Resection of intracranial nasal dermoid sinus cyst by endoscopic-assisted open rhinoplasty approach

Abstract

Background: Nasal dermoid sinus cysts (NDSC) are infrequent congenital midline lesions. Complete removal is the treatment of choice. When there is intracranial involvement, the traditional surgical approach requires a bicoronal flap and frontal craniotomy.Case report: A 17-year-old male presented with a midline nasal dorsum mass. The radiological exams revealed a cystic lesion within nasal dorsum with intracranial extension through a patent foramen caecum into a bifid crista galli. Total macroscopic resection was performed through an endoscopic-assisted open rhinoplasty approach. The patient remains asymptomatic and free of recurrence after 20 months follow-up. Conclusion:This case demonstrates the feasibility of an endoscopic-assisted open rhinoplasty approach for successful resection of NDSC, avoiding a frontal craniotomy and the significant morbidity associated herewith.

Endoscopy‐assisted excision of nasoglabellar dermoid cyst

“…CT can be used to assess the bony anatomy associated with nasal dermoid cyst. We agree with Wales et al, 4 Santamaría‐Gadea et al 2 and Rahbar et al 1 to recommend that initial investigation in adults should be CT to define bony anatomy and affection and if there is an intracranial extension concern, MRI to determine intracranial extension and operative planning.…”

“…CT can be used to assess the bony anatomy associated with nasal dermoid cyst. We agree with Wales et al,4 Santamaría-Gadea et al2 and Rahbar et al1 to recommend that initial investigation in adults should be CT to define bony anatomy and affection and if there is an intracranial extension concern, MRI to determine intracranial extension and operative planning.We agree with Rahbar et al1 that CT should be included in nasal dermoid workup, and complementary MRI is mandatory if there is concern for intracranial extension. Hartley et al6 proposed radiological classification of nasal dermoids into four groups: superficial, intraosseus, intracranial extradural and intracranial intradural, to allow better surgical planning.…”

“…We did not report recurrence similar to Santamaría‐Gadea study 2 while Herrington et al 5 used open rhinoplasty approach and reported 8% recurrence. Incomplete excision is usually the recurrence cause.…”

“…Open rhinoplasty or transnasal endoscopic approach to simple nasal dermoid cysts is generally used in children 5 . However, glabellar or nasion lesion is difficult to access with these approaches and usually approached through vertical midline incision in adults 2 …”

“…5 However, glabellar or nasion lesion is difficult to access with these approaches and usually approached through vertical midline incision in adults. 2 Thus, we aimed to assess endoscopy-assisted excision of nasoglabellar dermoid cyst to minimise length of skin incision and avoid scarring in the brow with precise and complete cyst removal. Design: After history taking, general and otorhinolaryngological examinations, CT evaluation was done for all cases.…”