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Expanded endonasal endoscopic approach for resection of a skull base low-grade smooth muscle neoplasm

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Abstract

Benign smooth muscle tumors rarely occur in the head and neck and, to the best of our knowledge, have not been reported in the pterygopalatine fossa. In this report, we describe a 15-year-old adolescent who presented with facial pain and was found to have a large skull base tumor centered in the pterygopalatine fossa. The patient underwent an expanded endonasal endoscopic approach for complete resection of this lesion with resolution of his symptoms. Pathology revealed a well-differentiated smooth muscle neoplasm consistent with a leiomyoma. This case adds to the growing body of literature supporting a role for endoscopic procedures in the treatment of skull base pathologies in pediatric patients.

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References

  1. Agarwal AK, Bansal R, Singhal D (2005) Sinonasal leiomyoma: report of 2 cases. Ear Nose Throat J 84(224):226–230

    Google Scholar 

  2. Arat YO, Font RL, Chaudhry IA, Boniuk M (2005) Leiomyoma of the orbit and periocular region: a clinicopathologic study of four cases. Ophthal Plast Reconstr Surg 21:16–22

    Article  PubMed  Google Scholar 

  3. Badoza D, Weil D, Zarate J (1999) Orbital leiomyoma: a case report. Ophthal Plast Reconstr Surg 15:460–462

    Article  PubMed  CAS  Google Scholar 

  4. Barr GD, More IA, McCallum HM (1990) Leiomyoma of the nasal septum. J Laryngol Otol 104:891–893

    Article  PubMed  CAS  Google Scholar 

  5. Batsakis JG (1979) Tumors of the head and neck, clinical and pathological considerations, 2nd ed. Williams and Wilkins, Baltimore. 354–356

  6. Belmont JR (1988) The Le Fort I osteotomy approach for nasopharyngeal and nasal fossa tumors. Arch Otolaryngol Head Neck Surg 114:751–754

    Article  PubMed  CAS  Google Scholar 

  7. Bloom DC, Finley JC Jr, Broberg TG, Cueva RA (2001) Leiomyoma of the nasal septum. Rhinology 39:233–235

    PubMed  CAS  Google Scholar 

  8. Browne JD, Jacob SL (2000) Temporal approach for resection of juvenile nasopharyngeal angiofibromas. Laryngoscope 110:1287–1293

    Article  PubMed  CAS  Google Scholar 

  9. Cavallo LM, Messina A, Gardner P, Esposito F, Kassam AB, Cappabianca P, de Divitiis E, Tschabitscher M (2005) Extended endoscopic endonasal approach to the pterygopalatine fossa: anatomical study and clinical considerations. Neurosurg Focus 19:E5

    PubMed  Google Scholar 

  10. Colnat-Coulbois S, Schmitt E, Klein O, Weinbreck N, Auque J, Civit T (2008) Angioleiomyoma of the cavernous sinus: case report. Neurosurgery 62:E257–E258, discussion E258

    Article  PubMed  Google Scholar 

  11. Crockett DJ (1963) Surgical approach to the back of maxilla. Br J Surg 50:819–821

    Article  PubMed  CAS  Google Scholar 

  12. Daisley H (1987) Leiomyoma of the nasal cavity. West Indian Med J 36:181–183

    PubMed  CAS  Google Scholar 

  13. de Divitiis E, Cappabianca P, Gangemi M, Cavallo LM (2000) The role of the endoscopic transsphenoidal approach in pediatric neurosurgery. Childs Nerv Syst 16:692–696

    Article  PubMed  Google Scholar 

  14. DelGaudio JM (2003) Endoscopic transnasal approach to the pterygopalatine fossa. Arch Otolaryngol Head Neck Surg 129:441–446

    Article  PubMed  Google Scholar 

  15. Duhig JT, Ayer JP (1959) Vascular leiomyoma. A study of sixty-one cases. Arch Pathol 68:424–430

    PubMed  CAS  Google Scholar 

  16. Farman AG (1975) Benign smooth muscle tumours. S Afr Med J 49:1333–1340

    PubMed  CAS  Google Scholar 

  17. Figueiredo EG, Gomes M, Vellutini E, Rosemberg S, Marino R Jr (2005) Angioleiomyoma of the cavernous sinus: case report. Neurosurgery 56:E411, discussion E411

