PMC555567_01
Preoperative CT scan. Preoperative coronal CT scan which shows a large bony tumor arising from the left ethmoid sinus with orbital and intracranial extension.
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F1
Intracranial extension into the anterior cranial fossa on the left side was noted (Figure 1).
Elevation of pericranial flap and craniotomy. Pericranial flap being raised after elevation of the scalp flap (B) followed by a single burr hole frontoorbitotomy (A).
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F2
A single burr hole left fronto orbital bone flap was raised including the orbital roof and left zygomaticofrontal process (Figure 2).
Intracranial portion of the tumor. Dura being retracted after the craniotomy and visualization of the intracranial portion of the tumor. The tumor core has been drilled. The shell was subsequently nibbled away.
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F3
This was excised using the high speed drill (Figure 3).
Facial approach Weber Ferguson incision (B) followed by inferior orbitotomy (A) which enabled the retraction of the eyeball.
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F4
The intraorbital contents could now be retracted laterally and the tumor visualized (Figure 4).
Specimen. Specimen after it was excised in 2 pieces with part of the ethmoid sinus mucous membrane attached to one of the pieces. The ethmoidal portion was subsequently drilled away.
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F5
The ethmoidal portion was drilled and radical excision achieved (Figure 5).
Microphotograph of the tumor. Microphotograph (250X) of the specimen in H & E stain showing new osteoid lined by plump osteoblasts (solid arrow) in a highly vascularised stroma (broken arrow).
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F6
Histopathological examination revealed an osteoid osteoma (Figure 6).
Postoperative CT. Postoperative CT scan of the patient showing total excision of the tumor and the presence of free temporalis graft in the ethmoid and sphenoid sinus (arrow).
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F7
On follow up after 12 months patient was disease free (Figure 7).