Báo cáo khoa học: Resection of giant ethmoid osteoma with orbital and skull base extension followed by duraplasty

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Báo cáo khoa học: "Resection of giant ethmoid osteoma with orbital and skull base extension followed by duraplasty"World Journal of Surgical Oncology BioMed Central Open AccessCase reportResection of giant ethmoid osteoma with orbital and skull baseextension followed by duraplastyIoannis Yiotakis, Anna Eleftheriadou*, Evagelos Giotakis,Leonidas Manolopoulos, Eliza Ferekidou and Dimitrios KandilorosAddress: Department of Otolaryngology, University of Athens, Hippokration Hospital, Athens, GreeceEmail: Ioannis Yiotakis - jyiot@otenet.gr; Anna Eleftheriadou* - aegika@yahoo.gr; Evagelos Giotakis - giotakis@gmail.com;Leonidas Manolopoulos - leomanol@hol.com; Eliza Ferekidou - eliferan@uop.gr; Dimitrios Kandiloros - dkandiloros@yahoo.gr* Corresponding authorPublished: 14 October 2008 Received: 14 March 2008 Accepted: 14 October 2008World Journal of Surgical Oncology 2008, 6:110 doi:10.1186/1477-7819-6-110This article is available from: http://www.wjso.com/content/6/1/110© 2008 Yiotakis et al; licensee BioMed Central Ltd.This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0),which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background: Osteomas of ethmoid sinus are rare, especially when they involve anterior skull base and orbit, and lead to ophthalmologic and neurological symptoms. Case presentation: The present case describes a giant ethmoid osteoma. Patient symptoms and signs were exophthalmos and proptosis of the left eye, with progressive visual acuity impairment and visual fields defects. CT/MRI scanning demonstrated a huge osseous lesion of the left ethmoid sinus (6.5 cm × 5 cm × 2.2 cm), extending laterally in to the orbit and cranially up to the anterior skull base. Bilateral extensive polyposis was also found. Endoscopic and external techniques were combined to remove the lesion. Bilateral endoscopic polypectomy, anterior and posterior ethmoidectomy and middle meatus antrostomy were performed. Finally, the remaining part of the tumor was reached and dissected from the surrounding tissue via a minimally invasive Lynch incision around the left middle canthus. During surgery, CSF rhinorrhea was observed and leakage was grafted with fascia lata and coated with bio-glu. Postoperatively, symptoms disappeared. Eighteen months after surgery, the patient is still free of symptoms. Conclusion: Before management of ethmoid osteomas with intraorbital and skull base extension, a thorough neurological, ophthalmological and imaging evaluation is required, in order to define the bounders of the tumor, carefully survey the severity of symptoms and signs, and precisely plan the optimal treatment. The endoscopic procedure can constitute an important part of surgery undertaken for giant ethmoidal osteomas. In addition, surgeons always have to take into account a possible CSF leak and they have to be prepared to resolve it. very often incidental radiographic findings, most authorsBackgroundOsteomas are relatively rare, slow-growing, osteogenic agree that small lesions do not need surgery suggestingtumors. They are the most frequent benign neoplasm of periodic imaging in order to follow the growth and allowthe paranasal sinuses, usually originating in the frontal intervention before the development of complicationssinus and much less in ethmoid, sphenoid and maxillary [1]. Ethmoid osteomas appear early, as the limited ana-sinus. As osteomas are usually asymptomatic, they are tomical space results to complaining by the patient. Page 1 of 5 (page number not for citation purposes)Worl ...