The clinical challenge for the physician who encounters unilateral MEE is to identify the small percentage of patients with persistent MEE secondary to eustachian tube invasion or compression by occult lesions of the middle cranial fossa
, petrous apex, or infratemporal fossa.
Imaging revealed the presence of a Radkowski stage IIIb and Fisch stage IVb JNA that extended into the nasal cavities, the paranasal sinuses, cavernous sinuses, left posterior orbit, and left middle cranial fossa
(figure 2, A).
On computed tomography (CT) with intravenous contrast, a large, soft-tissue nasopharyngeal mass with extension into and erosion of the sphenoid sinus walls, pterygoid plates, and sella turcica and protrusion into the middle cranial fossa
was found (figures 1 and 2).
Imagawa et al reported an enchondroma in the left middle cranial fossa
of a patient with generalized enchondromatosis.
Magnetic resonance imaging (MRI) revealed extension of the mass into the extradural anterior cranial fossa
(figure 1, B).
The location of an MPNST in the infratemporal fossa and its extension into the middle cranial fossa
is very uncommon, as fewer than 50 cases of a maxillomandibular site have been reported in the literature.
High-resolution computed tomography (CT) of the anterior cranial fossa
demonstrated air in the cranial cavity, indicating a fracture or breach of the cribiform plate (figure 1).
Computed tomography (CT) of the sinuses demonstrated a large, enhancing mass within the left ethmoid sinus; CT also showed tumor erosion through the anterior cranial fossa
and the left lamina papyracea and compression of the medial rectus muscle and optic nerve (figure 1).
In fact, the jugular foramen is an opening in the skull that connects the posterior cranial fossa
and the jugular fossa.
It is rare in the smaller joints and especially rare in the head and neck; several cases of temporomandibular joint (TMJ) involvement have been reported, (1-5) some with invasion into the middle cranial fossa
We present a case in which a 23-year-old male patient diagnosed with nasoseptal chondrosarcoma with anterior cranial fossa
extension underwent combined surgical approaches to optimize complete resection of the tumor.
Both middle cranial fossa
and suboccipital approaches have been employed.