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Background:
Case Report

Delayed Presentation of Nasal Glioma—Case Report and Literature Review

by
Prabhpreet Kaur
1,
Yilong Wu
2,
Henry K. K. Tan
3,
Sze Jet Aw
4,
Wan Tew Seow
2,5,6 and
Sharon Y. Y. Low
2,5,6,7,*
1
NUS Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
2
Neurosurgical Service, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore
3
Department of Otolaryngology, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore
4
Department of Pathology and Laboratory Medicine, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore
5
Department of Neurosurgery, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore
6
SingHealth Duke-NUS Neuroscience Academic Clinical Program, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore
7
SingHealth Duke-NUS Pediatrics Academic Clinical Program, 100 Bukit Timah Road, Singapore 229899, Singapore
*
Author to whom correspondence should be addressed.
Surgeries 2026, 7(2), 56; https://doi.org/10.3390/surgeries7020056
Submission received: 8 March 2026 / Revised: 28 April 2026 / Accepted: 29 April 2026 / Published: 4 May 2026
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Abstract

Background: Nasal glioma (NG), also known as nasal glial heterotopia, is an extremely rare congenital anomaly characterized by the presence of mature glial tissue outside the cranial cavity. Most patients present with midline craniofacial malformations at birth. However, a small subset of them is entirely intranasal and have no accompanying visible features. We present an unusual case of delayed diagnosis of NG, in tandem with a systematic literature review. Methods: A previously well 2-year-old male presented with obstructive apnea secondary to an intranasal mass. Neuroimaging of his paranasal sinuses demonstrated a bony defect in the anterior cribriform plate with herniation of a soft tissue structure into the right nasal cavity. He underwent craniotomy, total excision of the lesion and repair of skull base defect. His postoperative period was uneventful with resolution of his symptoms. Histology reported infiltrates of mature glial tissue with rare neurons forming the excised nasal mass. We conducted a structured literature review using PRISMA guidelines to evaluate clinical features of NG. Results: A comprehensive search of PubMed and Scopus databases featured 133 published cases of NG relevant to our case. Overall, NG is more common in males, with most cases diagnosed within the first year of life. Clinical presentation usually involved an external nasal mass (82.8%) and/or respiratory symptoms (28.7%), with prenatal detection reported in a subset of cases. Magnetic resonance imaging was the preferred imaging modality. Surgical excision was the mainstay of treatment. Postoperative outcomes were favorable in most patients, with 84.7% showing no complications or recurrence. Incomplete excision was associated with recurrence (10%). Conclusions: We present an intranasal case of NG with late diagnosis that was successfully managed with surgery. Our review underscores the importance of early imaging, accurate diagnosis, and complete surgical resection for best outcomes in affected children.

1. Introduction

Nasal gliomas (NG) are extremely rare entities [1,2]. These congenital lesions are hypothesized to occur due to incomplete closure of the anterior neuropore between the nasal and frontal skull bones. During retraction of the embryonic dural diverticulum, remnants of neural glial tissue become sequestered when their connections to the subarachnoid space are separated out and obliterated [3,4]. As a result, an abnormal connection persists between embryonic ectodermal and neuroectodermal elements [1]. Subsequently, a mass of mature glial cells is found in a location outside the central nervous system (CNS) [5,6]. Complete surgical excision is the recommended treatment of choice. The current consensus is that NGs consist of benign, heterotopic neural tissue and the term ‘glioma’ is a misnomer [7]. Although the alternative label of ‘nasal glial heterotopia’ has been proposed, this entity’s traditional nomenclature is still applicable today. For the purposes of this writing, we henceforth refer to the diagnosis of ‘nasal glioma’ or ‘nasal glial heterotopia’ as ‘NG’. Most patients present with visually apparent midline craniofacial malformations at birth [1]. However, a small subset of NGs are entirely intranasal and have no accompanying visible features. We present an unusual case of patient with a delayed diagnosis of NG.

