Minimally Invasive Approach for Orbital and Parameningeal Rhabdomyosarcoma

Minimally Invasive Approach for Orbital and Parameningeal Rhabdomyosarcoma

Author Info

Corresponding Author
Joel Caballero-García
Neurosurgeon, National Institute of Oncology and Radiobiology

A B S T R A C T

Rhabdomyosarcoma (RMS) of head and neck region in adult is rare. Orbital and parameningeal subtypes constitute a treatment challenge due its relationship to the skull base and orbit. We report a 21-year-old male patient who presented with right ocular proptosis, bilateral nasal obstruction, frontal headache, right nasal discharge, epiphora and decrease of visual acuity in the right eye for the past 6 months. Computed Tomography (CT) and Resonance Magnetic Images (RMI) scans documented a large mass of the right nasal cavity, occupying totally the ethmoid and maxilar sinuses with markedly extension into the right orbit and anterior cranial base erosion with post contrast homogeneous enhancement. A previous biopsy of the neoplasm revealed an esthesioneuroblastoma. An endonasal endoscopic approach extended to the anterior cranial base and right orbit was performed with orbital preservation. Minimally invasive pericranial flap was used for the reconstruction. There were not transoperative or postoperative complications. 24 hours CT and three months postoperative RMI scans show a gross total resection. Definitive biopsy informs an embryonal RMS. He was immediately referred to chemoradiotherapy. Orbital parameningial RMS is a rare entity in adults but should be included in differential diagnosis. Endonasal endoscopic resection offers a faster recovery with minimal morbidity, providing a better life quality and immediately adjuvant treatment. Minimally invasive pericranial flap constitute a good alternative in cases with non-viable mucosal vascularized nasoseptal flap. Multimodality treatment, including chemoradiation and surgery, play an important role in the management. Highlights Rhabdomyosarcoma is a rare soft tissue malignancy derived from myogenic cells. There is very little literature that provides substantial evidence regarding the outcomes of surgical treatment of parameningeal subtype. Endonasal endoscopic resection offers a faster recovery with minimal morbidity, providing a better life quality and immediately adjuvant treatment. Minimally invasive pericranial flap constitute a good alternative in cases with non-viable mucosal vascularized nasoseptal flap. Multimodal treatment ae essential.

Article Info

Article Type
Case Report
Publication history
Received: Mon 14, May 2018
Accepted: Fri 25, May 2018
Published: Thu 28, Jun 2018
Copyright
© 2023 Joel Caballero-García. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Hosting by Science Repository.
DOI: 10.31487/j.SCR.2018.01.011