Endoscopic resection of sellar and suprasellar epidermoid cyst: report of two cases and review of literature

Resection of suprasellar and retrosellar epidermoid cyst by supraorbital approach (minimally invasive approach). illustrative case and literature review

“…Epidermoid cysts are slow growing embryonal tumors caused by aberrant incorporation or incomplete separation of the neuroectoderm during the third to fifth week of gestation with persisting ectodermal tissue during neural tube closure. 1,3,[5][6][7] Among other theories, they have been related to the proliferation and metaplasia of adenohypophyseal cells in the sellar region. 5,7 Epidermoid tumors account for the 0.2-2% of intracranial tumors and 2.5-7% of CPA lesions; these lesions usually invade extra-axial regions 3,7,8 extending through the subarachnoid cisterns and adhering to neurovascular structures, including the perforating arteries.…”

“…1,3,[5][6][7] Among other theories, they have been related to the proliferation and metaplasia of adenohypophyseal cells in the sellar region. 5,7 Epidermoid tumors account for the 0.2-2% of intracranial tumors and 2.5-7% of CPA lesions; these lesions usually invade extra-axial regions 3,7,8 extending through the subarachnoid cisterns and adhering to neurovascular structures, including the perforating arteries. 3,9,10 These tumors are generally found in a paramedian or off midline location, 10,11 being the CPA the most frequent location (37.3-50%), 3,6,11 by the middle fossa (15%) and parasellar region (10%).…”

“…During the last decade, the endoscopic endonasal approach has been chosen for sellar, parasellar and infrasellar lesions; however, in Vaz-Guimaraes et al series they analyzed the benefits of EEA and the factors associated with incomplete resection of the cyst and they exposed the great importance of the remaining tissue; this series, like some others, have concluded that near-total resection (complete resection of the lesion, incomplete of the capsule) or subtotal resection (incomplete resection of the lesion and capsule) lead to a production of keratin that progressively causes the cyst growth, increasing the percentage of recurrence in 27-33.4%. 10,14 We must consider that the state of chronic inflammation, secondary to the desquamation of epithelial cells, will allow greater adhesion to vascular and nervous structures causing a greater difficulty in resection; 3,9,10 being this reason why total excision is complicated. The Citation: Sánchez-Sánchez JF, Velázquez-Santana H, Serrano-Verduzco JJ.…”

“…Despite being congenital lesions, they are unusual to be found at an early age due to the lack of clinical manifestations that they present, being mostly diagnosed between 20-40 years. [1][2][3] Lepoire and Pertuiset, having 7 cases of epidermoid cysts, proposed a classification according to their pathogenesis and vascular relationship, dividing them into 3 types: retrosellar, suprasellar and intraventricular; relating them to the distribution of the basilar, carotid and choroidal arteries respectively. 4 These lesions are commonly located in the cerebellopontine angle (CPA), followed by the middle floor, prepontine area and chiasmatic region.…”

“…Cerebellar signs are commonly found due to the mass effect on the CPA, while hormonal compromise is observed in those lesions with invasion of the sellar region. [1][2][3][4] In our case, we present an epidermoid tumor that invades the suprasellar, retrosellar and interpeduncular cistern region, being an unusual location, it was decided to be resolved through a transciliary supraorbital approach (minimally invasive).…”