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
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Weitere Informationen

Publikationsverlauf

08. Juli 2016

16. September 2016

Publikationsdatum:
30. Dezember 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.


 
  • References

  • 1 Regezi JA, Kerr DA, Courtney RM. Odontogenic tumors: analysis of 706 cases. J Oral Surg 1978; 36 (10) 771-778
  • 2 Rajasekhar G, Vura NG, Sudhir R, Dhanala S, Alwala AM. Versatility of Dieffenbach's modification of Weber Fergusson's approach for treatment of maxillary pathologies. J Maxillofac Oral Surg 2012; 11 (04) 416-419
  • 3 Bredenkamp JK, Zimmerman MC, Mickel RA. Maxillary ameloblastoma. A potentially lethal neoplasm. Arch Otolaryngol Head Neck Surg 1989; 115 (01) 99-104
  • 4 Goldenberg D, Sciubba J, Koch W, Tufano RP. Malignant odontogenic tumors: a 22-year experience. Laryngoscope 2004; 114 (10) 1770-1774
  • 5 Olaitan AA, Adeola DS, Adekeye EO. Ameloblastoma: clinical features and management of 315 cases from Kaduna, Nigeria. J Craniomaxillofac Surg 1993; 21 (08) 351-355
  • 6 Zwahlen RA, Grätz KW. Maxillary ameloblastomas: a review of the literature and of a 15-year database. J Craniomaxillofac Surg 2002; 30 (05) 273-279
  • 7 Arotiba GT, Effiom AO, Ayodele AS. , et al. A classification system for recurrent ameloblastoma of the jaws—review of 30 cases in Nigerians. Nig Q J Hosp Med 2012; 22 (01) 44-51
  • 8 Brazis PW, Miller NR, Lee AG, Holliday MJ. Neuro-ophthalmologic aspects of ameloblastoma. Skull Base Surg 1995; 5 (04) 233-244
  • 9 Harrer WV, Patchefsky AS. Mandibular ameloblastoma with intracerebral and pulmonary metastasis. Oral Surg Oral Med Oral Pathol 1970; 29 (06) 893-898
  • 10 Hoffman PJ, Baden E, Rankow RM, Potter GD. The fate of the uncontrolled ameloblastoma. Oral Surg Oral Med Oral Pathol 1968; 26 (04) 419-426
  • 11 Kunze E, Donath K, Luhr HG, Engelhardt W, De Vivie R. Biology of metastasizing ameloblastoma. Pathol Res Pract 1985; 180 (05) 526-535
  • 12 Munir M. Ameloblastoma of the jaws. Gan To Kagaku Ryoho 2000; 27 (Suppl. 02) 261-267
  • 13 Scaccia FJ, Strauss M, Arnold J, Maniglia AJ. Maxillary ameloblastoma: case report. Am J Otolaryngol 1991; 12 (01) 20-25
  • 14 Yoshida K, Kawase T, Tomita T. , et al. Surgical strategy for tumors located in or extending from the intracranial space to the infratemporal fossa—advantages of the transcranial approach (zygomatic infratemporal fossa approach) and the indications for a combined transcranial and transcervical approach-. Neurol Med Chir (Tokyo) 2009; 49 (12) 580-586
  • 15 Zarbo RJ, Marunick MT, Johns R. Malignant ameloblastoma, spindle cell variant. Arch Pathol Lab Med 2003; 127 (03) 352-355
  • 16 Leibovitch I, Schwarcz RM, Modjtahedi S, Selva D, Goldberg RA. Orbital invasion by recurrent maxillary ameloblastoma. Ophthalmology 2006; 113 (07) 1227-1230
  • 17 Sato K, Sudo S, Fukuya Y, Sakuma H. Maxillary ameloblastoma with intracranial invasion—case report. Neurol Med Chir (Tokyo) 1994; 34 (10) 704-707
  • 18 Hayashi N, Iwata J, Masaoka N, Ueno H, Ohtsuki Y, Moriki T. Ameloblastoma of the mandible metastasizing to the orbit with malignant transformation. A histopathological and immunohistochemical study. Virchows Arch 1997; 430 (06) 501-507
  • 19 Oka K, Fukui M, Yamashita M. , et al. Mandibular ameloblastoma with intracranial extension and distant metastasis. Clin Neurol Neurosurg 1986; 88 (04) 303-309
  • 20 Phillips SD, Corio RL, Brem H, Mattox D. Ameloblastoma of the mandible with intracranial metastasis. A case study. Arch Otolaryngol Head Neck Surg 1992; 118 (08) 861-863
  • 21 Bailey IC. Intracranial spread of adamantinoma. Case report. J Neurosurg 1966; 25 (04) 455-457
  • 22 Dandriyal R, Gupta A, Pant S, Baweja HH. Surgical management of ameloblastoma: conservative or radical approach. Natl J Maxillofac Surg 2011; 2 (01) 22-27
  • 23 Woodroffe RW, Abel TJ, Fletcher A. , et al. Endoscopic transnasal resection of ameloblastoma with intracranial extension. J Clin Neurosci 2014; 21 (05) 855-859
  • 24 Kyriazis AP, Karkazis GC, Kyriazis AA. Maxillary ameloblastoma with intracerebral extension. Report of a case. Oral Surg Oral Med Oral Pathol 1971; 32 (04) 582-587
  • 25 Baumgarten P, Harter PN, Tönjes M. , et al. Loss of FUBP1 expression in gliomas predicts FUBP1 mutation and is associated with oligodendroglial differentiation, IDH1 mutation and 1p/19q loss of heterozygosity. Neuropathol Appl Neurobiol 2014; 40 (02) 205-216