    Article  PubMed  Google Scholar 

  18. Fu YS, Perzin KH (1975) Nonepithelial tumors of the nasal cavity, paranasal sinuses, and nasopharynx: a clinicopathologic study. IV. Smooth muscle tumors (leiomyoma, leiomyosarcoma). Cancer 35:1300–1308

    Article  PubMed  CAS  Google Scholar 

  19. Galassi E, Pasquini E, Frank G, Marucci G (2008) Combined endoscopy-assisted cranionasal approach for resection of infantile myofibromatosis of the ethmoid and anterior skull base. Case report. J Neurosurg Pediatr 2:58–62

    Article  PubMed  Google Scholar 

  20. Gallia GL, Ramanathan M, Jr., Blitz AM, Reh DD (2010) Expanded endonasal endoscopic approach for resection of a juvenile nasopharyngeal angiofibroma with skull base involvement. J Clin Neurosci 17: 1423–1427

    Google Scholar 

  21. Gil Z, Constantini S, Spektor S, Abergel A, Khafif A, Beni-Adani L, Leonor TL, DeRowe A, Fliss DM (2005) Skull base approaches in the pediatric population. Head Neck 27:682–689

    Article  PubMed  Google Scholar 

  22. Gil Z, Patel SG, Cantu G, Fliss DM, Kowalski LP, Singh B, Snyderman C, Kraus DH, Shah JP, Bridger PG, Cheesman AD, Donald P, Gullane P, Janecka I, Kamata SE, Levine PA, Medina LR, Pradhan S, Schramm V, Wei WI (2009) Outcome of craniofacial surgery in children and adolescents with malignant tumors involving the skull base: an international collaborative study. Head Neck 31:308–317

    Article  PubMed  Google Scholar 

  23. Gunduz K, Gunalp I, Erden E, Erekul S (2004) Orbital leiomyoma: report of a case and review of the literature. Surv Ophthalmol 49:237–242

    Article  PubMed  Google Scholar 

  24. Gurung U, Gurung B, Jha A (2009) Nasal leiomyoma. JNMA J Nepal Med Assoc 48:72–74

    PubMed  CAS  Google Scholar 

  25. Hanbali F, Tabrizi P, Lang FF, DeMonte F (2004) Tumors of the skull base in children and adolescents. J Neurosurg 100:169–178

    PubMed  Google Scholar 

  26. Harcourt JP, Gallimore AP (1993) Leiomyoma of the paranasal sinuses. J Laryngol Otol 107:740–741

    Article  PubMed  CAS  Google Scholar 

  27. Hirano A, Arakaki M, Nishida H, Hamada Y, Fujii T (1996) Hemifacial degloving approach to tumours in the infratemporal and pterygopalatine fossae: a preliminary report. J Craniomaxillofac Surg 24:285–288

    Article  PubMed  CAS  Google Scholar 

  28. Hofstetter CP, Singh A, Anand VK, Kacker A, Schwartz TH (2010) The endoscopic, endonasal, transmaxillary transpterygoid approach to the pterygopalatine fossa, infratemporal fossa, petrous apex, and the Meckel cave. J Neurosurg 113:967–974

    Article  PubMed  Google Scholar 

  29. Honeybul S, Neil-Dwyer G, Evans BT, Lang DA (1997) The transzygomatic approach: an anatomical study. Br J Oral Maxillofac Surg 35:334–340

    Article  PubMed  CAS  Google Scholar 

  30. Jakobiec FA, Jones IS, Tannenbaum M (1973) Leiomyoma. An unusual tumour of the orbit. Br J Ophthalmol 57:825–831

    Article  PubMed  CAS  Google Scholar 

  31. Jakobiec FA, Howard GM, Rosen M, Wolff M (1975) Leiomyoma and leiomyosarcoma of the orbit. Am J Ophthalmol 80:1028–1042

