Benign inverted papilloma with intracranial extension: prognostic factors and outcomes

Abstract

We describe a case of benign inverted papilloma with intracranial extension treated with endoscopic resection combined with craniotomy. Intracranial involvement of inverted papilloma, in the absence of malignancy, is uncommon. We present an analysis of the literature identifying the characteristics and outcomes of benign intracranial inverted papilloma. PubMed database was searched using keywords intracranial, inverted or inverting, and papilloma. There are 17 reports of benign inverted papilloma with intracranial extension reported with a mean age of 49.2 years (range, 23 to 92 years), a female predominance, 22% of cases with an associated mucocele, and 60% recurrent disease. The most common sites of invasion are the frontal sinus or cribriform plate. The prognosis for benign intracranial inverted papilloma is dependent on the presence of dural invasion and the achievement of total resection. There are no reported recurrences after craniofacial resection with a mean follow-up of 7.9 years. Adjuvant radiation therapy has demonstrated benefit in cases of residual disease after resection. We expect that endoscopic resection, the standard treatment for sinonasal inverted papilloma, will be increasingly used in the presence of intracranial extension.

Keywords: Intracranial; Schneiderian; inverted; inverting; papilloma.

Figure 1

(A) Coronal T1-weighted magnetic resonance image with gadolinium contrast showed an enhancing mass in the left nasal cavity extending into the left frontal sinus and anterior cranial fossa as well as extending into the orbit and compressing the intraorbital structures. The left maxillary sinus shows evidence of postobstructive disease. (B) Sagittal T1-weighted magnetic resonance image demonstrated a mass in the superior left orbit significantly compressing the orbital contents and also extending intracranially.