Skull base inverted papilloma (IP) is an unusual entity for many neurosurgeons. IP is renowned for its high rate of recurrence, its ability to cause local destruction, and its association with malignancy. This paper is a comprehensive review of the reports, studies, and reviews published in the current biomedical literature from 1947 to September 2010 and synthesize this information to focus on its potential invasion to the base of the skull and possible intradural extension. The objective is to familiarize the clinician with the different aspects of this unusual disease. The role of modern diagnostic tools in medical imaging in order to assess clearly the limits of the tumors and to enhance the efficiency and the safety in the choice of a surgical approach is pointed out. The treatment guidelines for IP have undergone a complex evolution that continues today. Radical excision of the tumour is technically difficult and often incomplete. Successful management of IP requires resection of the affected mucosa which could be achieved with open surgery, endoscopic, or combined approach. Radio and chemotherapy were used for certain indications. More optimally research would be a multicenter randomized trials with large size cohorts. 1. Background Inverted papillomas generate considerable interest because they are locally aggressive, have a propensity to recur, and are associated with malignancy [1, 2]. Recurrent disease and metachronous carcinoma can develop after a prolonged period of time [2]. Skull base inverted papilloma is a benign sinonasal neoplastic proliferation. Papilloma per se lacks the essential criteria for malignancy, such as metastasis. It has the propensity for invasion into adjacent structures, such as the orbit and CNS, even in the absence of malignancy. Intracranial involvement of inverted papilloma is unusual and is usually seen in recurrent cases [3]. Recognition of the propensity for recurrence and the association with malignancy has led to the evolution of treatment. Many aspects of sinonasal inverted papillomas are still controversial [4] and active fields of research. This could be more challenging in a case of intracranial with intra- or extradural extension. 2. Definition The term papilloma means neoplasia with epithelial growth. The US National Cancer Institute’s [5] has defined inverted papilloma as a type of tumor in which surface epithelial cells grow downward into the underlying supportive tissue. The term inverted is derived from the characteristic proliferation of metaplastic surface epithelium (respiratory, transitional, or
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