2. Case Description

A previously well 2-year-old male presented with a history of an increasing frequency of loud snoring and noisy breathing over a period of 3 months. There were no visually apparent facial anomalies or congenital medical conditions. He was referred to an Ear, Nose and Throat (ENT) specialist for evaluation. Nasal endoscopy revealed a right intranasal mass—a likely underlying cause of his symptoms of obstructive sleep apnea. Follow-up imaging was arranged. This included a computed tomographic (CT) imaging of his paranasal sinuses which demonstrated a bony defect in the anterior cribriform plate with herniation of a soft tissue structure into the right nasal cavity. Based on CT modality alone, it is difficult to evaluate for brain herniation due to surrounding bony density and lack of soft tissue contrast. Subsequent magnetic imaging resonance (MRI) of his brain confirmed this herniated tissue to be a lobulated, fluid-filled mass causing distortion of the right olfactory nerve. There was no observed contrast enhancement of the mass. At this point, the differential diagnoses included either a meningocele or encephalocele (Figure 1).
A multi-disciplinary team (MDT) discussion between the ENT, neurosurgery and plastic surgery teams was convened. Pertinent perioperative concerns were those of bleeding, infection, cerebrospinal spinal fluid (CSF) leak and frontal lobe prolapse into the paranasal space. The decision was made for the patient to undergo craniotomy, total excision of the lesion and open repair of the skull base defect. Intraoperatively, there was no connecting stalk encountered between the mass and the subarachnoid space. The mass was removed en bloc and the defect on the floor of the anterior cranial fossa was repaired with a synthetic graft to prevent interval parenchyma herniation. His postoperative period was uneventful with resolution of his initial presenting symptoms. Histology reported infiltrates of mature glial tissue with rare neurons forming the excised nasal mass, consistent with the diagnosis of NG (Figure 2). At 10 years’ follow-up, the patient was clinically well with no sleep apnea symptoms. Although no subsequent imaging was performed, surveillance nasal endoscopies performed in the outpatient setting did not show recurrence of the excised NG.

3. Systematic Literature Review

A comprehensive search of the literature was conducted using two databases, PubMed and Scopus Review, using the following keywords: (“glioma” OR “glial” OR “neuroglial”) AND (“nasal” OR “endonasal” OR “nose” OR “intranasal” OR “extranasal”) AND (“heterotopia” OR “heterotopic”), including records up to 30 April 2024. Duplicates between the two databases were removed. Screening of search results was conducted in three sequential stages: first by title, then by abstract, and then by full-text based on predetermined inclusion and exclusion criteria [8]. A total of 171 articles from PubMed and 392 articles from Scopus were identified. During the initial screening by title, 272 articles were excluded—these included publications before the year 2000, papers that focused on topics clinically irrelevant to our case, lesion locations not in the nasal region, and pathologies that were not glial heterotopia. Next, when screening by abstract, 36 articles were excluded for non-English language texts or lack of original clinical cases. Lastly, when screening via full-text, 43 articles were excluded for lack of relevant clinical information or unavailable full text. Figure 3 illustrates this process–with the corresponding number of studies and cases selected–in the form of a PRISMA flowchart [8,9].

3.1. Demographic Characteristics

The systematic review included 133 cases of NG from 71 published studies relevant to our case [1,2,4,5,6,7,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74]. Of these, gender was reported in 122 cases with a slight male predominance (57.4%, n = 70) compared to females (42.6%, n = 52). Age at diagnosis was reported in 119 cases, with most patients diagnosed during the first year of life (67.4%), including prenatal/gestational cases (11.9%, n = 14), newborns (23.7%, n = 28), infants aged 1–6 months (19.5%, n = 23), and infants aged 6 months to 1 year (12.3%, n = 15). Children aged 1 to 3 years old constituted 22.9% (n = 27) of cases, while only 7.6% (n = 9) were diagnosed between 4 to 18 years old, and 1.7% (n = 2) in adulthood (Figure 4a,b).

