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Wu J, Deng P, Qian J, Lu Y, Ding Z, Hu X, Gong Y, Tang X, Ma M. Endoscopic endonasal transsphenoidal surgery for unusual sellar lesions: eight cases and review of the literature. Front Neurol 2024; 15:1309691. [PMID: 38414554 PMCID: PMC10896968 DOI: 10.3389/fneur.2024.1309691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 01/26/2024] [Indexed: 02/29/2024] Open
Abstract
Background Preoperative imaging for some unusual lesions in the sellar region can pose challenges in establishing a definitive diagnosis, impacting treatment strategies. Methods This study is a retrospective analysis of eight cases involving unusual sellar region lesions, all treated with endoscopic endonasal transsphenoidal surgery (EETS). We present the clinical, endocrine, and radiological characteristics, along with the outcomes of these cases. Results Among the eight cases, the lesions were identified as follows: Solitary fibrous tumor (SFT) in one case, Lymphocytic hypophysitis (LYH) in one case, Cavernous sinus hemangiomas (CSH) in one case, Ossifying fibroma (OF) in two cases; Sphenoid sinus mucocele (SSM) in one case, Pituitary abscess (PA) in two cases. All patients underwent successful EETS, and their diagnoses were confirmed through pathological examination. Postoperatively, all patients had uneventful recoveries without occurrences of diabetes insipidus or visual impairment. Conclusion Our study retrospectively analyzed eight unusual lesions of the sellar region. Some lesions exhibit specific imaging characteristics and clinical details that can aid in preoperative diagnosis and inform treatment strategies for these unusual sellar diseases.
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Affiliation(s)
- Jiandong Wu
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Peng Deng
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Jinhong Qian
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Yanli Lu
- Department of Radiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Zhiliang Ding
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Xiaolong Hu
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Yuhui Gong
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Xiaoyu Tang
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Mian Ma
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
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Wang Y, Du J, Jiang Z, Meng J. Transformation of Cemento-Ossifying Fibroma into Osteosarcoma after Radiotherapy and Nine Endoscopic Surgeries. EAR, NOSE & THROAT JOURNAL 2023; 102:24-27. [PMID: 35575211 DOI: 10.1177/01455613221101944] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Cemento-ossifying fibromas (COFs) are benign fibro-osseous tumors usually found in the mandible and maxilla that can show malignancy in rare situations. COFs usually grow slowly and asymptomatically until they produce local bulges, pain, headaches, and visual impairment, and have a Ki-67 index within 3%, even in aggressive and recurrent cases. Surgical resection can usually provide a satisfactory prognosis. However, no cases of COF transforming into osteosarcoma have been reported. We present a case of COF involving a 58-year-old woman whose initial symptom was hearing loss in the right ear accompanied by tinnitus. Enhanced magnetic resonance imaging revealed a 3.1 cm x 3.2 cm mass centered on the right pterygoid process of the sphenoid bone. Postoperative pathology revealed a COF with a high Ki-67 index (8%-10%). Over the next two years, the tumor relapsed repeatedly. The patient underwent nine endoscopic surgeries and radiotherapy. The sixth postoperative biopsy showed that the COF had transformed into an osteosarcoma. The patient subsequently experienced respiratory and cardiac arrests and was receiving treatment in the intensive care unit with a poor prognosis at the time of writing this manuscript. Thus, a high Ki-67 index may be a risk factor for malignant transformation for COFs.
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Affiliation(s)
- Yang Wang
- Department of Oto-Rhino-Laryngology, West China Hospital, 34753Sichuan University, Chengdu, China
| | - Jintao Du
- Department of Oto-Rhino-Laryngology, West China Hospital, 34753Sichuan University, Chengdu, China
| | - Zihan Jiang
- Department of Oto-Rhino-Laryngology, West China Hospital, 34753Sichuan University, Chengdu, China
| | - Juan Meng
- Department of Oto-Rhino-Laryngology, West China Hospital, 34753Sichuan University, Chengdu, China
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Eswaran S, Djeamoorthy U, Saravanam PK. Endoscopic Transnasal Management of Giant Paediatric Sinonasal Ossifying Fibroma. Indian J Otolaryngol Head Neck Surg 2022; 74:1479-1482. [PMID: 36452801 PMCID: PMC9702491 DOI: 10.1007/s12070-021-02607-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/03/2021] [Indexed: 10/21/2022] Open
Abstract
The ossifying fibroma is a rare fibro-osseous benign lesion of bone in the head and neck region. The mandible is the most common site reported followed by maxilla and other bones of the skull. A paediatric male presented with protrusion of the right eyeball for one-month duration. Further evaluation by diagnostic nasal endoscopy revealed a smooth mass confined to the superior and middle meatus on the right side. Computed tomography of paranasal sinus showed a large heterogenous bony lesion involving the ethmoid and sphenoid sinus and extending laterally into the orbit and superiorly into anterior skull base. Endoscopic biopsy was suggestive of ossifying fibroma. Transnasal endoscopic excision of the lesion was done and the patient is currently on follow-up. This case is reported for the rarity of presentation and the difficulties in management.
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Affiliation(s)
- Sudhagar Eswaran
- Department of ENT, Head and Neck Surgery, Sri Ramchandra Institute of Higher Education and Research, Chennai, India
| | - Usha Djeamoorthy
- Department of ENT, Head and Neck Surgery, Sri Ramchandra Institute of Higher Education and Research, Chennai, India
| | - Prasanna Kumar Saravanam
- Department of ENT, Head and Neck Surgery, Sri Ramchandra Institute of Higher Education and Research, Chennai, India
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Pediatric Benign Fibro-Osseous Lesions of the Nose and Paranasal Sinuses: A Tertiary Hospital Experience. Int J Otolaryngol 2022; 2022:1608015. [PMID: 36060197 PMCID: PMC9436620 DOI: 10.1155/2022/1608015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 08/01/2022] [Indexed: 12/02/2022] Open
Abstract
Background Pediatric benign fibro-osseous lesions of the nose and paranasal sinuses are considered rare neoplastic entities. These fibro-osseous lesions are difficult to accomplish owing to the multifaceted anatomy of the skull base in addition to the closeness to neurovascular configurations. Objective The study aimed to study different clinical presentations, radiological manifestations, surgical management, and consequences of different benign fibro-osseous lesions in the pediatric age groups. Methods and Settings. This is a case series study of a single-center experience. Results Four different cases were presented and discussed (osteoma, fibrous dysplasia, and ossifying fibroma. Conclusion We reported four different cases of osteoma, ossifying fibroma, and fibrous dysplasia. All of these cases were managed endoscopically with no postoperative complications. Endoscopic management is considered highly effective with reduced morbidity. Preoperative radiographic studies are highly essential for diagnosis and operative planning.
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Endoscopic Resection of a Massive Ossifying Fibroma in the Sinonasal Cavity. J Craniofac Surg 2021; 32:1800-1802. [PMID: 33534305 DOI: 10.1097/scs.0000000000007504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT An ossifying fibroma (OF) is a type of benign fibro-osteoma that rarely involves the sinonasal cavity. Recent developments in endoscopic sinus surgery allow the removal of large benign tumors from the nasal cavity and sinuses. Here, the athors report the case of a 48-year-old female who underwent endoscopic sinus surgery under general anesthesia to completely remove a large OF involving the sphenoid sinus and nasal cavity. No recurrence was noted during the recent 3-year follow-up. Endoscopic resection of OFs is an excellent choice for very experienced surgeons, affording the advantages of direct observation as well as visual enhancement and magnification, thus reducing intra- and post-operative morbidity.
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Kim M, Otten M, Kazim M, Gudis DA. Frontal osteoplastic flap without frontal sinus obliteration for orbital roof decompression. Orbit 2020; 40:145-149. [PMID: 32340509 DOI: 10.1080/01676830.2020.1757126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: We describe a novel surgical approach for bilateral orbital roof decompression using a frontal osteoplastic flap without frontal sinus obliteration. This technique utilizes a combined external and endonasal endoscopic approach for wide exposure to the orbital roof bilaterally. We demonstrate this technique for the resection of a massive frontal fibrous dysplasia lesion in a healthy male with bilateral orbital roof involvement. The endonasal endoscopic portion of the technique includes a Draf III frontal sinusotomy (endoscopic modified Lothrop procedure) which precludes the need for frontal sinus obliteration, restores normal frontal sinus function, and allows for postoperative endoscopic surveillance. Methods: Report of novel surgical technique with video demonstration. Results: This technique for orbital roof decompression allows for removal of a frontal lesion, wide decompression of the bilateral orbital roof, and post-operative endonasal endoscopic surveillance of the cavity. The patient in whom we demonstrate this technique had complete resolution of his orbital symptoms and minimal residual fibrous dysplasia postoperatively. Conclusion: Bilateral orbital roof decompression for frontal lesions can be performed safely and effectively with a frontal osteoplastic flap without frontal sinus obliteration, restoring normal orbital and sinus function.
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Affiliation(s)
- Matthew Kim
- Division of Rhinology and Anterior Skull Base Surgery, Department of Otolaryngology - Head and Neck Surgery, Columbia University Irving Medical Center , New York, New York, USA.,NewYork-Presbyterian Hospital , New York, New York, USA
| | - Marc Otten
- Department of Neurological Surgery, The Neurological Institute of New York, Columbia University Irving Medical Center , New York, New York, USA.,NewYork-Presbyterian Hospital , New York, New York, USA
| | - Michael Kazim
- Oculoplastic and Orbital Surgery, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center , New York, New York, USA.,NewYork-Presbyterian Hospital , New York, New York, USA
| | - David A Gudis
- Division of Rhinology and Anterior Skull Base Surgery, Department of Otolaryngology - Head and Neck Surgery, Columbia University Irving Medical Center , New York, New York, USA.,NewYork-Presbyterian Hospital , New York, New York, USA
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Ta NH, Addison A, Beigi B, Philpott C. Unilateral visual loss resulting from orbital encroachment of an ethmoidal juvenile trabecular ossifying fibroma. Ann R Coll Surg Engl 2019; 101:e111-e114. [PMID: 30854866 DOI: 10.1308/rcsann.2019.0030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Ossifying fibromas are mainly found in the mandible and maxilla. Reports of them arising in the ethmoid sinuses and orbits are rare. We present a case of an otherwise healthy 20-year-old man with gradual onset of right visual disturbance signified by right relative afferent pupillary defect due to a large unilateral ossifying fibroma arising from the ethmoid sinus compressing the medial half of the right orbit. We emphasise the multidisciplinary combined endoscopic endonasal and external approach to ensure a successful debulking of the fibroma.
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Affiliation(s)
- N H Ta
- Norwich Medical School, University of East Anglia , Norwich , UK
| | - A Addison
- Ear, Nose and Throat Department, James Paget University Hospital , Great Yamouth , UK
| | - B Beigi
- Ophthalmology Department, Norfolk and Norwich University Hospitals NHS Foundation , Norwich , UK
| | - C Philpott
- Norwich Medical School, University of East Anglia , Norwich , UK
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Wu Z, Xing Y, Liu X, Chen W, Kong J, Wu R, Zhang L. Surgical correction of residual facial deformity following conservative excision of a giant maxillary ossifying fibroma: A case report. Medicine (Baltimore) 2018; 97:e13186. [PMID: 30461617 PMCID: PMC6393081 DOI: 10.1097/md.0000000000013186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Ossifying fibroma (OF) is a benign fibro-osseous lesion that can develop in the oral and maxillofacial region. OF is more common in females and has a marked predilection for the mandible, occurring rarely in the maxilla. Lesions grow slowly and are usually asymptomatic until growth produces an obvious swelling, pain, paresthesia, and facial deformity. With low rates of recurrence, treatment is usually curettage or resection. Very large lesions that invade other organs and that cannot be completely removed should be excised conservatively. PATIENT CONCERNS We present a case of a 46-year-old female with a very large fibro-osseous lesion arising from the maxilla who was more concerned about the facial appearance and requested conservative treatment for economic reasons. DIAGNOSES The pathological results based on conservative excision of the lesion confirmed the diagnosis of OF. INTERVENTIONS We chose conservative excision via the Weber-Ferguson approach and followed up every 6 months. Facial deformity correction was performed 2 years postoperatively and right lower eyelid ectropion correction 3 years after the primary excision. OUTCOMES The ectropion deformity in the right lower eyelid improved dramatically with a better facial appearance and no obvious swelling. LESSONS Treatment programs for OF should be individualized based on the size, growth rate, invasion, and interference with facial function and esthetics. If lesions grow slowly, we suppose that it is feasible to excise conservatively when reconstruction cannot be performed due to esthetic and functional problems. Also regular postoperative follow-up is necessary to detect recurrence, and to improve facial appearance as required.
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Affiliation(s)
- Zhuoxia Wu
- Department of Plastic and Reconstructive Surgery
| | - Yunlong Xing
- Department of Plastic and Reconstructive Surgery
| | - Xin Liu
- Department of Stomatology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Wanying Chen
- Department of Plastic and Reconstructive Surgery
| | - Jiao Kong
- Department of Plastic and Reconstructive Surgery
| | - Ronghui Wu
- Department of Plastic and Reconstructive Surgery
| | - Lianbo Zhang
- Department of Plastic and Reconstructive Surgery
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