Complete endoscopic resection of a pituitary stalk epidermoid cyst using a combined infrasellar interpituitary and suprasellar endonasal approach: case report

Nakassa, Ana Carolina Igami; Chabot, J; Snyderman, Carl H.; Wang, Eric; Gardner, Paul A.; Fernández-Miranda, Juan C.

doi:10.3171/2016.11.jns161605

Cited by 12 publications

(24 citation statements)

References 17 publications

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“…In 2017, Nakassa et al published a report describing successful resection of an epidermoid cyst involving the pituitary stalk using a combined infra-and suprasellar approach-again with postoperative improvement in vision. 35 These reports are consonant with other studies that have described excellent visual outcomes after endonasal approaches for various pathologies in this region. 3,34 To date, the only case series dedicated to this topic was provided by Formichev et al, who reported radiological GTR in 5 of 6 patients with chiasmatic-region ECs with no recurrences noted during a mean follow-up of 42 months.…”

Section: Traditional Microsurgical Approachessupporting

confidence: 87%

“…The benefits of the EEA to access various alternative pathologies of the ventral cranial base have been well described. 3,33,34 While isolated case reports and small case series exist that describe the utility of these approaches in the resection of ECs of the cranial base, 11,17,19,35 there is an overall paucity of information in the literature regarding this surgical option, especially regarding ventral ECs of the posterior fossa. Thus, we sought to describe the clinical presentation and surgical outcomes of 7 consecutive patients with ventral ECs of the cranial base treated using the EEA.…”

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confidence: 99%

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Endoscopic endonasal resection of epidermoid cysts involving the ventral cranial base

Forbes

Banu

Lehner

et al. 2019

Journal of Neurosurgery

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OBJECTIVE Epidermoid cysts (ECs) commonly extend to involve the ventral cisterns of the cranial base. When present, symptoms arise due to progressive mass effect on the brainstem and adjacent cranial nerves. Historically, a variety of open microsurgical approaches have been used for resection of ECs in this intricate region. In recent years, the endoscopic endonasal approach (EEA) has been proposed as an alternative corridor that avoids crossing the plane of the cranial nerves. To date, there is a paucity of data in the literature regarding the safety and efficacy of the EEA in the treatment of ECs of the ventral cranial base. METHODS The authors reviewed a prospectively acquired database of EEAs for resection of ECs over 8 years at Weill Cornell, NewYork-Presbyterian Hospital. All procedures were performed by the senior authors. Standardized clinical and radiological parameters were assessed before and after surgery. Statistical tests were used to determine the impact of previous surgery and tumor volume on extent of resection and recurrence as well as the method of closure on rate of CSF leak. RESULTS Between January 2009 and February 2017, 7 patients (4 males and 3 females; age range 16-70 years) underwent a total of 8 surgeries for EC resection utilizing the EEA. Transplanum and transclival extensions were performed in 3 and 5 patients, respectively. Methods of closure incorporated a gasket seal in 6 of 8 procedures and a nasoseptal flap in 7 of 8 procedures. Gross-total resection (GTR) was achieved in 43% of patients, and near-total resection (> 95%) was obtained in another 43%. Complications included diabetes insipidus (n = 2), postoperative CSF leak (n = 2), transient third cranial nerve palsy (n = 1), and epistaxis (n = 1). With a mean follow-up of 43.5 months, recurrence has been observed in 2 of 7 patients. In 1 case, reoperation for recurrence was required 71 months following the initial surgery. Use of the gasket-seal technique with nasoseptal flap coverage significantly correlated with the absence of postoperative CSF leakage (p = 0.018). GTR was achieved in 25% of the patients who had prior surgeries and in 50% of patients without previous resections. The mean volume of cysts in which GTR was achieved (4.3 ± 1.8 cm) was smaller than that in which subtotal or near-total resection was achieved (12.2 ± 11 cm, p = 0.134). CONCLUSIONS The EEA for resection of ECs of the ventral cranial base is a safe and effective operative strategy that avoids crossing the plane of the cranial nerves. In the authors' experience, gasket-seal closure with nasoseptal flap coverage has been associated with a decreased risk of postoperative CSF leakage.

