A giant, complex fronto-ethmoidal ivory osteoma: Surgical technique in a resource-limited practice

Abstract

Background:Unlike small and medium size fronto-ethmoidal osteomas which are amenable to surgical excision through limited craniofacial openings, giant lesions require extensive and complex craniofacial dissection, and post lesionectomy reconstruction using an array of modern-day surgical adjuncts. This is a report of our surgical technique for the successful and esthetically fair operative resection of a giant fronto-ethmoidal osteoma in a difficult practice setting.Case Description:A 32-year-old Nigerian lady harbored a giant complex fronto-ethmoidal ivory osteoma. Deploying our understanding of modern-day advanced microsurgical anatomy and technique of skull base surgery, but under severe resource limitations, a radical total surgical resection was performed and an esthetically fair post lesionectomy reconstruction was achieved. The patient remains tumor-free in 20 months, so far, of postoperative follow-up.Conclusions:Even under severe resource limitations, inventive adaptations of modern-day skull base surgery techniques can facilitate hitherto unusual functional and esthetically successful resection of giant osteomas of the fronto-ethmoidal sinus complex.

Surgical Management of Complex Skull Base Tumor Using Preoperative Multimodal Image Fusion Technology

“…During intraoperative resection of the tumor, attention should be paid to preserving the meningeal residuals of the skull base and not over-excising the meningeal residual potion by emphasizing total tumor resection. [26][27][28][29] In these cases, there were no cerebral fluid leakage occurred. Cranial nerve protection should follow the same principle.…”

“…We follow the basic principle that intraoperative separation of tumors adhered to the meninges should be performed carefully and gently to preserve integrity. During intraoperative resection of the tumor, attention should be paid to preserving the meningeal residuals of the skull base and not over-excising the meningeal residual potion by emphasizing total tumor resection 26–29 . In these cases, there were no cerebral fluid leakage occurred.…”

Pediatric Cases of Recurrent Skull Giant Osteoma Misdiagnosed as Fibrous Dysplasia

“…Many cases of recurrence of skull osteomas have indeed been reported in the literature, especially after a non-radical surgery. 6,7 Only shaving the lesions often temporarily ameliorates the problem, resulting in recurrence, and radical excision, if possible, is the best treatment option for giant osteoma. 8 After radical excision of giant osteoma, skull defect reconstruction is needed.…”

Giant osteoma of the skull vault: A rare case of mixed variety

“…However, management of the large ones with involvement of paranasal sinus and/or orbit is more complicated and has been well described by other workers. (1,6) The giant tumors involving the vault, especially when containing both exostotic and enostotic components, present a different set of challenges. The planning of craniotomy requires careful surface marking of the enostotic component apart from the obvious exostotic component.…”