Pure endoscopic transsphenoidal treatment of skull base ameloblastoma with intracranial extension: Case report and literature review

Background: Ameloblastoma is a benign locally invasive lesion that represents 1% of all oral tumors. Epidemiological characteristics are variable in the literature. The most common origin sites are mandible and maxilla. Rarely presents metastasis, but the skull base, lymph nodes, and the lung are described as metastatic sites. Low recurrence rates were reported by the authors when surgical treatment achieved complete resection.

Case description: A female patient, 19 years old presenting moderate headache associated with nausea, vomiting, left facial hypoesthesia, and low visual acuity. Resonance image showed a heterogeneous expansive solid formation in sphenoid bone and clivus with neoplastic aspect. Signs of dissemination due to contiguity and invasion of skull base structures, especially cavernous sinus and internal carotid artery, determining also compression of the brainstem. First, an endoscopic biopsy was performed with otorhinolaryngology service. The pathological study showed histological characteristics of ameloblastoma. After, the patient was submitted to endoscopic surgery for resection of tumor.

Conclusion: Ameloblastoma is a rare tumor with benign behavior and slow growing. It arises from odontogenic epithelium and accounts 1% of all oral tumors. The mandible and maxilla are the most common sites of origin. Ameloblastoma with intracranial involvement is a rare presentation with few literature reviews. A long time illness course and multiple surgeries are characteristics present in the majority of cases described. Total resection surgery is the treatment of choice and endoscopic transnasal resection is a viable option.

Keywords: Ameloblastoma; Endoscopy; Skull base surgery; Transsphenoidal.