Extracranial spheno-ethmoidal sinus meningioma: case report

Abstract

Extracranial meningiomas of the paranasal sinus are the rare tumors of unclear etiology. We report a case of primary extracranial meningioma arising from the roof of the sphenoid sinus.A 60-year-old female presented with 5-month history of right visual disturbance. Imaging studies showed a mass in the sphenoid sinus extending into posterior ethmoid sinus. The tumor was resected completely including the affected bone of anterior cranial base via the endonasal endoscopic approach. Pathological diagnosis was meningothelial meningioma.On the basis of imaging features and intraoperative findings, the tumor was diagnosed as primary extracranial meningioma of the sphenoethmoid sinus. Recent advancement of skull base surgery technique allows removing this rare tumor completely and safely without complications such as cerebrospinal fluid leakage. This is the first report of the management of spheno-ethmoid sinus meningioma with the skull base surgery technique. KEywoRds: Extracranial meningioma, Sphenoid sinus, Ethmoid sinus, Skull base surgery, Endoscopic surgery ÖZParanazal sinüslerin ekstrakraniyal menenjiyomları, etiyolojisi belirsiz nadir tümörlerdir. Sfenoid sinüs çatısından kaynaklanan bir primer ekstrakraniyal menenjiyom olgusunu sunuyoruz. 60 yaşındaki kadın hasta 5 aydır sağ tarafta görme rahatsızlığı ile başvurdu. Görüntüleme çalışmaları sfenoid sinüste posterior etmoid sinüse uzanan bir kitle saptadı. Tümör endonazal endoskopik yaklaşımla anterior kraniyal tabanın etkilenen kemiği dahil tamamen çıkartıldı. Patolojik tanı meningotelyal menenjiyomdu.Görüntüleme özellikleri ve ameliyat bulgularına dayanarak, tümöre sfeno-etmoid sinüs primer ekstrakraniyal menenjiyomu tanısı konuldu. Kafa tabanı cerrahisi tekniklerindeki güncel gelişmeler bu nadir tümörün beyin omurilik sıvısı kaçağı gibi komplikasyonlar olmadan, tamamen ve güvenle çıkarılmasını sağlamaktadır. Bu makale kafa tabanı cerrahisi tekniği ile sfeno-etmoid sinüs menenjiyomu tedavisinin ilk bildirimidir.

Primary Extracranial Meningiomas of the Sinonasal Tract: A Systematic Review

“…Only a few patients received radiotherapy (5.7%). The median duration of clinical follow-up was 12 months (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). We observed that PEMs have low recurrence (8.5%, n ¼ 5/59; Cases 13, 27, 49, 55, 57) with the median time from surgical resection to recurrence at 24 months (13-36).…”

“…Majority were positive for S100 (68.8%, n ¼ 11), whereas none were positive for CD34 (n ¼ 0). All cases that tested for Ki-67 (n ¼ 9) were positive with varying labelling indexes ranging from 1 to 20%, [13][14][15][16][17][18][19][20][21] with majority of cases with labelling index of <5%.…”

Extracranial Nasosinusal Meningioma: A Case Report of a Rare Entity

“…Among all cases of meningiomas with extracranial localization involving the nasosinusal tract, the paranasal region has the tendency to be affected in more than one sinus [ 4 ]. The endoscopic endonasal approach represents the gold standard in the treatment of extracranial nasosinusal meningioma for its many benefits: direct and wide vision of the surgical field, multi-angled visualization, and scar-less surgery with minimal invasiveness.…”

“…The endoscopic endonasal approach represents the gold standard in the treatment of extracranial nasosinusal meningioma for its many benefits: direct and wide vision of the surgical field, multi-angled visualization, and scar-less surgery with minimal invasiveness. In particular, considering the necessity to remove the attachments, a close-up visualization improves the macroscopic radicality [ 4 ].…”

“…Extracranial Meningiomas (EMs) are very rare, with a incidence of less than 2% [ 3 ]. In particular, among the extracranial localizations, the nasosinusal tract is involved in only 24% of cases [ 4 ]. Commonly, meningiomas do not have a tendency to infiltrate the surrounding structures but have a slow expansive evolution [ 5 ].…”