3.2. Clinical Presentation

Clinical presentation was documented in 118 of 133 cases. Respiratory symptoms due to nasal obstruction were the most common presentations (47.5%, n = 58), including respiratory distress, noisy breathing, dyspnea, cyanosis, rhinorrhea, and nasal congestion or discharge. In severe cases (4.2%, n = 5), patients required endotracheal intubation or ventilatory support, or experienced failed extubation as reported by Al-Amar et al. [24]. Five patients required endotracheal intubation or experienced failure of extubation. The second most common presenting feature was an external mass, lump, or polyp in or on the nose/nasal cavity (41.0%, n = 50). Some of these masses had distinctive appearances, such as subcutaneous blue or red coloration along the nasal bridge [62], or a purplish mass with multiple telangiectatic vessels [27]. Prenatal detection on sonography occurred in 11.5% (n = 14) of cases. Occasionally, unusual clinical presentations such as strabismus [18] and laceration due to manual manipulation by the infant [21] were reported (Figure 5).

3.3. Diagnostic Methods and Imaging Features

Various methods were employed across the 116 cases with reported diagnostic approaches. MRI was the most common imaging modality, used either alone (48.7%, n = 56) or in combination with CT (26.1%, n = 30). CT alone was used in 22.6% (n = 26) of cases, while ultrasound (US) either alone or with other modalities was used in 17.4% (n = 20) of cases. Endoscopic examination was performed in 13.0% (n =15) of cases. Key differential diagnoses included hemangioma (6.8%, n = 9) and encephalocele (8.3%, n = 11). Misdiagnosis of NG as hemangioma sometimes led to inappropriate conservative management with corticosteroids [56]. Other differentials included epidermoid cyst and pilocytic astrocytoma [16]. Of the 130 cases with reported imaging features, the most significant finding was the absence of intracranial connection (80.4%, n = 86), which is crucial for distinguishing nasal gliomas from encephaloceles. Bony defects were present in 14.9% (n = 16) of cases, particularly in the floor of the anterior cranial fossa. Infrequently, a cystic component was identified in 4.7% (n = 5) of cases.

3.4. Histopathological Findings

Of the 99 cases with histopathological data, 76.3% (n = 71) showed positive staining for glial fibrillary acidic protein (GFAP) or neurofibrillary background (only), the defining histopathological feature of nasal glial heterotopia. S-100 protein positivity together with the GFAP positivity was reported in 23.7% (n = 22) of cases. The presence of respiratory mucosa was noted in 16.1% (n = 15) of cases. In 30.1% (n = 40) of cases, specific histological features were not mentioned or described, either reporting nothing at all, or simply reporting as “consistent with nasal glioma” (Figure 6).

