Solitary fibrous tumor of the middle cranial fossa: Literature review and case report

Abstract

Solitary fibrous tumors (SFTs) exceptionally occur at the middle cranial fossa. A midline search from January 1997 up to June 2021 selected 16 articles for a total of 19 patients, where the tumor attachment was completely or largely (>75%) at the middle cranial fossa. The unique personal case concerns a 35 years old woman complaining of left hypoacusia and moderate left facial paresis. A high grade SFT of the left middle fossa was resected, with no recurrence 8 years after surgery and irradiation. The 20 patients of the review, including ours, are 11 men and 9 women with a median age of 47 years. The location was mainly intradural (47%) or extra-intradural (42%); the invasion of the petrous bone was evidenced in a half of the patients. Symptoms of involvement of the Vth, VIIth and VIIIth cranial nerve were more frequent (3/4 of the cases). Variable T2 signal, lobulated margins and inhomogeneous enhancement were the most frequent MRI features. Histologically most tumors (70%) were WHO grade III and 23% grade I. A gross total resection was possible in 55% of the cases. The recurrence rate is significant (23,5%). Older patient age (>50 years), large tumor size, incomplete resection and high WHO grade histology are significant prognostic factors for recurrence. However, the outcome is sometimes unpredictable. Thus, a follow-up by serial MRI studies is strongly advisable.

Keywords

• Solitary fibrous tumor
• Hemangiopericytoma
• Middle cranial fossa
• Petrous bone
• Hypoglossal-facial nerve anastomosis