Distant metastasis of hepatocellular carcinoma to Meckel’s cave and cranial nerves: A case report and review of literature

Table 1 Laboratory data on admission

Parameters	Results	Parameters	Results
WBC	67 × 103/μL	ALP	422 IU/L
Hb	13.6 g/dL	γ-GTP	90 IU/L
Platelets	32.0 × 104/μL	NH3	163 μg/dL
PT	88.3%	HBsAg	(-)
TP	7.3 g/dL	HCVAb	(+)
ALB	3.6 g/dL	HCV RNA	(-)
T-bil	1.3 mg/dL	AFP	30332.7 ng/mL
AST	92 IU/L	PIVKA-II	1395 mAU/mL
ALT	172 IU/L

WBC: White blood cell; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; ALB: Albumin; TP: Total protein; PT: Pertussis toxin; AFP: Alpha-fetoprotein; HCV: Hepatitis C virus; HBsAg: Hepatitis B surface antigen; ALP: Alkaline phosphatase; γ-GTP: Gamma-glutamyl transpeptidase.

Table 2 Hepatocellular carcinoma cases of metastasis to the brain from literature

No	Age	Sex	Presenting symptoms	Site of metastasis	Survival (from the onset of symptoms)	Ref.
1	25	M	Headache and left weakness	Right temporoparietal brain	1 d	Chang and Chen[5], 1979
2	50	M	Weakness of right leg, focal seizure of right leg	Calvarium of the skull, dura, brain	3 mo	Chang and Chen[5], 1979
3	51	F	Epistaxis, ptosis, diplopia, facial weakness in the left side	Skull base	6 mo	Chang and Chen[5], 1979
4	64	M	Loss of vision in the left eye, anorexia, weight loss	Lateral aspect of the temporal fossa and in the anterior portion of the middle cranial cavity	3 mo	Zubler et al[7], 1981
5	59	M	Left arm weakness and numbness, headache with left weakness, disturbed consciousness	Brain parenchyma (right frontotemporal parietal) with intracranial haemorrhage	2 mo	Lee[8], 1992
6	58	F	Progressive enlarging scalp mass over vertex for 4 mo	Calvarium, dura, brain parenchyma	10 mo	Lee[8], 1992
7	48	F	Progressive enlarging scalp mass over the left parietal and right frontal region for 6 mo	Calvarium	8 mo	Lee[8], 1992
8	36	M	Progressive enlarging scalp mass in right occipital region for 2 mo	Calvarium	3 mo	Lee[8], 1992
9	60	M	Diplopia and proptosis for 2 mo. Ophthalmoplegia for 1 mo	Skull base (retrobulbar)	7 mo	Lee[8], 1992
10	54	M	Progressive dysarthria and atrophy of left tongue for 2 mo	Skull base (jugular fossa hypoglossal canal)	4 mo	Lee[8], 1992
11	47	M	Right hemicrania for 3 mo blurred vision with ptosis and limitation of eye movement (OD) numbness on the right forehead for one month	Skull base (parasellar)	6 mo	Lee[8], 1992
12	70	M	Left-sided weakness	Acute epidural hematoma adjacent to the right parietal bone	2 mo	Hayashi et al[9], 2000
13	58	F	Progressive weakness of her right leg, right hemianesthesia and weakness	Left parietal region, left high parietal area	6 mo	Lee and Lee[11], 1988
14	50	M	Hemiparesis and numbness of left upper arm, explosive headache and vomiting, disturbance of consciousness	Right frontotemporoparietal area	2 mo	Lee and Lee[11], 1988
15	65	M	Progressive painful right sided proptosis and ptosis, intermittent right temporal and facial pain, loss of sensation on the right side of the face	Right orbital apex	9 d	Phadke and Hughes[12], 1981
16	55	M	Mild right weakness	Left fronto-parietal cerebral hemisphere	11 d	Phadke and Hughes[12], 1981
17	50	F	Ptosis, diplopia, left abducens palsy	Clivus, cavernous sinus, petrous apex	Not described	Kim et al[13], 2006
18	40	M	Diplopia, retro-orbital headache, and occasional vomiting	Pituitary fossa, clivus, sphenoid sinus, and right petrous apex	3 mo	Aung et al[14], 2002
19	71	M	Headache, diplopia, ptosis of the right eye	Pituitary gland, optic chiasma, cavernous sinus	1 yr	Aung et al[14], 2002
20	67	M	Diplopia, left retro-orbital headache	Sphenoid sinus, pituitary gland, clivus	15 mo	Tamura et al[15], 2013
21	58	M	Headache, visual disturbance, general fatigue, diplopia, oculomotor nerve palsy	Pituitary fossa, cavernous sinus	3 wk	Tamura et al[15], 2013
22	73	F	Frontotemporal and left periorbital headache with associated photophobia	Left sphenoid sinus, cavernous sinus	Not described	Morais et al[16], 2018
23	82	F	Hyperalgesia of the right face and limited abduction of the right eye	Cavernous sinus, Meckel's cave, petrous bone	5.5 mo	Our case