Transnasal endoscopic resection of a recurrent pleomorphic adenoma of the sphenoid sinus and anterior skull base

OBJECTIVES: To illustrate a case report of a rare location for recurrence of a primary parotid pleomorphic adenoma (PA) and to demonstrate via video the transnasal endoscopic approach for resection of tumors of the anterior skull base. Study Design: Case report and review of the literature. Methods: A patient is presented with recurrent PA, originally with a rightsided deep lobe parotid and parapharyngeal space tumor that was resected 18 years ago. Her first recurrence was discovered in 2001, and since then she has had multiple recurrences in the peri-parotid tissue, the neck, and the nasopharynx for which she has undergone five separate surgeries as well as radiation. The patient presented rightsided trigeminal pain and numbness. MRI demonstrated a large enhancing mass in the sphenoid sinus with erosion of the clivus, displacing the pituitary and optic chiasm. There was widening of the foramen ovale as well as involvement of the right cavernous sinus and Meckel's cave. Results: The patient underwent a transnasal endoscopic resection of the sphenoid and anterior skull base mass in piecemeal fashion without complication. Postoperatively, no residual enhancing tumor was seen within the remaining sphenoid sinus and adjacent nasopharynx. Conclusions: Recurrent PA is a difficult disease to treat with great morbidity secondary to repeat operations and the tendency for the disease to recur. For lesions of the anterior skull base, endoscopic resection is safe and preferable, carrying less morbidity compared to open procedures. The open cavity allows easy access for regular inspection for recurrent disease.