Access to the crista galli and the foramen caecum in nasal dermal sinus cysts – lessons learned in a single tertiary care centre

Abstract

Access to the crista galli and the foramen caecum in nasal dermal sinus cystslessons learned in a single tertiary care centre* Summary Objective: Several surgical techniques have been suggested for the treatment of nasal dermal sinus cysts (NDSC). We have used several di erent techniques and have developed a minimally invasive approach. The aim of this study is to describe the evolution to this approach and compare the results with those achieved with our experience of more traditional techniques. Methodology/Principal:A retrospective data collection of patients with NDSC presenting to our clinic between 1998 and 2012 was performed. We initially performed external approaches as outlined elsewhere. With an increasing number of young children requiring surgery, the technique was modi ed to a less invasive form. This new approach starts with mobilisation of the pit via a tiny skin incision. An open rhinoplasty approach is used to follow the stula on the nasal bone. Once the stula passes underneath the nasal bone, an endoscopic endonasal approach is used. Following the stula cranially, the area of the foramen caecum can be identi ed.Results: Twelve out of 15 patients (80%) were treated surgically. The transfacial, coronal subcranial and minimally invasive approach was used in 3 (25%), 4 (33%) and 5 patients (42%), respectively. Radical resection was achieved in all patients. Cosmetic problems were present in all patients undergoing a transfacial and in half of the patients after the coronal subcranial approach.Patients treated by the minimally invasive technique remained without sequelae. Conclusion:The minimally invasive approach enables a perfect exposure of the stula up to the crista galli and provides less morbidity and better cosmetic results than the transfacial and subcranial approach.

Extending borders

“…In 2010 this Journal already produced an extensive overview in the European position paper on endoscopic management of tumours of the nose, paranasal sinuses and skull base (5) . In the mean time a number of papers on skull base surgery has been published in Rhinology (3,(6)(7)(8)(9)(10)(11) . With the rhinologist involvement in more and more complex benign and malignant sinus and skull base tumours we became part of endoscopic skull base teams.…”