Giant Tumor of the Anterior Cranial Fossa with Extensive Nasosinusal Invasion
Keywords:
olfactory groove meningioma; sinonasal malignancies; sinonasal invasion; extended endoscopic endonasal transcriptiform approach; supraorbital endoscopic keyhole; diagnostic mimicry.Abstract
ABSTRACT
Introduction: Tumors that invade the sinonasal compartments and anterior cranial fossa simultaneously pose a diagnostic and therapeutic challenge.
Objective: To analyze the diagnostic elements and treatment options for a rare case of a tumor that invades the sinonasal compartment and the anterior cranial fossa simultaneously.
Case presentation: A 39-year-old female patient presented with progressive loss of olfactory function, nasal obstruction, and recurrent epistaxis. Magnetic resonance imaging (MRI) of the head revealed a tumor involving the anterior cranial base, cribriform plate, and right nasal cavity, with initial suspicion of a sinonasal tumor with intracranial invasion. Initial surgical management was performed using an Extended Endonasal Transcribriform Approach with resection of 80% of the lesion. Intraoperative frozen-cell biopsy revealed a grade I meningioma, negative for malignancy. Postoperative recovery was uneventful, with complete resolution of nasal obstruction and epistaxis, maintaining only the preoperative anosmia. Six months later, the remaining tumor was treated using a supraorbital endoscopic keyhole approach, achieving a macroscopically complete resection. Twelve months later, the patient was asymptomatic (except for the preoperative anosmia) with no evidence of recurrence on follow-up MRI.
Conclusions: This case highlighted the diagnostic challenges of olfactory groove meningiomas with sinonasal extension, which can mimic aggressive malignancies due to overlapping symptoms and imaging findings. Staged endoscopic approaches facilitated symptom resolution and a macroscopically complete resection of the lesion.
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