A RARE TYPE OF EXTRACRANIAL MENINGIOMA-CASE REPORT

Objective -Meningiomas arising from paranasal sinuses are rare,less than 40 cases have been reported in the literature.This objective is to report a patient with a rare type of meningioma arising from the ethmoidal sinus presenting with proptosis and nasal obstruction and highlight the treatment modality. Method- A twenty five year-old male patient with the complaints of nasal obstruction and proptosis and dimness of vision on the right eye with the diagnosis of primary extracranial meningioma of the paranasal sinuses . MRI showed a irregular, illdefined, heterogenously enhancing lesion involving right side maxillary,right anterior posterior ethmoidal and frontal sinuses.Result -Total surgical resection by a facial translocation approach was done and patient recovered with no morbidity.Conclusion - Extra cranial meningioma accounts only 2 of all meningioma .The most common localizations of extracranial meningiomas are the skull bone,scalp, nose, orbit, paranasalsinuses, middle ear,neck and skin.The most frequent chromosomal aberration are monosomy 22,and Von Recklinghausen neurofibromatosis (NF-I). Friedman et al on reviewing the literature,found fewer than 150 cases of extracranial meningiomas of the head neck reported.Only 31 of these involved the paranasal sinuses .Clinical presentation is usually with nasal obstruction, headache ,epistaxis ,hyposmiaanosmia, nose deformity, proptosis, orbital pain,blurring of vision,diplopia.The diagnosis of these tumors is dificult,. It is part of the differential diagnosis of squamous cell carcinoma, angiofibroma (specially in men), esthesioneuroblastoma, sarcoma and lymphomas Recent advances in skull base surgery enable radical resection of these tumors. Long term follow up is necessary to monitor for recurrences.