ABSTRACTAneurysmal bone cysts (ABCs) are benign tumors caused by a disturbance in intraosseous circulation. These lesions typically involve the metaphysis of the long tubular bones in patients younger than 20 years old. Previous research has reported the rarity of ABCs in the skull base, but only a limited number of reports have been published. This study presents a case of a giant skull base ABC in a 39-year-old man with acute visual impairment. Magnetic resonance imaging and computed tomography revealed multiple cystic lesions in the right middle cranial fossa. Given the complexity of the tumor and its critical location, we adopted a two-stage surgical approach. The initial surgery achieved subtotal resection, successfully alleviating symptoms and improving the patient’s visual acuity. Subsequently, a second stage operation utilizing a combined transcranial and endoscopic endonasal approach enabled gross total resection of the residual tumor. No recurrence has been observed for more than one year, demonstrating the efficacy of this staged treatment strategy. Total resection is the optimal treatment for ABCs, but complete resection can be challenging when the lesion extends into the skull base. While radical resection is recommended, symptom relief and complication minimization are equally important. Our case demonstrates that a two-stage surgical approach is a viable and effective option, particularly for recurrenceprone giant ABCs in the cranial base. Notably, no previous reports have described multi-stage surgical treatment for ABCs, highlighting the potential of this strategy for both early symptom relief and long-term disease control.
ADACHI et al. (Tue,) studied this question.