A case of a large solitary fibrous tumor of the paranasal sinus with intracranial and orbital extension

Solitary fibrous tumor (SFT) is a rare mesenchymal neoplasm, and cases originating from the sinonasal cavity with intracranial extension are very uncommon.Here, we report a case of sinonasal SFT with intracranial and orbit extension that was successfully resected using a combined endoscopic endonasal and transcranial approach.A 70-year-old man was incidentally found to have a right sinonasal tumor, and a biopsy confirmed the diagnosis of SFT.Imaging studies demonstrated that the tumor was confined to the extradural space and that the orbital periosteum was preserved, suggesting that radical surgical resection was feasible.With regard to surgical management, bilateral maxillary arteries were first managed using an endoscopic endonasal approach to achieve adequate bleeding control, followed by tumor resection through a frontal craniotomy.The skull base was reconstructed using a multilayer technique with a temporalis muscle-pericranial flap, fascia lata, and iliac bone.The postoperative course was uneventful, and contrast-enhanced MRI showed no evidence of residual tumor or recurrence.These findings suggest that a combined endoscopic endonasal and transcranial approach represents a useful surgical strategy that can achieve both radicality and functional preservation in patients with sinonasal SFT with intracranial extension.