Dr. Oana Irina Popa, MD, ENT Resident1, Assist. Prof. Dr. Mihaela

RARE SKULL BASE BENIGN TUMORS
Dr. Oana Irina Popa, MD, ENT Resident , Assist. Prof. Dr. Mihaela Cristiana Tatu, MD, PhD, ENT Specialist , Dr. Maria Galaman, MD, Radiologist Specialist
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Central University Military Emergency Hospital Bucharest, ENT Clinic, 2Central University Military Emergency Hospital Bucharest, Imaging Clinic
Introduction
Many different tumor types originate from or extend to the base of the skull,
which is the sloped area behind the eyes and nasal cavities that forms the
“floor,” or base of the skull. The spinal cord, multiple nerves and the major
blood vessels of the brain and head and neck pass through holes (foramina)
in the skull base.
Aside the skull base malignant tumors, there are benign tumors that can
cause symptoms or threaten the health and well-being of the patient.
Objectives
Through this presentation we would like to highlight how benign skull base
tumors may have malignant evolution.
Case Presentation
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We present a rare case of an old male patient (73 years) with benign tumor
of the skull without significant clinical symptoms.
The patient accused mild hipoacusia and later a stuffy feeling in the right
ear. Upon repeated ENT examination tympanic membrane remained normal,
and also audiological testing (audiogram, tympanogram) showed no modification. Afterwards unilateral serous otitis media occurred during an episode
of acute viral rhinopharyngitis and persisted in spite of therapy.
Head CT scan revealed a tumor mass in the skull base.
Myringotomy with tube insertion and nasopharyngeal cavum biopsy was
performed - salivary gland pleomorphic adenoma of the right parapharyngeal space, with under 1% proliferation index, with no histological sign of
malignancy.
Contrast MRI was performed for better evaluation and showed the tumor
mass in the right parapharyngeal and masticator space with intracranial extension through the foramen ovale and carotid canal, of 42/34/55 cm, eroding
the right clivus and right temporal bone pyramid, no lymphadenopathy.
There is no protocol established for such cases. An ENT and oncology commission was formed and decided that radiotherapy is best in this case (localization, extension, histological form of the tumor and clinical signs – chronic
serous otitis media and mild cranial neuralgias).
ENT examination prior to radiotherapy showed slight swell of the right nasopharyngeal wall.
External conformational Al Primus radiotherapy was performed: total dose
43,2 Gy, 32 days, 24 fractions.
Imaging reevaluation
after 4 weeks – reduction of the tumor mass 34/34/36 cm, with small neck
lymphadenopathies
At 14 months the patient develops horizontal diplopia, Gradenigo syndrome
with trigeminal neuralgia, 6th nerve paresis caused by lesions of the petrous
apex. Contrast MRI shows VI nerve compression.
after ten weeks 25/15/26 cm.
Gamma knife radiosurgery is considered the best option.
Results
After the procedure diplopia persists (one month after). The patient remains
under observation.
Conclusions
one year after the tumor remained at the same dimensions.
Because of their location and proximity to other vital structures, skull base
tumors present unique challenges for surgeons.
The area is hardly accessible to surgery but recent advances in diagnostic and treatment techniques provided new treatment opportunities for these
patients.
References
Johns ME, Kaplan MJ: Surgical approaches to the anterior skull base. Ear Nose Throat
Castro JR, Linstadt DE, Bahary JP, et al: Experience in charged particle irradiation of tumors of the skull base: 1977-1992.
Keisch ME, Garcia DM, Shibuya RB: Radiation oncology: Retrospective long-term follow-up analysis in 21 patients with chordomas of
various sites treated at a single institution. J Neurosurg
Kondziolka D, Lunsford LD, Flickinger JC: The role of radiosurgery in the management of chordoma and chondrosarcoma of the cranial
base. Neurosurgery
Dreyfuss Al, Clark JR, Fallon BG, Posner MR, Norris CM Jr, Miller: Cyclophosphamide, doxorubicin, and cisplatin combination
chemotherapy for advanced carcinomas of salivary gland origin.