Giant meningioma in paranasal sinuses: an atypical nasal occupation

摘要

An 80-year-old man presented with a 1-month history of frontal headache and pressure, irradiating to the nose. He did not have other complaints or relevant health issues besides high blood pressure and diabetes mellitus. The initial physical examination did not reveal any abnormality. Because of his severe complaints, he underwent a CT scan of the brain and paranasal sinuses, which showed an expansive solid mass in the right frontal sinus with erosion of its posterior wall and extension to the frontoethmoidal recess. These findings motivated a cranial MRI that revealed a giant mass (6.3×3.1×7.5 cm) in the frontoethmoidal area with both intracranial and extra-axial extension ( ). The patient underwent a frontal sinus biopsy, performed by functional endoscopic sinus surgery that revealed a transitional meningioma with usual epithelial membrane antigen expression ( ). A combined approach with neurosurgery team was decided and the patient was submitted to a craniofacial resection with removal of the mass, followed by skull base and ethmoidal roof reconstruction with titanium plates, dura mater and pericranial flap ( ). Histopathological analysis was compatible with a WHO grade I meningioma. The patient was discharged on the 12th day, without neurological deficits. He presented a good evolution, without signals of relapse in the follow-up appointments ( ).