{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:45:18Z","timestamp":1791852318862,"version":"4.3.4"},"reference-count":10,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec id=\"st1\">\n<jats:title>Background: <\/jats:title>\n<jats:p>Hepatocellular carcinoma (HCC) is a common malignant tumor with a 5-year survival rate of 10%, presenting with extrahepatic metastases in 15\u201317% of patients. HCC-bone metastases represent approximately one-quarter of all HCC metastases, most frequently in the spine, pelvis, ribs, or femur. HCC-skull metastases, however, make up 0.4\u20131.6% of all HCC- bone metastases. Furthermore, solitary HCC-skull metastasis without known active primary HCC is an unusual presentation warranting further review and consideration.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st2\">\n<jats:title>Case Description: <\/jats:title>\n<jats:p>Here, the authors report a unique case of a solitary HCC-skull metastasis in a patient without known active cancer but in long-term remission for HCC. The patient is a 69-year-old male with past HCC who presented with a nontender skull mass. A computed tomography scan showed a heterogeneously enhancing mass centered in the high left parietal bone with intracranial extension. There was a noted mass effect on the left posterior frontoparietal region without worrisome midline shift. Pathology ultimately revealed the mass to be metastatic HCC. To aid in the understanding and clinical management of this rare presentation, we reviewed the literature regarding clinical presentation, radiological features, pathology, and outcome.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st3\">\n<jats:title>Conclusion: <\/jats:title>\n<jats:p>Ultimately, early detection of the primary source of cancer is pivotal to successful treatment and prognosis, and skull lesions such as these must include HCC in the differential diagnosis.<\/jats:p>\n<\/jats:sec>","DOI":"10.25259\/sni_77_2023","type":"journal-article","created":{"date-parts":[[2023,7,21]],"date-time":"2023-07-21T07:51:54Z","timestamp":1689925914000},"page":"252","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Solitary metastasis to the skull as the first sign of hepatocellular carcinoma in a patient in long-term remission"],"prefix":"10.25259","volume":"14","author":[{"given":"Zachary","family":"Bernstein","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David Cory","family":"Adamson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10894","published-online":{"date-parts":[[2023,7,21]]},"reference":[{"key":"10.25259\/SNI_77_2023\/ref-1","doi-asserted-by":"crossref","first-page":"2333","DOI":"10.3892\/ol.2015.3569","article-title":"Hepatocellular carcinoma presenting as thoracic spinal canal metastasis with no clinical primary foci: A report of a rare case and review of the literature","volume":"10","author":"Chen","year":"2015","journal-title":"Oncol Lett"},{"key":"10.25259\/SNI_77_2023\/ref-2","first-page":"2897048","article-title":"Lesion in scalp and skull as the first manifestation of hepatocellular carcinoma","volume":"2016","author":"Ferraz","year":"2016","journal-title":"Case Rep Neurol Med"},{"key":"10.25259\/SNI_77_2023\/ref-3","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1007\/s00701-006-1071-3","article-title":"Skull metastasis from hepatocellular carcinoma","volume":"149","author":"Hsieh","year":"2007","journal-title":"Acta Neurochir (Wien)"},{"key":"10.25259\/SNI_77_2023\/ref-4","doi-asserted-by":"crossref","first-page":"681","DOI":"10.2147\/NDT.S58059","article-title":"Solitary skull metastasis as the first symptom of hepatocellular carcinoma: Case report and literature review","volume":"10","author":"Jiang","year":"2014","journal-title":"Neuropsychiatr Dis Treat"},{"key":"10.25259\/SNI_77_2023\/ref-5","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1002\/hep.29225","article-title":"Liver resection for hepatocellular carcinoma associated with hepatic vein invasion: A Japanese nationwide survey","volume":"66","author":"Kokudo","year":"2017","journal-title":"Hepatology"},{"key":"10.25259\/SNI_77_2023\/ref-6","first-page":"5945726","article-title":"Superior sagittal sinus tumor eroding through the skull: An unfamiliar presentation of hepatocellular carcinoma and literature review","volume":"2019","author":"Sadik","year":"2019","journal-title":"Case Rep Surg"},{"key":"10.25259\/SNI_77_2023\/ref-7","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1186\/1477-7819-6-66","article-title":"Solitary skull metastasis as initial manifestation of hepatocellular carcinoma","volume":"6","author":"Shim","year":"2008","journal-title":"World J Surg Oncol"},{"key":"10.25259\/SNI_77_2023\/ref-8","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/s13022-015-0013-2","article-title":"Solitary scalp metastasis-a rare presentation of hepatocellular carcinoma","volume":"9","author":"Subasinghe","year":"2015","journal-title":"Ann Surg Innov Res"},{"key":"10.25259\/SNI_77_2023\/ref-9","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/S0090-3019(03)00269-6","article-title":"Skull metastases: Clinical features, differential diagnosis, and review of the literature","volume":"60","author":"Stark","year":"2003","journal-title":"Surg Neurol"},{"key":"10.25259\/SNI_77_2023\/ref-10","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1007\/s12029-009-9081-z","article-title":"Isolated skull base metastasis as the first manifestation of hepatocellular carcinoma--a rare case report with review of literature","volume":"40","author":"Trivedi","year":"2009","journal-title":"J Gastrointest Cancer"}],"container-title":["Surgical Neurology 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