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J Neurol Surg B Skull Base 2022; 83(S 02): e555-e563
DOI: 10.1055/s-0041-1735558
Original Article

Treatment and Prognosis of Inflammatory Pseudotumor of the Skull Base

Sidney J. Perkins 
1   Medical School, University of Michigan Medical School, Ann Arbor, Michigan, United States
,
Rebecca Gao
2   Department of Otolaryngology—Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, United States
,
Tiffany A. Glazer
3   Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin, Madison, Wisconsin, United States
,
Cher X. Zhao
4   Department of Otolaryngology, Harvard Medical School, Pediatric Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, United States
,
Gregory Basura 
2   Department of Otolaryngology—Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, United States
,
Erin L. McKean
2   Department of Otolaryngology—Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, United States
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Abstract

Background Inflammatory pseudotumor (IPT) of the skull base is a rare, locally destructive lesion managed with a variety of treatments. We explore the impact of treatment on outcome and assess the prognosis of IPT.

Methods This is a retrospective review of IPT of the skull base at a tertiary academic medical center. The primary outcome was radiographic progression after treatment. Outcome versus tumor location was also examined and a prognostic model was developed using a logistic regression.

Results The demographics of 21 patients with IPT are reported. Treatment consisted of corticosteroids (in 80.1% of patients), disease modifying antirheumatic drugs (DMARDs; 33.3%), surgical resection (28.6%), radiation (23.8%), antibiotics (14.3%), chemotherapy (rituximab; 9.5%), and antivirals (4.8%). At 50.7 months, 50.8% had radiographic progression. Local therapy trended toward having a better response than systemic therapy (p = 0.60). IPT of the orbit required 2.4 treatment modalities, compared with 2.0 for pharyngeal IPT, and 1.3 for posterior skull base masses (p = 0.14). A total of 75% orbital IPT underwent radiographic progression, compared with 71% of pharyngeal IPT and 50% of posterior skull base masses (p = 0.62). Sixteen patients were used to create the logistic model of radiographic progression. The Cox–Snell R 2 was 0.71 (p = 0.03). No individual variables were statistically significant.

Conclusion To our knowledge, this is among the largest sample of cases describing the presentation, treatment, and prognosis of IPT of the skull base. Our data suggest that there may be an improved response with local therapy over systemic therapy and better prognosis among posterolateral skull base masses.

Keywords

Inflammatory pseudotumor - skull base - plasma cell granuloma - inflammatory myofibroblastoma - fibroinflammatory pseudotumor


Publication History

Received: 12 April 2021

Accepted: 25 July 2021

Article published online:
10 September 2021

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