ConclusionsExtensive multifocal RDD involving the brain, spine, and paranasal sinuses is exceedingly rare and often mimic meningiomas on imaging. Surgical management can be challenging. We recommend a conservative approach with close observation and reserve surgical treatment for enlarging symptomatic lesions. AbstractIntroduction: Rosai-Dorfman disease (RDD) is a rare benign lymphocytic disorder characterized by idiopathic histiocytic proliferation affecting lymph nodes. RDD in the central nervous system (CNS) without nodal disease is exceedingly uncommon. We describe a rare case of extensive multifocal RDD involving the CNS, skull base, and paranasal sinuses. We review the literature and propose a surgical strategy to manage extensive multifocal disease. Methods: This 39 year-old-male with known RDD and multiple previous surgeries for intracranial and spinal RDD lesions presented with worsening spasticity, gait dysfunction, left facial pain and numbness, and mild dysphagia. Neuroimaging demonstrated multifocal enhancing dural-based lesions in the brain including right frontal, right temporal, right cerebellopontine angle, left clinoidal, left petroclival and bilateral Meckel's cave lesions. There was progressive growth of the left petroclival lesion causing symptomatic brainstem compression. The patient also had obstructive sleep apnea due to RDD occupying the entire nasal and paranasal sinuses. Results: The patient underwent a left-sided retrolabyrinthine transpetrosal-transtentorial approach to remove the left petroclival tumor and decompress the brainstem. The mass was carefully dissected off of cranial nerves IV through XI with excellent decompression of the brainstem. Endoscopic resection of the paranasal sinus mass was performed at a later date. Histologically, both masses were consistent with RDD. Conclusions: Extensive multifocal RDD involving the brain, spine, and paranasal sinuses is exceedingly rare and often mimic meningiomas on imaging. Surgical management can be challenging. We recommend a conservative approach with close observation and reserve surgical treatment for enlarging symptomatic lesions.
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