J Neurol Surg A Cent Eur Neurosurg 2017; 78(06): 582-587
DOI: 10.1055/s-0036-1594236
Technical Note
Georg Thieme Verlag KG Stuttgart · New York

Intracranial Ameloblastoma Arising from the Maxilla: An Interdisciplinary Surgical Approach

Johanna Quick-Weller
1   Department of Neurosurgery, Goethe-University Frankfurt, Frankfurt, Germany
,
Felix Koch
2   Department of Oral, Cranio-Maxillofacial, and Facial Plastic Surgery, Goethe-University Frankfurt, Frankfurt, Germany
,
Nazife Dinc
1   Department of Neurosurgery, Goethe-University Frankfurt, Frankfurt, Germany
,
Stephanie Lescher
3   Institute for Neuroradiology, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
,
Peter Baumgarten
1   Department of Neurosurgery, Goethe-University Frankfurt, Frankfurt, Germany
,
Patrick Harter
4   Edinger Institute, Neurological Institute, Goethe-University Frankfurt, Frankfurt, Germany
,
Friedrich Scheerer
2   Department of Oral, Cranio-Maxillofacial, and Facial Plastic Surgery, Goethe-University Frankfurt, Frankfurt, Germany
,
Robert Sader
2   Department of Oral, Cranio-Maxillofacial, and Facial Plastic Surgery, Goethe-University Frankfurt, Frankfurt, Germany
,
Volker Seifert
1   Department of Neurosurgery, Goethe-University Frankfurt, Frankfurt, Germany
,
Gerhard Marquardt
1   Department of Neurosurgery, Goethe-University Frankfurt, Frankfurt, Germany
,
Thomas Freiman
1   Department of Neurosurgery, Goethe-University Frankfurt, Frankfurt, Germany
› Author Affiliations
Further Information

Publication History

08 July 2016

16 September 2016

Publication Date:
30 December 2016 (online)

Abstract

Background Ameloblastomas are a rare tumor entity accounting for only 10% of all odontogenic tumors. They mostly originate from the mandible. Only a few cases are known to grow aggressively and to invade the orbit, nasal cavity, or even the brain.

Patient and Methods/Case Report We present the case of a 57-year-old patient who was admitted with a huge tumor involving the nasal cavity, the left maxilla, and the anterior fossa. Histologic diagnosis was made by biopsy. A combined two-stage neurosurgical maxillofacial approach was planned. First the intracranial tumor mass was removed using bifrontal trepanation. A duraplasty was sewn in to cover the brain. In the second procedure, a combined bifrontal and midfacial approach was used by craniofacial plastic surgeons and neurosurgeons. A perisinusoidal tumor mass and retropharyngeal tumor mass was removed up to the skull base. The left orbit was completely exenterated, and a fibular bone-muscle graft was used for palatal, orbital, and facial reconstruction. The facial vein and artery were carefully prepared to feed the bone-muscle graft by end-to-end anastomoses.

Conclusion Ameloblastomas are very rare slow-growing tumors that show a tendency to recur. They are responsible for only 1% of all oral tumors. Their growth can be enormous, and they can extend into sinusoidal cavities, the orbit, and the brain. Complex and extensive palliative surgery can ease the concerns of these patients and prolong their survival.

Funding

No funding was received for this research.