3.5. Surgical Management and Outcomes

Specified surgical approaches were described in 75 cases. Intranasal and endonasal techniques were predominant (50.0%, n = 37), including rhinotomy/rhinoplasty (medial or lateral) (12.2%, n = 9), external approaches (12.2%, n = 5), trans-nasal (5.4%, n = 4), transoral (4.1%, n = 3), and combined approaches (6.8%, n = 5). Polypectomy was performed in 5.4% (n = 4) of cases. Additional reconstruction following resection was reported in 5.3% (n = 7) of cases. Various adjunctive surgical techniques were reported. For instance, Nair et al. described using digital subtraction angiography and trans-arterial super-selective preoperative embolization to assist with devascularization [63]. Taege et al. reported ablation at the base of the tumor stalk [64], while Sayegh et al. utilized a methylene blue dye injection to identify potential ruptures or connections during dissection [57] (Figure 7).
Duration of postoperative follow-up was reported in 84 cases. Long-term follow-up exceeding 2 years was conducted in 43.4% (n = 36) of cases, while 28.9% (n = 24) were followed for 1–2 years and 27.7% (n = 23) for less than 1 year. Postoperative evaluation data were available for 110 cases. Most reported no complications, or explicitly mentioned satisfactory cosmetic outcomes (85.5%, n = 94). Recurrence or need for revision surgery occurred in 8.2% (n = 9) of cases, due to residual glial tissue [30,39] or incomplete margin resection [4]. Serious complications were rare, including CSF leaks and infections (5.5%, n = 6) and mortality (0.9%, n = 1). Infections included delayed postoperative meningitis via connection between CSF and nasopharyngeal spaces within the sphenoid bone [37], and pneumococcal meningitis in a patient who had CSF leak recurrence 5 years postoperatively [17]. A single reported death occurred in the case described by Okumura et al., where the patient developed postoperative pneumonia progressing to septicemia, despite initial improvement in respiratory symptoms [19]. Cumulative findings of the literature review are summarized in Table 1.
We were particularly interested in the factors that may impact the risk profile of NG patients. To address this, a subgroup analysis using the variables of recurrence, demographics and various surgical approaches were considered. Of note, three newborn cases (10.7%) versus two cases of more than 3 years old (18.2%) are observed to have displayed higher recurrence rates. Although the underlying reasons are unclear at this stage, we postulate that these higher recurrences rate may be related to the intraoperative technical challenges faced during complete removal of all abnormal tissues, and/or identifying clear surgical margins. In our analysis, no significant difference was identified between males (n = 4, 5.7%) and females (n = 3, 5.8%). Regarding surgical approaches, the highest rate of recurrence was seen in the combined approach cohort (n = 2, 20%), followed by the open cranial facial approach (n = 2, 16.7%), rhinotomy (n = 1, 11.1%) and the endoscopic approach (n= 3, 7.1%). Nonetheless, our subgroup analysis is based on a limited sample size due to the low incidence rate of recurrence—likely due to the benign nature of NG—and hence, these findings need to be interpreted with caution. We acknowledge that our descriptive analysis is exploratory due to the inherent heterogeneity of the existing publications and limited sample sizes. Additionally, a formal risk-of-bias assessment was not performed, which should be considered when interpreting the results.

4. Discussion

4.1. Overview of Nasal Gliomas

Neural tube defects occur during the 4th week of gestation due to the failure of the anterior or posterior neuropores to achieve complete fusion, resulting in a persistent connection between the amniotic cavity and the spinal canal [75]. Here, anterior neuropore developmental aberrations have been directly linked to the primary origin of neonatal frontonasal masses—the three top-cited benign lesions being nasal dermoid cyst, encephalocele and NG [16,75] (Table 2).
To date, there are less than 300 cases of NG reported in the literature since it was first described in 1852 [2]. Based on our systematic review, contemporary literature on the topic is heterogeneous whereby most entries are case reports and small patient series [2,4,6,65,80]. The exact etiology and causative factors for NG remain uncertain [25]. They are usually classified according to anatomical location: extranasal (60%), intranasal (30%) or both (10%) [7]. The more common extranasal NGs usually present as visually apparent, firm nasal masses that do not swell or pulsate when crying, coughing or straining [33,66]. Additionally, these lesions may be linked to hypertelorism [33]. If left untreated, there may be potential risks of infections or deformities of the septum or nasal bone [33].
Intranasal subtypes tend to arise from the lateral nasal wall and patients often complain of nasal obstruction. Although NGs are reported to have negligeable risk for malignant transformation, late intervention may result in infection, bony distortion of the nasal bones or life-threatening apnea, as seen in our case [2]. Our case shares some common similarities with the published literature such as our patient being male and presenting with respiratory symptoms, and that the intranasal mass was initially assumed to be an encephalocele. Specific to our patient, it is crucial to distinguish between the intranasal subtype of NGs from nasal polyps and other congenital conditions as depicted in Table 2. Congruently, biopsy of nasal masses in this age group should be cautioned due to the potential risks of meningitis, bleeding and CSF leak [67]. Nasal polyps are lesions that are commonly accompanied by nasal congestion, runny nose, and other symptoms of sinusitis. Affected patients often have accompanying allergic rhinitis, and the lesion shrinks in response to ephedrine [6]. In contrast, encephaloceles present with brain and/or meningeal herniation through a bony skull or sinus defect, maintaining a true connection to the subarachnoid space [6]. Of note, although encephaloceles and NGs are developmental anomalies with similar clinical manifestations, each diagnosis requires distinct treatments. Thorough clinical and imaging investigations need to be undertaken before any form of surgical intervention is performed [6]. Here, modalities typically include MRI to assess the presence of intracranial connection and parenchymal details of the lesion, and CT to determine if there is any associated bony defect in the anterior skull base osseous structures [68,81]. Even after gross total excision of the lesion is achieved, the role of long-term follow-up to assess for recurrence in a growing child is important.

