Endonasal Endoscopic Approach for a Psammomatous Juvenile Active Ossifying Fibroma: 2-Dimensional Operative Video

We present the case of an 18-yr-old female with 4 mo of progressive vision loss in the left eye. She underwent a computed tomography (CT) and magnetic resonance imaging (MRI), which revealed a large mass in the sphenoid sinus, sella, and anterior cranial fossa. This mass was T1 isointense, with heterogenous enhancement noted on T1 with gadolinium sequences. The mass was found to have calcifications and cystic portions on T2-weighted MRI scans and CT-based imaging. She underwent an endonasal endoscopic approach for resection of the mass. The tumor was found to be bloody, with islands of bone nests within the dura mater of the anterior cranial fossa. The patient improved postoperatively. The pathological diagnosis was found to be the psammomatoid variant of juvenile active ossifying fibroma (JAOF). We present the neuroimaging, anatomic nuances,1 and operative techniques used in this case. We also review the disease background of this rare lesion of the anterior skull base.2-4 The patient gave informed consent for the procedure and verbal consent for the publication of this article.