance and help differentiate lesions, which often decides management. When in doubt, a biopsy may offer the best solution. Bony reconstruction and adjuvant therapy with close follow-up often decide prognosis.