4.2. Neural Tube Defects: Prevention Is Key

As part of the discussion on causative factors for NG, we believe that it is important to highlight the broader role of prevention of neural tube defects (NTDs)—the most common major structural birth defects affecting the CNS [82]. Briefly, human NTDs are reported to form around 28 days after conception; however, the clinical phenotypes and outcomes tend to be variable [82]. Emerging evidence cites that both genetic and environmental factors are involved in their etiology [83,84]. Although embryonic mechanisms leading to the formation of NTD have been previously described, the exact pathogenesis of NTDs is currently unelucidated. Here, NG falls under this wide and heterogeneous spectrum of NTD that encompasses modifiable and non-modifiable risk factors [85]. There are presently a few hypotheses for the pathogenesis of NG [69]. Some experts consider NG as an encephalocele that has lost communication with the CNS [69]. During weeks 3 to 8 of embryonic development, the anterior neuropore develops medial to the optic recesses [69,70]. Here, a merger of the fronticulus nasofrontalis takes place and consequently the nasofrontal sutures are formed and the prenasal space obliterates. At that time, the dural diverticulum regresses, and the foramen cecum closes [69,71]. The foramen cecum refers to the anterior skull base opening that is a funnel-shaped dural projection. It extends inferiorly and anteriorly through a midline opening anterior to the crista galli of the ethmoid bone [70]. Failure of involution at these primitive sites where the surface and neural ectoderm approximate each other leads to anomalous development of the previously mentioned entities of nasal dermal sinus, encephalocele, and NG [70,72,73].
For NG cases, the presence of neural tissue within the nasal cavity is postulated to be a consequence of premature closure of the foramen cecum. Here, the fonticulus naso-frontalis remains patent in the lower part of the frontal and nasal bones—this causes the meningeal protrusion to extend antero-inferiorly through the foramen cecum into the prenasal space. Following that, the dural projection expands in a direction posterior and inferior to the frontal and nasal bones yet superior and anterior to the nasal cartilage. Following that, the end of the dural diverticulum reaches the subcutaneous space near the future rhinion. During this process there may appear individual heterotopic nasal tissues, heterotopic nasal tissue connected through a thin fibrous stalk to the dura, or an encephalocele, with a connection to the CNS [69]. In tandem, ossification within the cribriform plate begins laterally at 6 months to 8 months after birth and progresses medially. By approximately 12–14 months, the cribriform plate completely ossifies [70]. Under such circumstances, intranasal NGs may extend externally between the nasal bone and the upper lateral cartilage [74]. Thus, nasal encephaloceles and NG have a similar embryological origin but, as the nasal encephalocele is a herniation of the intracranial contents, it must have an intracranial connection through a bone defect. The nasal glioma, however, is ectopic sequestrated tissue and not a herniated structure although it may rarely retain an intracranial connection [74]. The current recommendation is for MRI as the imaging modality of choice to evaluate the pediatric frontonasal region. Advantages include multiplanar imaging, distinguishing interfaces among cartilage, bone, brain and fluid, diffusion imaging to detect epidermoid lesions and to assess for associated intracranial anomalies [70].
Put together, prevention of these NTDs requires specific risk factors to be addressed —in particular, maternal intake of folic acid [82]. Several studies have established that consumption of folic acid in the preconception period and during the first 4 weeks of pregnancy significantly reduces the risk of NTDs [82,86,87,88]. Presently, global health initiatives are ongoing for the mandatory fortification of staple foods with folic acid as an effective NTD prevention strategy [82,89,90]. As the way forward, improved prenatal education for women of child-bearing age should be a priority to avoid future cases. Additionally, we advocate collaborative, in-depth research into the rarer subtypes of NTDs, such as NG.

