26 yr old male with epistaxis n decreased vision in right eye more than left.endoscopic nasal biopsy attempted but abandoned due to bleeding in periphery.possible dds.mx.surgical approach.?

1 Like

LikeAnswersShare

That appears like a Sino nasal malignant lesion though the present cut is if brain but nasal mass with this pic is s/o malignant nasal mass. Most likely this would be a high grade Tumor like esthesioneuroblastoma/ undifferentiated ca.. plz refer to a higher centre to a skull base surgeon. I practice In Ahmedabad, Gujarat as endoscopic skull base surgeon. Would be very much happy to help this pt

Sir i agree with u. Contrast CT and Contrast MRI should be done to determine the site of origin of the lesion . Sino nasal malignancies are rare and are known to present like this. Decompression of rt optic nerve is of prime importance as an urgent procedure. I would have done a rt frontal craniotomy with maximal safe resection of tumor on rt side and across the falx as a neurosurgeon. What approach do u prefer sir?
0

right frontal or bicoronal as u would most probably need a good pericranial flap to prevent csf rhinorrhea postoperatively.

It's cavernous sinus syndrome Will require bifrontal craniotomy with osteotomies for skull base approach depending on the lesions encroachment of which areas below the orbital plate

Other cuts in the Scan, Clinical photograph and Endoscopic appearance would be more helpful to decide on the case. A large Institution with ENT Skull Base. And Neuro Surgeons should deal the case.

could be tumor related to pns could also be cavernoma impinging on orbit else optic nerve tumor needs mri may be referred to consulting ophthalmologist for the needful radiofrequency ablation or fenestration may be considered

Heterogenous extraaxial anterior cranial foss mass lesion with edema in adjacent frontal lobes Imaging and clinical features are in favour of olfactory neuroblastoma

A contrast MRI brain is needed

Look like fresh bleed in frontal lobes , image is poor cannot comment further

R/o lesion, vascular & inf.