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Section: Traditional Microsurgical Approachessupporting

confidence: 87%

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confidence: 99%

Endoscopic endonasal resection of epidermoid cysts involving the ventral cranial base

Forbes

Banu

Lehner

et al. 2019

Journal of Neurosurgery

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“…They can be found in the subarachnoid space, at the cerebellopontine angle and parasellar space (4). Only 3 epidermoid cysts involving the pituitary infundibulum have been reported in the literature ( 5,6,7). We report a case of a cerebral epidermoid cyst of the median line resected by a transsphenoidal approach.…”

Section: Introductionmentioning

confidence: 92%

A rare epidermoid cyst occurring in an young female: a case report and literature review

Duşceac

Dumitrașcu

Poiană

2020

Preprint

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Background Epidermoid cysts are very rare benign lesions of epithelial origin, slow growing extra-axial tumours and they accord for 1% of all intracranial tumours. They frequently occur at the cerebellopontine angle and parasellar regions insinuating brain structures. They are often associated with a high rate of residual tumor and recurrence. Clinical Case We present the case of a 18 year old patient who was admitted in the our clinic for secondary amenorrhea. The CT scan showed a large median mass with a mixed structure (calcareous and cystic) resembling a craniopharyngioma. Preoperatively the hormonal profile showed deficiency of all anterior pituitary hormones. Transsphenoidal surgery was performed and the histopathological exam established the diagnosis of sellar epidermoid cyst with parasellar extension. Postoperatively the patient developed iatrogenic Cushing syndrome (due to large amounts of dexamethasone given) and diabetes insipidus. Conclusion Epidermoid cysts are challenging tumours because of the extension along the subarachnoid spaces around delicate neurovascular structures therefore they are difficult to be completely resected. The particularity of this case stands in the rare occurrence of this types of tumours and the fact that although in these patients with hypopituitarism diabetes insipidus is present primarily our patient developed postoperatively.

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“…The process corresponds to $ 0.2 to 1.8% of all primary intracranial tumors and are 4 to 9 times as common as dermoid cysts. [1][2][3][4] Most ECs compromising the central nervous system (CNS) are extraaxial, leptomeningeal lesions, with the cerebellopontine angle (40-50% of patients) being the most common location. Epidermoid cysts can also be found in the 4 th ventricle (17%), in the sellar/parasellar region (10-15%), in the cerebral hemispheres, in the brainstem, in the skull, and in the spine.…”

Section: Introductionmentioning

confidence: 99%

“…Epidermoid cysts can also be found in the 4 th ventricle (17%), in the sellar/parasellar region (10-15%), in the cerebral hemispheres, in the brainstem, in the skull, and in the spine. [1][2][3][4][5][6] Most tumoral and non-tumoral sellar lesions are solid process, and pituitary adenoma is the most common tumor in this topography. Cystic sellar lesions are not as frequent as pituitary adenoma, and Rathke cysts and craniopharyngioma are usually the final diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Physiopathological Aspects of Sellar Epidermoid Cyst Determining Endocrine Disturbances: A Case Report

et al. 2019

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Epidermoid cysts (ECs) of the central nervous system (CNS) constitute benign circumscribed lesions that are more common in lateral than in midline sites. Epidermoid cysts of the CNS arise more frequently in the cerebellopontine angle, around the pons, near the sella, within the temporal lobe, in the diploe, and in the spinal canal. Most common tumoral lesion of sellar region is pituitary adenoma, and sellar cystic epithelial masses may be difficult to differentiate based only on clinical and imaging findings. Epidermoid cysts are covered by keratinized squamous epithelium and are usually filled with keratin lamellae. The process is, for the most part, maldevelopmental in origin, presumably arising from trapped surface ectodermal elements in association with the developing CNS during the closure of the neural groove or formation of the secondary cerebral vesicles. In the present study, the authors describe a case of sellar epidermoid cyst producing endocrine alterations and visual disturbance in a 35 years woman, and review the physiopathological and diagnostic criteria of this lesion.

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Complete endoscopic resection of a pituitary stalk epidermoid cyst using a combined infrasellar interpituitary and suprasellar endonasal approach: case report

Cited by 12 publications

References 17 publications

Endoscopic endonasal resection of epidermoid cysts involving the ventral cranial base

Endoscopic endonasal resection of epidermoid cysts involving the ventral cranial base

A rare epidermoid cyst occurring in an young female: a case report and literature review

Physiopathological Aspects of Sellar Epidermoid Cyst Determining Endocrine Disturbances: A Case Report

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