A rare case of nasal glioma in the sphenoid sinus of an adult presenting with meningoencephalitis

Abstract

Nasal gliomas are rare embryologic development defects that commonly present shortly after birth. Very few cases have ever been reported in adults. Of those presenting in adult life, most were casual findings in patients with no symptoms. Rare localizations have been described in the nasopharynx, soft palate, orbital cave and scalp. We present an unusual case of a 56-year-old man who initially presented with meningoencephalitis and was found to have nasal glioma in the sphenoid sinus. Having discussed their embryology and histology, we conclude that MRI scanning is the preferred method of investigation. However, radiological evaluation preoperatively should not lead to any sense of security if no bony defect (and thus, the possibility of intracranial extension) is demonstrated. Extirpation via a functional surgical approach is the treatment of choice to prevent deformities in the facial bones. This can range from direct incision over the gliomata to removal transnasally by endoscopy or using a lateral rhinotomy approach depending on the location, size and involvement of the glioma.

Adult nasal gliomas

“…Diagnosis was usually made following an incidental finding of heterotrophic glial tissue after incisional biopsy of a nasal polyp. Other presentations were acute or recurrent meningitis, 13,16 meningoencephalitis, 21 and visual loss. 17,18 Histologically, nasal gliomas have no meningeal envelope, and are covered by skin or nasal respiratory mucosa.…”

“…However, radiographic reports do not always exclude a bony defect or an associated intracranial connection, as was the case in our experience and others. 12,16,21 The management of nasal gliomas in children is generally accepted as being surgical excision, in order to prevent the lesion from affecting developing facial structures or increasing the risk of meningitis. 29 Surgical excision is approached either endoscopically or via an external lateral rhinotomy and/or craniotomy if there is a significant intracranial connection.…”

“…[13][14][15][16][17][18][19][20][21][22][23][24][25][26] Most patients were asymptomatic, or had symptoms of nasal obstruction or clear rhinorrhoea. Diagnosis was usually made following an incidental finding of heterotrophic glial tissue after incisional biopsy of a nasal polyp.…”

Nasal Glioma: An Unusual Presentation in Adult

“…3,4 A lateral rhinotomy or endoscopic approach is recommended for surgical excision of nasal glioma without intracranial extension. 7 We describe a case in which extranasal glioma with intracranial extension was removed successfully by combined extracranial and endoscopic approach without craniotomy. In this report, management, especially the surgical procedures employed and the benefits of endoscopy, in cases with nasal glioma are discussed.…”

Endoscopic Management of a Rare Case of Nasal Glioma in Meckel's Cave in an Adult: Case Report

“…Nasal glioma is a rare developmental abnormality frequently symptomatic in children with no malignant potential [1] . The occurrence of nasal glioma in an adult is very rare [2,3] . Although nasal gliomas have been described in locations such as the nasopharynx, soft palate, sphenoid sinus, orbital cave and scalp [2 -4] , a nasal glioma of Meckel ' s cave has not yet been reported in the literature, especially in an adult.…”