Sinonasal Inverted Papilloma with Intracranial Extension

Introduction: Inverted papilloma (IP) is the most common benign paranasal sinus neoplasm. It is characterized by a high rate of local recurrence, a tendency to destroy surrounding structures, and a potential for malignant transformation. Intracranial extension through the anterior skull base is extremely rare. We present five cases and the surgical management strategies employed in management of this difficult clinical presentation.

Methods: Five patients were identified with sinonasal inverted papilloma demonstrating intracranial extension. All underwent surgical treatment at The University of Texas Southwestern Medical Center between June 2008 and February 2010.

Results: Gross total resections were achieved in all patients. Three patients required an anterior craniofacial resection and two were resected via a purely endoscopic approach. Focal high-grade dysplasia was seen in one patient and verrucous squamous cell carcinoma was seen arising in a background of inverted papilloma in another patient. Complications included an asymptomatic frontal venous infarct in one patient. There were no CSF leaks. There have been no recurrences with a mean follow-up of 6.8 months.

Conclusions: Intracranial extension represents a rare and potentially challenging surgical dilemma. Gross total resection should be the goal of surgery, whether that is achieved via a purely endoscopic approach or in combination with an anterior craniofacial resection. Long-term endoscopic and radiographic surveillance is imperative to detect early recurrence of this difficult clinical entity.