title: Inflammatory Pseudotumors of the Skull Base: Meta-Analysis.
abstract: OBJECTIVE
  To describe the presentation, treatment, and outcome of inflammatory pseudotumors (IPs) of the skull base.
  
  
  METHODS
  English-language articles in PubMed, Web of Science, and EMBASE from earliest available through April 2014.
  
  
  METHODS
  Articles were identified using a keyword search for "inflammatory pseudotumor," "inflammatory myofibroblastoma," or "plasma cell granuloma," including a keyword localizing to the skull base.
  
  
  METHODS
  One hundred papers with 157 cases met inclusion criteria. History, tumor site, initial and subsequent treatment, outcomes, and complications were extracted. Student t test, z test, and analysis of variance were used to analyze demographics, symptoms, sites involved, and outcomes. Odds ratios for site versus initial treatment were calculated.
  
  
  RESULTS
  At diagnosis, average patient age was 41 years. Approximately 70% of lesions primarily involved the anterior skull base, 29% the lateral skull base, and 1.2% the occiput. The most common initial treatments were steroids (44%), surgery (28%), and surgery with steroids (16%). Anterior lesions were 55.8 times more likely than lateral lesions to be treated initially with steroids (CI, 14.7-212). Seventy-six percent of patients had stable or resolved symptoms after a single course of treatment.
  
  
  CONCLUSIONS
  Diagnosis of skull base IP requires ruling out other aggressive pathologies, such as malignancy and infection, and maintaining a high index of suspicion. Surgery is favored for lesions that can be removed in toto with minimal morbidity, as well as steroids for those sites where anatomy limits complete resection, such as within the orbit, cavernous sinus, or brain. An option for larger lesions involving vital anatomy is debulking, followed by postoperative steroids.
authors.affiliation: *Departments of Otolaryngology-Head and Neck Surgery, †Neurosurgery, and ‡Pathology, Stanford University School of Medicine, Stanford, California; and §Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Alyono
authors.forename: Yangyang
authors.initials: Y
authors.lastname: Shi
authors.forename: Gerald J
authors.initials: GJ
authors.lastname: Berry
authors.forename: Lawrence D
authors.initials: LD
authors.lastname: Recht
authors.forename: Griffith R
authors.initials: GR
authors.lastname: Harsh
authors.forename: Robert K
authors.initials: RK
authors.lastname: Jackler
authors.forename: C Eduardo
authors.initials: CE
authors.lastname: Corrales
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D018450:Disease Progression; D005260:Female; D006104:Granuloma, Plasma Cell / Q000175:diagnosis / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019291:Skull Base / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones