Case Report: Giant communicating solitary fibrous tumor of the temporal skull base and infratemporal fossa.

Background: Solitary fibrous tumor (SFT) is a rare mesenchymal spindle-cell neoplasm that can arise in the central nervous system and the head and neck region. Giant communicating lesions spanning the temporal skull base and infratemporal fossa are exceptionally uncommon and remain diagnostically and surgically challenging. Case presentation: We report a 76-year-old man who presented with more than 3 years of intermittent headache and dizziness, recent symptom progression, and a palpable right maxillofacial mass. Magnetic resonance imaging demonstrated a strongly enhancing right temporal skull base lesion extending through the foramen ovale into the infratemporal/masticator space, measuring approximately 74 × 61 mm. Preoperative MR angiography did not show an obvious close relationship between the tumor and adjacent major vessels. After multidisciplinary evaluation, the patient underwent combined craniofacial tumor resection and skull base reconstruction performed jointly by neurosurgery and oral and maxillofacial surgery. Histopathology showed a spindle-cell neoplasm with alternating cellularity and staghorn-like vessels, 1-2 mitotic figures per 10 high-power fields, no necrosis, and no marked cytologic atypia. Immunohistochemistry showed nuclear STAT6 positivity together with CD34, CD99, and Bcl-2 expression and a Ki-67 labeling index of approximately 5%, supporting the diagnosis of central nervous system World Health Organization grade 1 SFT. The postoperative course was uneventful, symptoms improved, and no recurrence was reported on outside follow-up magnetic resonance imaging at 22 months. Conclusion: This case adds to the limited literature on skull base SFT with intracranial-extracranial extension and highlights the importance of careful clinicoradiological assessment, multidisciplinary maximal safe resection, pathological confirmation with STAT6, and sustained radiological surveillance.