Endoscopic endonasal approach for resection of ventral skull base keratinaceous cysts

McCoul, Edward D.; Chow, Samuel Man-Wai; Lee, Dennis L.Y.; Anand, Vijay K.; Schwartz, Theodore H.

doi:10.1002/alr.21005

Cited by 22 publications

(16 citation statements)

References 30 publications

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“…15,16 Nonetheless, the endoscopic endonasal resection of ventrally located epidermoid and dermoid cysts has been rarely reported. 7,9,25,26,31,38,42,45 We present a 10-year experience in the management of 21 patients with epidermoid and dermoid cysts treated with endoscopic endonasal surgery (EES) in a single institution. The benefits of this surgical approach and factors that might be associated with incomplete cyst resection and postoperative complications were analyzed.…”

Section: Sions Historically Epidermoid and Dermoid Cysts Havementioning

confidence: 99%

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

Vaz-Guimarães

Koutourousiou

Almeida

et al. 2019

Journal of Neurosurgery

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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 cm) 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.

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Section: Sions Historically Epidermoid and Dermoid Cysts Havementioning

confidence: 99%

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

Vaz-Guimarães

Koutourousiou

Almeida

et al. 2019

Journal of Neurosurgery

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“…A subsequent report by McCoul et al in 2012, that included cases 1 and 2 from this series, described the early results following EEA for resection of keratinaceous cysts involving the ventral cranial base at our institution. 31 Of the 3 patients in this series, one of whom harbored a dermoid cyst, GTR was achieved in 2 (67%). Both epidermoid cysts were located ventral to the brainstem.…”

Section: Traditional Microsurgical Approachesmentioning

confidence: 74%

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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“…Endoscopic-assisted techniques have been shown to be useful in the visualization of epidermoid tumors in several studies [27,28]. In addition, the endoscopic endonasal corridor has been utilized to resect epidermoid cysts from other locations along the cranial base [29][30][31][32]. However, to our knowledge, there have only been two reports of this approach for the successful resection of an epidermoid cyst in MC by a purely endoscopic endonasal approach, each describing just one adult patient [12,33].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Endonasal Resection of Meckel’s Cave Epidermoid Cysts: Case Discussion and Literature Review

Zakaria

Saini

Yanovskaya

et al. 2020

Case Reports in Neurological Medicine

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Meckel’s cave (MC) epidermoid cysts are relatively uncommon lesions. In cases where surgical excision is indicated, resection is often carried out via a frontosphenotemporal craniotomy from an anterolateral approach or a temporal craniotomy with or without a petrosectomy for a lateral corridor; both of these routes are associated with brain retraction and potential neurovascular injury. The anterior location of MC in the middle cranial fossa makes safe access via posterior fossa-based approaches—such as the retrosigmoid approach—challenging as well. Here, we present the cases of two patients diagnosed with epidermoid cysts in MC who underwent surgical resection via an endoscopic endonasal transpterygoid approach. Near-total resection was achieved in both cases, with only mild transient neurologic disturbances postoperatively. Radiographically, no evidence of residual disease was noted in either patient. We further review the nuances of an extended endoscopic endonasal approach to these lesions.

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Endoscopic endonasal approach for resection of ventral skull base keratinaceous cysts

Abstract: The endoscopic endonasal approach allows the rhinologic surgeon to access the ventral midline skull base for the successful management of keratinaceous cysts without major complications.

Cited by 22 publications

References 30 publications

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

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

Endoscopic endonasal resection of epidermoid cysts involving the ventral cranial base

Endoscopic Endonasal Resection of Meckel’s Cave Epidermoid Cysts: Case Discussion and Literature Review

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