5. Conclusions

We herein describe a case of delayed diagnosis of NG in a toddler and subsequent management, in corroboration with an extended systematic literature review. At this juncture, we hope our findings add to the growing body of literature, keeping in view the potential for future meta-analysis studies. From a clinical perspective, this report highlights the need for physicians to be mindful of NG as a possible diagnosis when faced with a young child with obstructive apnea.

Author Contributions

Conceptualization, S.Y.Y.L.; methodology, P.K., Y.W. and S.Y.Y.L.; software, P.K. and Y.W.; validation, S.J.A., H.K.K.T., W.T.S. and S.Y.Y.L.; formal analysis, P.K., Y.W., S.J.A. and S.Y.Y.L.; investigation, S.J.A., H.K.K.T. and W.T.S.; resources, S.J.A., H.K.K.T., and W.T.S.; data curation, P.K. and Y.W.; writing—original draft preparation, P.K. and Y.W.; writing—review and editing, P.K., Y.W. and S.Y.Y.L.; visualization, P.K., Y.W., S.J.A. and S.Y.Y.L.; supervision, Y.W. and S.Y.Y.L.; project administration, S.Y.Y.L. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

Ethical review and approval were waived by the SingHealth Central Institutional Review Board (CIRB). According to institutional policy, case reports involving two or fewer patients do not require formal ethics approval.

Informed Consent Statement

Informed consent for publication was waived for this single patient case report as per the SingHealth Central Institutional Review Board (CIRB).

Data Availability Statement

The original contributions presented in this study are included in the article. Further inquiries can be directed to the corresponding author.

Acknowledgments

The preliminary results of this paper were accepted as a poster presentation (reference number: 00962) for the 51st Annual Meeting of the International Society of Pediatric Neurosurgeons (ISPN) held in Lyon, France (26–30 October 2025).

Conflicts of Interest

The authors declare no conflicts of interest.

