Endoscopic endonasal removal of an intrasphenoidal paranasal sinus meningioma mimicking a squamous cell carcinoma

Abstract

Extracranial meningiomas comprise 1% to 2% of all meningiomas. Primary extracranial paranasal meningiomas are even less common. A pure intrasphenoidal localization is exceptional, and it may cause misdiagnosis. A 60 year old male patient was suffering from a headache. Anosmia was the only neurological finding determined, but he was not aware of it. The magnetic resonance imaging demonstrated an intrasphenoidal mass resembling a squamous cell carcinoma; the patient underwent an endoscopic endonasal procedure. The histopathological studies revealed a meningotheliomatous meningioma. Postoperative course was uneventful. Different behaviors of a tumor in an unusual location may cause misdiagnosis. The possibility of an intrasphenoidal paranasal meningioma has to be considered in the differential diagnosis of sphenoidal region masses. Also, the use of an endoscopy can help to avoid significant nasal injury. A verification of their etiology, adequate diagnosis, and management principles will allow for a satisfactory procedure.