    PubMed  CAS  Google Scholar 

  32. Jenson HB, Leach CT, McClain KL, Joshi VV, Pollock BH, Parmley RT, Chadwick EG, Murphy SB (1997) Benign and malignant smooth muscle tumors containing Epstein–Barr virus in children with AIDS. Leuk Lymphoma 27:303–314

    PubMed  CAS  Google Scholar 

  33. Jian XC, Chen XQ, Wang CX (1998) A surgical approach to extensive tumors in the pterygopalatine fossa extending into the maxillary sinus. J Oral Maxillofac Surg 56:578–584

    Article  PubMed  CAS  Google Scholar 

  34. Jian XC, Liu JP (2003) A new surgical approach to extensive tumors in the pterygomaxillary fossa and the skull base. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 95:156–162

    Article  PubMed  Google Scholar 

  35. Jian XC, Wang CX, Jiang CH (2005) Surgical management of primary and secondary tumors in the pterygopalatine fossa. Otolaryngol Head Neck Surg 132:90–94

    Article  PubMed  Google Scholar 

  36. Jolly SS, Brownstein S, Jordan DR (1995) Leiomyoma of the anterior orbit and eyelid. Can J Ophthalmol 30:366–370

    PubMed  CAS  Google Scholar 

  37. Kassam AB, Gardner P, Snyderman C, Mintz A, Carrau R (2005) Expanded endonasal approach: fully endoscopic, completely transnasal approach to the middle third of the clivus, petrous bone, middle cranial fossa, and infratemporal fossa. Neurosurg Focus 19:E6

    PubMed  Google Scholar 

  38. Kassam AB, Thomas AJ, Zimmer LA, Snyderman CH, Carrau RL, Mintz A, Horowitz M (2007) Expanded endonasal approach: a fully endoscopic completely transnasal resection of a skull base arteriovenous malformation. Childs Nerv Syst 23:491–498

    Article  PubMed  Google Scholar 

  39. Kassam AB, Prevedello DM, Carrau RL, Snyderman CH, Gardner P, Osawa S, Seker A, Rhoton AL Jr (2009) The front door to Meckel’s cave: an anteromedial corridor via expanded endoscopic endonasal approach—technical considerations and clinical series. Neurosurgery 64:71–82, discussion 82–73

    Article  PubMed  Google Scholar 

  40. Kulkarni V, Rajshekhar V, Chandi SM (2000) Orbital apex leiomyoma with intracranial extension. Surg Neurol 54:327–330

    Article  PubMed  CAS  Google Scholar 

  41. LaBruna A, Reagan B, Papageorge A (1995) Leiomyoma of the maxillary sinus: a diagnostic dilemma. Otolaryngol Head Neck Surg 112:595–598

    PubMed  CAS  Google Scholar 

  42. Lee ES, Locker J, Nalesnik M, Reyes J, Jaffe R, Alashari M, Nour B, Tzakis A, Dickman PS (1995) The association of Epstein–Barr virus with smooth-muscle tumors occurring after organ transplantation. N Engl J Med 332:19–25

    Article  PubMed  CAS  Google Scholar 

  43. Lijovetzky G, Zaarura S, Gay I (1985) Leiomyoma of the nasal cavity (report of a case). J Laryngol Otol 99:197–200

    PubMed  CAS  Google Scholar 

  44. Llorente JL, Suarez C, Seco M, Garcia A (1996) Leiomyoma of the nasal septum: report of a case and review of the literature. J Laryngol Otol 110:65–68

    Article  PubMed  CAS  Google Scholar 

  45. Locatelli D, Castelnuovo P, Santi L, Cerniglia M, Maghnie M, Infuso L (2000) Endoscopic approaches to the cranial base: perspectives and realities. Childs Nerv Syst 16:686–691

    Article  PubMed  CAS  Google Scholar 

  46. Locatelli D, Rampa F, Acchiardi I, Bignami M, Pistochini A, Castelnuovo P (2006) Endoscopic endonasal approaches to anterior skull base defects in pediatric patients. Childs Nerv Syst 22:1411–1418

    Article  PubMed  Google Scholar 

  47. Mandonnet E, Kolb F, Tran Ba Huy P, George B (2008) Spectrum of skull base tumors in children and adolescents: a series of 42 patients and review of the literature. Childs Nerv Syst 24:699–706

