The Unusual Presentation of a Myxoma Within the Sphenoid Sinus: Case Report and Review of the Literature

• Published in: World neurosurgery 2017-07, Vol.103, p.951.e5-951.e12
• Main Authors: Clarke, Julian V, Mandpe, Aditi H, Weber, Peter B, Vogel, Hannes, Leng, Lewis Z
• Format: Article
• Language: English
• Subjects: Aged; Endoscopic management; Female; Humans; Magnetic Resonance Imaging; Meningeal Neoplasms - diagnostic imaging; Meningeal Neoplasms - surgery; Meningioma - diagnostic imaging; Meningioma - surgery; Myxoma; Myxoma - diagnostic imaging; Myxoma - surgery; Neoplasms, Multiple Primary - diagnostic imaging; Neoplasms, Multiple Primary - surgery; Neurosurgery; Paranasal Sinus Neoplasms - diagnostic imaging; Paranasal Sinus Neoplasms - surgery; Skull base; Sphenoid Bone - diagnostic imaging; Sphenoid Bone - surgery; Sphenoid sinus; Sphenoid Sinus - diagnostic imaging; Sphenoid Sinus - surgery
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2017.04.019

Background We describe a rare case of a sphenoid sinus myxoma that was resected via an endoscopic endonasal skull base approach. We review the literature regarding these rare tumors of the paranasal sinuses. Case Description A 72-year-old woman was diagnosed with an incidental sphenoid sinus tumor and left sphenoid wing meningioma during a workup for left-sided proptosis and diplopia. Biopsies of the sphenoid wing and sphenoid sinus tumors were obtained. After undergoing surgical resection of the meningioma, the patient then underwent definitive resection of the sphenoid sinus myxoma via endoscopic endonasal skull base approach. Postoperative imaging demonstrated a gross total resection. The patient suffered postoperative thromboembolic complications due to underlying hypercoagulable state but made a complete recovery and returned to her neurologic baseline. There has been no evidence of recurrent myxoma in the sphenoid sinus 24 months after surgery. Discussion Myxomas are benign tumors derived from primitive mesenchyme. Myxomas very rarely present in the paranasal or skull base location. Complete surgical resection is the primary treatment for these tumors. The endoscopic endonasal approach is an effective technique for resecting various benign and more aggressive extradural skull base tumors. Conclusions Myxomas of the sphenoid sinus are rare. The endoscopic endonasal skull base approach is an effective and minimal access technique for resection of this rare tumor of the sphenoid sinus.