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Combined endovascular therapy and surgery for central giant cell granuloma in the temporal bone: A case report
Takayuki Morimoto1, Sung-Chul Ko1, Keiji Shimada2
1Department of Neurosurgery, Nara City Hospital, Nara, Japan.
Insights
Central giant cell granuloma (CGCG) is a rare benign bone lesion. This study details a unique case of temporal bone CGCG treated with embolization and surgery, achieving subtotal resection.
Area of Science:
- Otolaryngology
- Neurosurgery
- Radiology
Background:
- Central giant cell granuloma (CGCG) is an uncommon benign intraosseous lesion.
- CGCG typically affects the mandible and maxilla.
- Rare occurrences in the temporal bone present unique diagnostic and therapeutic challenges.
Observation:
- A 31-year-old female with a history of Kawasaki disease presented with a right ear obstruction.
- Imaging revealed a temporal bone mass with osteolytic changes and invasion of surrounding structures.
- Angiography identified multiple arterial feeders to the lesion.
Findings:
- The temporal bone mass was diagnosed as CGCG via histopathology.
- A combined endovascular embolization and surgical resection approach was employed.
- Subtotal resection was achieved, preserving critical anatomical structures.
Implications:
- This case highlights the successful management of a rare temporal bone CGCG.
- Multidisciplinary treatment involving endovascular therapy and surgery can be effective.
- Preservation of function and surrounding structures is achievable with this combined approach.
Background:
Central giant cell granuloma (CGCG) is an uncommon, benign intraosseous lesion that most frequently occurs in the mandible and maxilla.
Case Description:
A 31-year-old female with a medical history of Kawasaki disease presented to our hospital complaining of a clogged right ear. Head computed tomography revealed a mass in the squamous part of the right temporal bone, with osteolytic changes and invasion of the external auditory canal, middle ear, temporomandibular joint, and mastoid air cells. Enhanced magnetic resonance imaging (MRI) showed a strong signal in the intraosseous lesion. Digital subtraction angiography revealed tumor staining from multiple feeders, including the middle meningeal, posterior deep temporal, and posterior auricular arteries. Preoperative feeder embolization using a detachable coil and Embosphere Microspheres were performed for the middle meningeal artery under general anesthesia. After the endovascular treatment, we operated on the temporal bone lesion. Postoperative enhanced MRI showed subtotal resection and residual tumor near the external auditory canal, which was left in place to prevent opening the external auditory canal. The histopathological examination showed proliferation of mononuclear cells intermingled with osteoclast-like multinucleated giant cells. A diagnosis of CGCG was made. The postoperative course was uncomplicated, and the patient was discharged on day 10 of hospitalization.
Conclusion:
We reported a rare case of CGCG in the temporal bone, managed by endovascular therapy and surgical resection. This combination therapy resulted in subtotal resection, preserving surrounding normal structures, such as the external auditory canal and tympanic cavity.