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Figure 1. Representative radiological images of the patient’s anterior skull base. (A,B) are CT bone window images in coronal and sagittal directions, respectively. They depict a bony defect in the anterior aspect of the cribriform plate (yellow arrow) with herniation of a soft tissue structure into the right nasal cavity. (C,D) are coronal and sagittal MRI images in T2-weighted sequences. They confirm the presence of a solid-cystic lesion distending the right nasal cavity with defect in the right cribriform plate (red arrows). Of note, there is no herniation of the frontal lobe through the defect.
Figure 1. Representative radiological images of the patient’s anterior skull base. (A,B) are CT bone window images in coronal and sagittal directions, respectively. They depict a bony defect in the anterior aspect of the cribriform plate (yellow arrow) with herniation of a soft tissue structure into the right nasal cavity. (C,D) are coronal and sagittal MRI images in T2-weighted sequences. They confirm the presence of a solid-cystic lesion distending the right nasal cavity with defect in the right cribriform plate (red arrows). Of note, there is no herniation of the frontal lobe through the defect.
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Figure 2. Histolopathological images of the excised intranasal mass. (A) Hematoxylin and eosin section (×10) shows nodular infiltrates of mature glial tissue with rare neurons forming nasal polyps. There is no evidence of malignancy. Immunohistochemical stains for (B) GFAP confirm presence of glial tissue (×4), and the stain for (C) synaptophysin is positive for neurons (×20).
Figure 2. Histolopathological images of the excised intranasal mass. (A) Hematoxylin and eosin section (×10) shows nodular infiltrates of mature glial tissue with rare neurons forming nasal polyps. There is no evidence of malignancy. Immunohistochemical stains for (B) GFAP confirm presence of glial tissue (×4), and the stain for (C) synaptophysin is positive for neurons (×20).
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Figure 3. PRISMA flowchart diagram, based on the PRISMA 2020 Statement [8].
Figure 3. PRISMA flowchart diagram, based on the PRISMA 2020 Statement [8].
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Figure 4. Descriptive analysis of data from the structured literature review to demonstrate pattern of data distribution (our case is featured with a red arrow). (a) Gender distribution (b) Age at presentation distribution. (Figures were constructed using Python version 3.13 software, available on https://www.python.org/).
Figure 4. Descriptive analysis of data from the structured literature review to demonstrate pattern of data distribution (our case is featured with a red arrow). (a) Gender distribution (b) Age at presentation distribution. (Figures were constructed using Python version 3.13 software, available on https://www.python.org/).
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Figure 5. Descriptive analysis of data from the structured literature review to demonstrate pattern of data distribution for clinical presentation of NG patients (our case is featured with a red arrow). (Figure was constructed using Python version 3.13 software, available on https://www.python.org/).
Figure 5. Descriptive analysis of data from the structured literature review to demonstrate pattern of data distribution for clinical presentation of NG patients (our case is featured with a red arrow). (Figure was constructed using Python version 3.13 software, available on https://www.python.org/).
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Figure 6. Descriptive analysis of data from the structured literature review to demonstrate pattern of data distribution for histopathological results of cumulative NG cases (our case is labelled in red with arrow). (Figure was constructed using Python version 3.13 software, available on https://www.python.org/).
Figure 6. Descriptive analysis of data from the structured literature review to demonstrate pattern of data distribution for histopathological results of cumulative NG cases (our case is labelled in red with arrow). (Figure was constructed using Python version 3.13 software, available on https://www.python.org/).
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Figure 7. Descriptive analysis of data from the structured literature review to show pattern of data distribution for various surgical approaches (our case is labelled in red with arrow). (Figure was constructed using Python version 3.13 software, available on https://www.python.org/).
