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ICAR SINONASAL TUMORS

TABLE XVIII.1 Evidence surrounding imaging workup of congenital midline nasal masses (CMNMs).

Clinical endpoints

Study

Year LOE Study design Study groups

Conclusions

1. Similar presentation in adults 2. Rate of intracranial extension of 27.5% in adult cases

Rateof

Vaghela and Bradley 881

2004 2

Systematic review

Adults ( > 16years of

intracranial extension of CMNMs presenting in adulthood imagingat predicting intracranial extension

age) presenting with nasal dermoids across 30 studies ( n = 44)

Winterton et al. 896

2010 4

Retrospective case series

Patients with nasal

1. Utility of

1. Positive and negative predictive values for intracranial extension were 85.7% and 50% for CT and 100% and 50% for MRI, respectively 2. No deep recurrences and 26% superficial nasal recurrence rate at 4years 1. MRI did not show any false-negative results, favoring the use of MRI as primary imaging tool 2. Intracranial extension is equally well detected by CT and MRI using indirect imaging signs 1. CT and MRI appear to be equally sensitive and excellent at detection of CMNMs 2. MRI appears superior in delineating extent and intracranial involvement identifying other concomitant anomalies, especially for encephaloceles

dermoid sinus cysts with 4-year follow-up ( n = 19)

2. Deepand superficial recurrence

rates at 4years

Huisman et al. 877

1. Imaging char acteristics 2. Sensitivity andCTand MRI modalities 1. Imaging char acteristics 2. Sensitivity andCTand MRI modalities

2004 4

Retrospective case series

Children with CMNMs (nine dermoids, one meningocele, one glioma) ( n = 11)

Barkovich et al. 893

1991

4

Case–control

Children with CMNMs (eight encephaloceles, seven dermoids, one glioma) and 45 matched normal patients as controls ( n = 61)

Abbreviations: CMNMs, congenital midline nasal masses; CT, computed tomography; MRI, magnetic resonance imaging.

(20%). 891 MRI reveals a soft tissue mass, usually isointense to brain and with contiguous connection with the sub arachnoid space. 892 CT may also help in identifying the osseous defects associated with encephaloceles and surgi cal planning. 893 Early surgical intervention appears to be associated with improved prognosis. 891 E Role of imaging Imaging is essential in the workup of congenital midline nasal masses to both accurately diagnose the lesion and identify potential intracranial involvement, which may occur in up to 30%–40% of cases (Table XVIII.1). 894,895 Both MRI and CT imaging are usually obtained, and both modalities appear to be equally sensitive and excellent at

detection of CMNMs. 893 Findings suggestive of intracra nial extension on CT may include a widened/bifid nasal septum or crista galli, as well as bony defects in the crib riform or ethmoid skull base. However, MRI appears to be superior in delineating soft tissue extent and intracranial involvement, as well as other concomitant anomalies. 893 In addition, due to its multiplanar capabilities, different image sequences, and lack of radiation exposure, many authors favor using MRI as primary imaging modality in children. 877,880,891–893 Of note, neither technique is able to completely visualize the sinus tract itself, which can be seen in dermoids and gliomas, especially if they are small. For nasal dermoids, the PPV and NPV for intracranial extension appear to be 86% and 50% for CT and were 100% and 50% for MRI, requiring a high index of intraoperative suspicion to ensure complete excision of the tract. 896