    Article  PubMed  CAS  Google Scholar 

  48. McCaffrey TV, McDonald TJ, Unni KK (1978) Leiomyoma of the nasal cavity. Report of a case. J Laryngol Otol 92:817–819

    Article  PubMed  CAS  Google Scholar 

  49. McClain KL, Leach CT, Jenson HB, Joshi VV, Pollock BH, Parmley RT, DiCarlo FJ, Chadwick EG, Murphy SB (1995) Association of Epstein–Barr virus with leiomyosarcomas in children with AIDS. N Engl J Med 332:12–18

    Article  PubMed  CAS  Google Scholar 

  50. McDermott MW, Durity FA, Rootman J, Woodhurst WB (1990) Combined frontotemporal-orbitozygomatic approach for tumors of the sphenoid wing and orbit. Neurosurgery 26:107–116

    Article  PubMed  CAS  Google Scholar 

  51. Merani R, Khannah G, Mann S, Ghabrial R (2005) Orbital leiomyoma: a case report with clinical, radiological and pathological correlation. Clin Experiment Ophthalmol 33:408–411

    Article  PubMed  Google Scholar 

  52. Nath K, Shukla BR (1963) Orbital leiomyoma and its origin. Br J Ophthalmol 47:369–371

    Article  PubMed  CAS  Google Scholar 

  53. Pasquini E, Ceroni Compadretti G, Sciarretta V, Ippolito A (2002) Transnasal endoscopic surgery for the treatment of fibrous dysplasia of maxillary sinus associated to aneurysmal bone cyst in a 5-year-old child. Int J Pediatr Otorhinolaryngol 62:59–62

    Article  PubMed  Google Scholar 

  54. Pasquini E, Sciarretta V, Farneti G, Ippolito A, Mazzatenta D, Frank G (2002) Endoscopic endonasal approach for the treatment of benign schwannoma of the sinonasal tract and pterygopalatine fossa. Am J Rhinol 16:113–118

    PubMed  Google Scholar 

  55. Pirris SM, Pollack IF, Snyderman CH, Carrau RL, Spiro RM, Tyler-Kabara E, Kassam AB (2007) Corridor surgery: the current paradigm for skull base surgery. Childs Nerv Syst 23:377–384

    Article  PubMed  Google Scholar 

  56. Price JC, Holliday MJ, Johns ME, Kennedy DW, Richtsmeier WJ, Mattox DE (1988) The versatile midface degloving approach. Laryngoscope 98:291–295

    PubMed  CAS  Google Scholar 

  57. Rhoton AL Jr (2002) The anterior and middle cranial base. Neurosurgery 51:S273–S302

    PubMed  Google Scholar 

  58. Rivera-Serrano CM, Terre-Falcon R, Fernandez-Miranda J, Prevedello D, Snyderman CH, Gardner P, Kassam A, Carrau RL (2010) Endoscopic endonasal dissection of the pterygopalatine fossa, infratemporal fossa, and post-styloid compartment. Anatomical relationships and importance of eustachian tube in the endoscopic skull base surgery. Laryngoscope 120(Suppl 4):S244

    Article  PubMed  Google Scholar 

  59. Rivera-Serrano CM, Snyderman CH, Gardner P, Prevedello D, Wheless S, Kassam AB, Carrau RL, Germanwala A, Zanation A (2011) Nasoseptal “rescue” flap: a novel modification of the nasoseptal flap technique for pituitary surgery. Laryngoscope 121:990–993

    Article  PubMed  Google Scholar 

  60. Robinson S, Patel N, Wormald PJ (2005) Endoscopic management of benign tumors extending into the infratemporal fossa: a two-surgeon transnasal approach. Laryngoscope 115:1818–1822

    Article  PubMed  Google Scholar 

  61. Salmasi V, Blitz AM, Ishii M, Gallia GL (2011) Expanded endonasal endoscopic approach for resection of a large skull base aneurysmal bone cyst in a pediatric patient with extensive cranial fibrous dysplasia. Childs Nerv Syst 27:649–656

    Article  PubMed  Google Scholar 

  62. Schwartzman J (1973) Leiomyoangioma of paranasal sinuses: case report. Laryngoscope 83:1856–1858

    Article  PubMed  CAS  Google Scholar 

  63. Sewall EC (1992) Surgical removal of the sphenopalatine ganglion. Report of three operations; elaborating an original technic to expose the pterygopalatine fossa, command the internal maxillary artery and its terminals and the infraorbital nerve and its branches. 1937. Ann Otol Rhinol Laryngol 101:285–292

    PubMed  CAS  Google Scholar 

  64. Solari D, Magro F, Cappabianca P, Cavallo LM, Samii A, Esposito F, Paterno V, De Divitiis E, Samii M (2007) Anatomical study of the pterygopalatine fossa using an endoscopic endonasal approach: spatial relations and distances between surgical landmarks. J Neurosurg 106:157–163

    Article  PubMed  Google Scholar 

  65. Tang SO, Tse CH (1988) Leiomyoma of the nasal cavity. J Laryngol Otol 102:831–833

    Article  PubMed  CAS  Google Scholar 

  66. Teo C, Dornhoffer J, Hanna E, Bower C (1999) Application of skull base techniques to pediatric neurosurgery. Childs Nerv Syst 15:103–109

    Article  PubMed  CAS  Google Scholar 

  67. Theodosopoulos PV, Guthikonda B, Brescia A, Keller JT, Zimmer LA (2010) Endoscopic approach to the infratemporal fossa: anatomic study. Neurosurgery 66:196–202, discussion 202–193

    Article  PubMed  Google Scholar 

  68. Trott MS, Gewirtz A, Lavertu P, Wood BG, Sebek BA (1994) Sinonasal leiomyomas. Otolaryngol Head Neck Surg 111:660–664

    Article  PubMed  CAS  Google Scholar 

  69. van Ingen G, Stel HV, Tiwari RM (1991) Atypical leiomyoma of the choana. J Laryngol Otol 105:1065–1067

    PubMed  Google Scholar 

  70. Wentges RT (1975) Surgical anatomy of the pterygopalatine fossa. J Laryngol Otol 89:35–45

    Article  PubMed  CAS  Google Scholar 

  71. Wolfowitz BL, Schmaman A (1973) Smooth-muscle tumours of the upper respiratory tract. S Afr Med J 47:1189–1191

    PubMed  CAS  Google Scholar 

  72. Yang BT, Wang ZC, Xian JF, Hao DP, Chen QH (2009) Leiomyoma of the sinonasal cavity: CT and MRI findings. Clin Radiol 64:1203–1209

    Article  PubMed  CAS  Google Scholar 

  73. Yannopoulos K, Stout AP (1962) Smooth muscle tumors in children. Cancer 15:958–971

    Article  PubMed  CAS  Google Scholar 

  74. Zhang M, Garvis W, Linder T, Fisch U (1998) Update on the infratemporal fossa approaches to nasopharyngeal angiofibroma. Laryngoscope 108:1717–1723

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, 21287, USA

    Vafi Salmasi & Gary L. Gallia

  2. Department of Otolaryngology, Johns Hopkins Hospital, Baltimore, MD, USA

    Douglas D. Reh & Masaru Ishii

  3. Department of Radiology, Johns Hopkins Hospital, Baltimore, MD, USA

    Ari M. Blitz

  4. Department of Pathology, Johns Hopkins Hospital, Baltimore, MD, USA

    Pedram Argani

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  1. Vafi Salmasi
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  2. Douglas D. Reh
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  3. Ari M. Blitz
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  4. Pedram Argani
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  5. Masaru Ishii
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  6. Gary L. Gallia
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Correspondence to Gary L. Gallia.

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Salmasi, V., Reh, D.D., Blitz, A.M. et al. Expanded endonasal endoscopic approach for resection of a skull base low-grade smooth muscle neoplasm. Childs Nerv Syst 28, 151–158 (2012). https://doi.org/10.1007/s00381-011-1589-4

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  • DOI: https://doi.org/10.1007/s00381-011-1589-4

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