Commentary “Malignant Solitary Fibrous Tumor of the Nasal Cavity”

Zeitler and coworkers report a case of a malignant solitary fibrous tumor of the nasal cavity and paranasal sinuses with extension into the orbit and intracranial space. These rare tumors of mesenchymal origin were originally described in the intrathoracic region but have since been found in many extrathoracic sites, including the head and neck region. The case presented is especially rare in that the histopathology revealed a malignant tumor, and on gross pathology it was found to be an aggressive tumor, having eroded through the anterior skull base. It is unfortunate that the authors are unable to follow this patient clinically to see whether this tumor would have recurred or metastasized, acting in a clinically malignant fashion after complete resection.

We agree that the midfacial degloving approach combined with either a conventional frontal craniotomy or the subcranial approach provides excellent exposure of both nasal cavities, ethmoid complexes, maxillary sinuses, ethmoid roof, cribriform plates, sphenoid sinuses, nasopharynx, and anterior skull base. This approach was an excellent means by which to ensure en bloc resection of this complex tumor with negative margins. Furthermore, this approach offers excellent cosmesis without disfiguring facial incisions.