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Osteoblastoma of the lateral skull base: work-up, surgical management, and a review of the literature".

Miller C, Khan R, Lemole GM, Jacob A - J Neurol Surg Rep (2013)

Bottom Line: Results A 15-year-old adolescent boy with a greater than 1-year history of right-sided retroauricular pain, a palpable postauricular mass, and chronic headaches presented for evaluation/management.Follow-up imaging studies found no evidence of recurrence.An en bloc resection is important for both diagnosis and definitive treatment of these neoplasms.

View Article: PubMed Central - PubMed

Affiliation: Division of Otolaryngology, The University of Arizona Ear Institute, University of Arizona, Arizona, USA.

ABSTRACT
Objectives To describe the work-up and surgical management of an osteoblastoma involving the lateral skull base. Typically occurring in the spine or long bones, osteoblastomas of the craniofacial skeleton are exceedingly rare and infrequently reported. A review of the current literature regarding temporal bone osteoblastoma, diagnosis, and treatment is described. Methods This case report describes the clinical presentation, radiographic studies, surgical management, histology, and postoperative follow-up of a young man presenting to a tertiary care neurotology practice with osteoblastoma involving the lateral skull base. A review of the current literature regarding osteoblastoma of the skull base, work-up, and treatment is described. Results A 15-year-old adolescent boy with a greater than 1-year history of right-sided retroauricular pain, a palpable postauricular mass, and chronic headaches presented for evaluation/management. Microscope examination of the ears, hearing, and cranial nerve function were normal. High-resolution temporal bone computed tomography and magnetic resonance imaging scans were obtained, which revealed an expansile mass involving the junction of the temporal and occipital bones. The patient underwent a combined retrosigmoid/retrolabyrinthine resection of this extradural tumor. Histology revealed a benign bone neoplasm consistent with osteoblastoma. Complete surgical resection was achieved, and the patient's symptoms fully resolved. Follow-up imaging studies found no evidence of recurrence. The scientific literature relevant to work-up and management of osteoblastoma is reviewed. Discussion Osteoblastomas of the lateral skull base are rare, histologically benign tumors that can present with radiographic features suggestive of malignancy. An en bloc resection is important for both diagnosis and definitive treatment of these neoplasms. The differential diagnosis on imaging and histology is discussed.

No MeSH data available.


Related in: MedlinePlus

Hematoxylin and eosin (H&E) stained slide at 200× magnification shows a bone-forming neoplasm with immature bone (arrow) and spindle cell population with rich vasculature.
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FI120062-3: Hematoxylin and eosin (H&E) stained slide at 200× magnification shows a bone-forming neoplasm with immature bone (arrow) and spindle cell population with rich vasculature.

Mentions: Initially, a limited retrosigmoid craniotomy was performed to allow posterior exposure of the tumor and control of the transverse sinus. This was followed by a mastoidectomy to allow for full exposure of the tumor mass that involved a significant portion of the posterior temporal bone. The mass extended from the tegmen all the way into the retrofacial air cell system, as well as a significant portion of the posterior petrous bone from tegmen to retrofacial air cells. Important landmarks were identified, including the tegmen, the region of the sinodural angle, and the ear canal, incus, horizontal semicircular canal, and the vertical segment of the facial nerve. The bone surrounding these structures was noted to be soft, doughy, and highly vascularized. Biopsies were taken and sent for frozen section and permanent section analysis. Intraoperative pathology revealed a bone-forming neoplasm with immature bone as well as spindle cell populations with rich vascularity (Fig. 3). The pathology team read the sample as a “benign tumor, otherwise unspecified.” There were no malignant features noted such as increased nuclear to cytoplasmic ratio or extensive mitotic figures to suggest a malignant process. At this point it was felt that a total en bloc resection would be curative, and the surgeons proceeded with the operation.


Osteoblastoma of the lateral skull base: work-up, surgical management, and a review of the literature".

Miller C, Khan R, Lemole GM, Jacob A - J Neurol Surg Rep (2013)

Hematoxylin and eosin (H&E) stained slide at 200× magnification shows a bone-forming neoplasm with immature bone (arrow) and spindle cell population with rich vasculature.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3713558&req=5

FI120062-3: Hematoxylin and eosin (H&E) stained slide at 200× magnification shows a bone-forming neoplasm with immature bone (arrow) and spindle cell population with rich vasculature.
Mentions: Initially, a limited retrosigmoid craniotomy was performed to allow posterior exposure of the tumor and control of the transverse sinus. This was followed by a mastoidectomy to allow for full exposure of the tumor mass that involved a significant portion of the posterior temporal bone. The mass extended from the tegmen all the way into the retrofacial air cell system, as well as a significant portion of the posterior petrous bone from tegmen to retrofacial air cells. Important landmarks were identified, including the tegmen, the region of the sinodural angle, and the ear canal, incus, horizontal semicircular canal, and the vertical segment of the facial nerve. The bone surrounding these structures was noted to be soft, doughy, and highly vascularized. Biopsies were taken and sent for frozen section and permanent section analysis. Intraoperative pathology revealed a bone-forming neoplasm with immature bone as well as spindle cell populations with rich vascularity (Fig. 3). The pathology team read the sample as a “benign tumor, otherwise unspecified.” There were no malignant features noted such as increased nuclear to cytoplasmic ratio or extensive mitotic figures to suggest a malignant process. At this point it was felt that a total en bloc resection would be curative, and the surgeons proceeded with the operation.

Bottom Line: Results A 15-year-old adolescent boy with a greater than 1-year history of right-sided retroauricular pain, a palpable postauricular mass, and chronic headaches presented for evaluation/management.Follow-up imaging studies found no evidence of recurrence.An en bloc resection is important for both diagnosis and definitive treatment of these neoplasms.

View Article: PubMed Central - PubMed

Affiliation: Division of Otolaryngology, The University of Arizona Ear Institute, University of Arizona, Arizona, USA.

ABSTRACT
Objectives To describe the work-up and surgical management of an osteoblastoma involving the lateral skull base. Typically occurring in the spine or long bones, osteoblastomas of the craniofacial skeleton are exceedingly rare and infrequently reported. A review of the current literature regarding temporal bone osteoblastoma, diagnosis, and treatment is described. Methods This case report describes the clinical presentation, radiographic studies, surgical management, histology, and postoperative follow-up of a young man presenting to a tertiary care neurotology practice with osteoblastoma involving the lateral skull base. A review of the current literature regarding osteoblastoma of the skull base, work-up, and treatment is described. Results A 15-year-old adolescent boy with a greater than 1-year history of right-sided retroauricular pain, a palpable postauricular mass, and chronic headaches presented for evaluation/management. Microscope examination of the ears, hearing, and cranial nerve function were normal. High-resolution temporal bone computed tomography and magnetic resonance imaging scans were obtained, which revealed an expansile mass involving the junction of the temporal and occipital bones. The patient underwent a combined retrosigmoid/retrolabyrinthine resection of this extradural tumor. Histology revealed a benign bone neoplasm consistent with osteoblastoma. Complete surgical resection was achieved, and the patient's symptoms fully resolved. Follow-up imaging studies found no evidence of recurrence. The scientific literature relevant to work-up and management of osteoblastoma is reviewed. Discussion Osteoblastomas of the lateral skull base are rare, histologically benign tumors that can present with radiographic features suggestive of malignancy. An en bloc resection is important for both diagnosis and definitive treatment of these neoplasms. The differential diagnosis on imaging and histology is discussed.

No MeSH data available.


Related in: MedlinePlus