Figure 7. Descriptive analysis of data from the structured literature review to show pattern of data distribution for various surgical approaches (our case is labelled in red with arrow). (Figure was constructed using Python version 3.13 software, available on https://www.python.org/).
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Table 1. Results of systematic literature review. (Abbreviation: OSA = obstructive sleep apnea).
Table 1. Results of systematic literature review. (Abbreviation: OSA = obstructive sleep apnea).
Variable of Interest Papers Included
(n = 133; Patient Number (%))		Our Case (n = 1)
GenderMale70 (52.6%)Yes
Female52 (39.1%)-
Not specified11 (8.3%)-
Age at presentationAntenatal14 (10.5%)-
Newborn28 (21.1%)-
1 to <6 months old23 (17.3%)-
6 to <12 months old15 (11.3%)-
1 to <3 years old27 (20.3%)Yes
≥3 years old11 (8.3%)-
Not reported15 (11/3%)-
Clinical presentationMass identified in antenatal scan14 (10.5%)-
Respiratory symptoms58 (43.6%)Yes (OSA)
Asymptomatic external mass50 (37.6%)-
Not reported11 (8.3%)-
Diagnostic methodsEndoscopic examination (in addition to radiologic imaging)15 (11.3%)-
MRI scan only56 (42.1%)-
CT scan only26 (19.5%)-
Both MRI and CT scan modalities30 (22.6%)Yes
US only/US with another modality20 (15%)-
Not reported18 (13.5%)-
Imaging features *Cystic component5 (3.8%)Yes
No intracranial connection86 (64.7%)-
Presence of deformity/bony defects16 (12%)Yes (cribriform plate)
No specific features mentioned26 (19.5%)-
Differential diagnosesHemangioma9 (6.8%)-
Encephalocele11 (8.3%)Yes
Surgical approachEndonasal42 (31.6%)-
Rhinotomy/Rhinoplasty9 (6.85%)-
Transoral3 (2.3%)-
Polypectomy4 (3%)-
Combined approach (endoscopic and open surgery)5 (3.8%)-
Open craniofacial approach5 (3.8%)-
Open craniofacial approach with reconstruction7 (5.3%)Yes
Not reported58 (43.6%)-
Histopathology findingsGFAP positive only/neurofibrillary background only71 (53.4%)Yes (also synaptophysin positive)
GFAP and S-100 protein positive22 (16.5%)-
Presence of respiratory mucosa15 (11.3%)-
Not reported/features not specifically described40 (30.1%)-
Postoperative outcomesNo complications, including satisfactory cosmesis and well-healed wounds94 (70.7%)Yes (at 10 years follow-up)
Recurrence/Re-operation9 (6.8%)-
CSF leak/infection6 (4.5%)-
Death1 (0.8%)-
Not reported23 (17.3%)-
* Only specialized imaging characteristics included.
Table 2. Key differences between three common frontal/frontonasal congenital masses.
Table 2. Key differences between three common frontal/frontonasal congenital masses.
Developmental AnomalyIncidence (Live Births)PathogenesisTypical MRI FeaturesRecommended Treatment
Encephalocele1 in 5000 to 10,000Incomplete separation of the surface ectoderm from neuroectoderm during neural fold closure [76].Herniated brain tissue in midline of anterior skull base defect that is iso- to hypointense on T1 and hyperintense on T2-weighted sequences [77].For all three conditions, surgical excision of lesion whereby complete removal is necessary to prevent recurrence.
Nasal dermoid cyst1 in 20,000 to 40,000Incomplete obliteration of neuroectoderm in frontonasal region [20].Well-circumscribed lesion that is hyper or variable in signal intensity on T1 and hyperintense on T2-weighted sequences [78,79]
Nasal glioma1 in 20,000 to 40,000Faulty closure of anterior neuropore (fonticulus frontalis) [33].Isointense signals to brain parenchyma on T1 and hyperintense on T2 (gliosis). No obvious intracranial connection or CSF surrounding lesion [80].
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Kaur, P.; Wu, Y.; Tan, H.K.K.; Aw, S.J.; Seow, W.T.; Low, S.Y.Y. Delayed Presentation of Nasal Glioma—Case Report and Literature Review. Surgeries 2026, 7, 56. https://doi.org/10.3390/surgeries7020056

AMA Style

Kaur P, Wu Y, Tan HKK, Aw SJ, Seow WT, Low SYY. Delayed Presentation of Nasal Glioma—Case Report and Literature Review. Surgeries. 2026; 7(2):56. https://doi.org/10.3390/surgeries7020056

Chicago/Turabian Style

Kaur, Prabhpreet, Yilong Wu, Henry K. K. Tan, Sze Jet Aw, Wan Tew Seow, and Sharon Y. Y. Low. 2026. "Delayed Presentation of Nasal Glioma—Case Report and Literature Review" Surgeries 7, no. 2: 56. https://doi.org/10.3390/surgeries7020056

APA Style

Kaur, P., Wu, Y., Tan, H. K. K., Aw, S. J., Seow, W. T., & Low, S. Y. Y. (2026). Delayed Presentation of Nasal Glioma—Case Report and Literature Review. Surgeries, 7(2), 56. https://doi.org/10.3390/surgeries7020056

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