TOPIC ARTICLE Common and unusual craniofacial manifestations of metastatic neuroblastoma Nicholas D’Ambrosio & John Lyo & Robert Young & Sophia Haque & Sasan Karimi Received: 10 December 2009 / Accepted: 29 March 2010 / Published online: 4 May 2010 # Springer-Verlag 2010 Abstract Although neuroblastoma is a common childhood malignancy, which frequently metastasizes, involvement of the facial bones and paranasal sinuses are uncommonly reported in the literature. However, over the last several years, we have encountered an increasing number of cases of metastatic neuroblastoma to the central nervous system and head and neck. This article will review the common and uncommon imaging manifestations of metastatic neuro- blastoma, with emphasis on the orbits, maxillofacial bones, and paranasal sinuses. Keywords Metastatic neuroblastoma . Head and neck . Orbital metastases Introduction Secondary craniocerebral neuroblastoma is manifested most often as osseous metastases involving the calvarium, orbit, or skull base [1]. Except in infants, in whom the liver is involved more frequently than the skeleton, bone is the most frequent site of metastases in patients with dissemi- nated neuroblastoma. Neuroblastoma is usually a secondary metastatic lesion rather than a primary lesion of the head and neck [2]. The differential diagnosis for rapidly progressive facial swelling in association with cranial nerve deficits should include rhabdomyosarcoma, Langerhans cell histiocytosis, Ewing sarcoma, osteogenic sarcoma, and metastatic neuro- blastoma [3, 4]. It is known that neuroblastoma embryologically develops from the neural crest, an ectodermal tissue with pluri- potential differentiating capability. It is postulated that tissues derived from the neural crest may provide the appropriate “soil” to support metastasizing tumors, such as neuroblasto- ma. This theory may explain the remarkable tendency for neuroblastoma to involve the facial bones and parts of the cranium, which are also derived from the neural crest [5]. Materials and methods We retrospectively reviewed neuroimaging of 90 neuro- blastoma patients presented at neuro-oncology tumor board rounds over the past 3 years at Memorial Sloan Kettering Cancer Center. This series of patients does not represent the entire population of neuroblastoma patients treated at our institution but represents a more selected subset of patients with central nervous system manifestations. The majority of these patients demonstrated primary or metastatic neuro- blastoma, confined to the spinal canal and paraspinal regions. These particular manifestations of the disease will not be emphasized in this review. Instead, this article will focus on the unusual manifestations of metastatic neuro- blastoma involving the craniofacial bones. Orbits Metastatic involvement of the bony orbit has been found in up to 25% of cases and is one of the most frequent clinical forms, a presentation that often precedes direct evidence of N. D’Ambrosio (*) : J. Lyo : R. Young : S. Haque : S. Karimi Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA e-mail: dambrosn@hotmail.com N. D’Ambrosio Department of Radiology, Crouse Hospital, Syracuse, NY 13210, USA Neuroradiology (2010) 52:549–553 DOI 10.1007/s00234-010-0697-2