Abstract
Skull base inverted papilloma (IP) is an unusual entity for many neurosurgeons. IP is renowned for its high rate of recurrence, its ability to cause local destruction, and its association with malignancy. This paper is a comprehensive review of the reports, studies, and reviews published in the current biomedical literature from 1947 to September 2010 and synthesize this information to focus on its potential invasion to the base of the skull and possible intradural extension. The objective is to familiarize the clinician with the different aspects of this unusual disease. The role of modern diagnostic tools in medical imaging in order to assess clearly the limits of the tumors and to enhance the efficiency and the safety in the choice of a surgical approach is pointed out. The treatment guidelines for IP have undergone a complex evolution that continues today. Radical excision of the tumour is technically difficult and often incomplete. Successful management of IP requires resection of the affected mucosa which could be achieved with open surgery, endoscopic, or combined approach. Radio and chemotherapy were used for certain indications. More optimally research would be a multicenter randomized trials with large size cohorts.
Highlights
Inverted papillomas generate considerable interest because they are locally aggressive, have a propensity to recur, and are associated with malignancy [1, 2]
A better understanding of alterations in epithelial cell proliferation and cell cycle regulation in inverted papilloma may lead to adjuvant medical therapies to decrease recurrence rates and improve treatment [339]
Endoscopic nasal and sinus diagnosis and surgery are appropriate for diagnosis, followup, and treatment of both limited and recurrent inverted papilloma, provided all patients are made aware of the possibility of recurrence and need for more extensive surgery as a result [386]
Summary
Inverted papillomas generate considerable interest because they are locally aggressive, have a propensity to recur, and are associated with malignancy [1, 2]. Papilloma per se lacks the essential criteria for malignancy, such as metastasis. It has the propensity for invasion into adjacent structures, such as the orbit and CNS, even in the absence of malignancy. Intracranial involvement of inverted papilloma is unusual and is usually seen in recurrent cases [3]. Many aspects of sinonasal inverted papillomas are still controversial [4] and active fields of research. This could be more challenging in a case of intracranial with intra- or extradural extension
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