Article
Giant Cell Reparative Granuloma of the middle part of the skull base : about one case
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Authors
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G. Pech-Gourg
- Service de Neurochirurgie, Hôpital Sainte-Marguerite, CHU Marseille, France
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J. Paris
- Service de Chirurgie ORL, Hôpital La Timone, CHU Marseille, France
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M. Zanaret
- Service de Chirurgie ORL, Hôpital La Timone, CHU Marseille, France
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C. Bouvier
- Service d' Anatomopathologie, Hôpital La Timone, CHU Marseille, France
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P. H. Roche
- Service de Neurochirurgie, Hôpital Sainte-Marguerite, CHU Marseille, France
| Published: | May 4, 2005 |
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Outline
Text
Objective
The giant cell reparative granuloma (GCRG) are non-neoplastic rare lesions, with an aggressive local potential. Their localization interests usually the maxillary and mandibular bones, but exceptional attacks of the cranial bones were described. The authors report the case of a GCRG of the great sphenoid wing and of the petrous bone, discuss its diagnostic and therapeutic aspects and present an exhaustive review of the relevant literature concerning the GCRG of the skull base.
Methods
A 25-year-old man, complained since 2 months and half about a left hearing loss revealed by an episode of brutal deafness, as well as pain of the left temporo-mandibulaire articulation. He presented an important tumefaction of the left cheek. Neurological examination was normal. The audiometric examination confirmed a severe conductive hear loss. He did not have any antecedent of traumatism or locoregional infection. An extradural tumoral lesion concerning the great sphenoid wing, the squamous portion of the temporal in its low part and the zygomatic arc on the left was highlighted by the cerebral imaging findings. The cerebral computed tomodensitometry scan showed an osteolytic heterogenous nonspecific lesion native from the spheno-petrous and temporal bones and extending to the middle fossa, responsible of a mass effect on the left temporal lobe. On T1-weighted magnetic resonance (MR) images, the mass was isointense. On T2-weighted images, the mass appeared frankly hypointense. After intravenous administration of Gadolinium, on the T1-weighted images, the mass enhancement was heterogenous. The cerebral angiography showed a blush in the left external carotid territory. The surgical operation (sub-temporal approach) allowed a sub-total removal of the lesion.
Results
The anatomopathologic diagnosis was GCRG, based on observation of clusters of giant cells, abondant reactional osteogenesis, foci of hemorrhage, and on the fibroblastic cytology of the mononucleated elements. Postoperatively, the patient had no neurological deficit. The MR follow-up at 2 years showed remnant tumor at the medial side of the lateral pterygoid muscle.
Conclusions
The optimal treatment of CGRG is complete surgical excision. Because of the difficulties encountered in the skull base surgery, remnant tumor is possible. The knowledge of the benign nature of this lesion authorize subtotal excision.
