Endoscopic endonasal surgery for epidermoid and dermoid cysts: a 10-year experience

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OBJECTIVE

Epidermoid and dermoid cysts may be found along the cranial base and are commonly resected via open transcranial approaches. The use of endoscopic endonasal approaches for resection of these tumors has been rarely reported.

METHODS

The authors retrospectively reviewed the medical records of 21 patients who underwent endoscopic endonasal surgery for epidermoid and dermoid cyst resection at the University of Pittsburgh Medical Center between January 2005 and June 2014. Surgical outcomes and variables that might affect the extent of resection and complications were analyzed.

RESULTS

Total resection (total removal of cyst contents and capsule) was achieved in 8 patients (38.1%), near-total resection (total removal of cyst contents, incomplete removal of cyst capsule) in 9 patients (42.9%), and subtotal resection (incomplete removal of cyst contents and capsule) in 4 patients (19%). Larger cyst volume (≥ 3 cm3) and intradural location (15 cysts) were significantly associated with nontotal resection (p = 0.008 and 0.0005, respectively). In the whole series, surgical complications were seen in 6 patients (28.6%). No complications were observed in patients with extradural cysts. Among the 15 patients with intradural cysts, the most common surgical complication was postoperative CSF leak (5 patients, 33.3%), followed by postoperative intracranial infection (4 patients, 26.7%). Larger cysts and postoperative CSF leak were associated with intracranial infection (p = 0.012 and 0.028, respectively). Subtotal resection was marginally associated with intracranial infection when compared with total resection (p = 0.091). All patients with neurological symptoms improved postoperatively with the exception of 1 patient with unchanged abducens nerve palsy.

CONCLUSIONS

Endoscopic endonasal approaches may be effectively used for resection of epidermoid and dermoid cysts in carefully selected cases. These approaches are recommended for cases in which a total or near-total resection is possible in addition to a multilayer cranial base reconstruction with vascularized tissue to minimize the risk of intracranial infection.

ABBREVIATIONS CN = cranial nerve; CPA = cerebellopontine angle; EEA = endoscopic endonasal approach; EES = endoscopic endonasal surgery; ICA = internal carotid artery.

Article Information

Correspondence Paul A. Gardner: UPMC Center for Cranial Base Surgery, Pittsburgh, PA. gardpa@upmc.edu.

INCLUDE WHEN CITING Published online March 16, 2018; DOI: 10.3171/2017.7.JNS162783.

Disclosures Dr. Snyderman reports being a consultant for SPIWay LLC.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Case 16. Endoscopic endonasal transpterygoid approach for Meckel’s cave dermoid cyst in a 19-year-old woman. A and B: Preoperative (A) and postoperative (B) T1-weighted postcontrast coronal MR images. The preoperative image shows a cystic lesion within Meckel’s cave. C and D: Intraoperative images obtained through a 0° endoscope showing removal of bone over the left Meckel’s cave (C) and exposed dura of the left Meckel’s cave with nerve stimulator on V3 (D). E: Dissection of tumor from Meckel’s cave with monitoring of cranial nerve function. F: View of residual cyst attached to the superomedial compartment of Meckel’s cave next to the abducens nerve (CN VI). CS/SOF = cavernous sinus/superior orbital fissure. Figure is available in color online only.

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    Case 17. Endoscopic endonasal transclival approach for prepontine epidermoid cyst. A: Preoperative T2-weighted axial MR image showing a large prepontine epidermoid cyst. B–D: Intraoperative images. Two-suction dissection of prepontine epidermoid cyst was performed using an endoscopic endonasal transclival approach (B). The tumor was sharply dissected from the basilar artery (BA) and its branches using scissors (C). Small fragments of residual cyst tissue were left attached to the pial surface of the brainstem (D, arrows). E and F: Postoperative T2-weighted axial MR image (E) and diffusion-weighted imaging sequence (F) demonstrating brainstem decompression and cyst residual (arrow). VI = CN VI. Figure is available in color online only.

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    Case 5. Preoperative and postoperative T1-weighted contrast-enhanced MR images obtained in an 11-year-old patient who underwent resection of a suprasellar dermoid cyst and subsequently developed an intracranial abscess. A and B: Preoperative coronal (A) and sagittal (B) images showing a large suprasellar dermoid cyst. C and D: Initial postoperative coronal (C) and sagittal (D) images showing a small residual (arrows, C and D) attached to the right hypothalamus. E and F: Follow-up coronal (E) and sagittal (F) images obtained 6 months after surgery revealing an intracranial abscess. The abscess was successfully treated with endoscopic endonasal surgical drainage and broad-spectrum antibiotic therapy.

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