Sinonasal and ventral skull base inflammatory pseudotumor: a systematic review.
OBJECTIVE
Inflammatory pseudotumor is a benign idiopathic inflammatory process often misdiagnosed as an infection or neoplasm. This review analyzes all reported cases of sinonasal and ventral skull base inflammatory pseudotumor to date, and provides a framework for evaluation and management of this uncommon condition.


METHODS
MEDLINE/PubMed database.


METHODS
A search for articles related to sinonasal and ventral skull base inflammatory pseudotumor, along with bibliographies of those articles, was performed. Demographics, presentation, radiographic findings, treatment, follow-up, and outcome were analyzed.


RESULTS
Thirty-three articles were reviewed, including a total of 87 patients. The most common presenting symptom was vision change (58.6%). Sinonasal and ventral skull base inflammatory pseudotumor was found in the cavernous sinus in 46.0% of cases. The lesion appeared isointense (66.7% of cases) and homogeneously enhancing on T1-weighted magnetic resonance imaging (MRI), whereas it appeared hypointense on T2-weighted MRI in 90.7% of cases. Inflammatory pseudotumor appeared hyperdense on computed tomography in 78.9% of cases. Histopathological analysis of biopsied specimens revealed presence of inflammatory cells (94.4%) and fibrosis (80.3%). Corticosteroids alone were the most common treatment modality (55.2%), resulting in disease-free patients in 22.9% of cases over a median follow-up period of 17.6 months. Surgical management alone was uncommon (8.0%), but showed high success rate (57.1%).


CONCLUSIONS
This review is the most comprehensive analysis of sinonasal and ventral skull base inflammatory pseudotumor to date. Radiologic findings and histopathological analysis are essential for diagnosis. Corticosteroids are the most common treatment modality. Surgery, although uncommon, appears to be an efficacious treatment modality.
Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.
Stuti V
SV
Desai
Eleonora F
EF
Spinazzi
Christina H
CH
Fang
Grace
G
Huang
Senja
S
Tomovic
James K
JK
Liu
Soly
S
Baredes
Jean Anderson
JA
Eloy
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D002648:Child; D002675:Child, Preschool; D004724:Endoscopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006104:Granuloma, Plasma Cell / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D007150:Immunohistochemistry; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D010254:Paranasal Sinus Diseases / Q000175:diagnosis / Q000628:therapy*; D018570:Risk Assessment; D012720:Severity of Illness Index; D019291:Skull Base / Q000473:pathology* / Q000503:physiopathology; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult
D000305:Adrenal Cortex Hormones
Inflammatory pseudotumor; endoscopic skull base surgery; head and neck inflammatory pseudotumor; sinonasal; sinonasal skull base inflammatory myofibroblastic tumor; sinonasal skull base inflammatory pseudotumor; skull base inflammatory myofibroblastic tumor; skull base surgery; ventral skull base; ventral skull base pseudotumor