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

Abstract

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.

Role of the apparent diffusion coefficient as a predictive factor for tumor recurrence in patients with intracranial epidermoid tumor

“…We also distinguished intracranial extradural epidermoid tumors and convexity tumors from cisternal and ventricular tumors, which tend to spread into the subarachnoid space, and classi ed them into the "limited" and "extensive" types, respectively. Limited type epidermoid tumors have low ADC values with well circumscribed margins in a limited space, and were totally removed without di culty in our cases, again consistently with previous reports [16,17]. However, extensive type epidermoid tumors, such as those located in the CPA area, have variable ADC values and prognosis.…”

“…The EOR was based on operative notes and con rmed by the rst postoperative MRI within 3 months of surgery. Gross total resection (GTR) was de ned as complete removal of both capsule and contents; neartotal resection (NTR) was de ned as complete content removal and incomplete capsule removal; subtotal resection (STR) was de ned as incomplete resection of both capsule and contents [17]. Postoperative diffusion-weighted MRI sequences were utilized to con rm the degree of resection.…”

Diagnosis and Treatment of Pituitary Adenomas

“…Для кистозных, чисто интраселлярных поражений, можно рассмотреть кисту из мешка Ратке и коллоидную кисту. В редких случаях в этой области диагностируется дермоид или эпидермоид [6]. Краниофарингиомы встречаются как в кистозной, так и в твердой формах [7].…”

Microsurgical Resection of Intracranial Dermoid and Epidermoid Tumors

“…Endoscopic endonasal resection of IDET`s especially those situated in anterior skull base has been attempted with significantly lower risk of neurovascular injury due to better visualization through the endoscope. 34 Endoscopic approach has also its inherent advantages over the microsurgical approach for anterior skull base lesions, like cosmetically more acceptable, retraction of brain parenchyma and neurovascular tissue is kept at a minimum and having shorter intra operative period and post op hospital stay. 34 Skill and experience of the surgeon is the most important factor in determining the outcome after ideal instruments and technology availability is ensured.…”

“…34 Endoscopic approach has also its inherent advantages over the microsurgical approach for anterior skull base lesions, like cosmetically more acceptable, retraction of brain parenchyma and neurovascular tissue is kept at a minimum and having shorter intra operative period and post op hospital stay. 34 Skill and experience of the surgeon is the most important factor in determining the outcome after ideal instruments and technology availability is ensured. Nevertheless attaining endoscopic skills and selecting suitable patients for this approach is a challenging task as this is a relatively recent advancement.…”