Suprasellar Epidermoid Cyst: Case Report of Extended Endoscopic Transsphenoidal Resection and Systematic Review of the Literature

Bobeff, Ernest J.; Sánchez-Viguera, Cristina; Arráez-Manrique, Cinta; Arráez-Sánchez, Miguel Ángel

doi:10.1016/j.wneu.2019.05.100

Cited by 9 publications

(6 citation statements)

References 48 publications

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“…Most of the epidermoid cysts are benign extracerebral lesions due to the origin of the epithelium ( 4 ), and a few cases can undergo malignant transformation into a squamous cell carcinoma, of which the exact mechanism of this transformation remains unclear ( 5 ). No malignant transformation was observed after complete surgical resection, which was in line with most of the previous reports ( 3 , 4 , 6 ). In this case report, the patient presented with non-specific symptoms such as dizziness, headache, nausea, and disturbed light reflex of the right eye, which can be explained by the local mass effect of the tumor on adjacent brain parenchyma or cranial neurovascular structures ( 7 ).…”

Section: Discussionsupporting

confidence: 92%

An unexpected case report of epidermoid cyst at the oculomotor nerve: mimicking a common cyst on MRI

Zhang

2023

Front. Endocrinol.

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Intracranial epidermoid cysts are benign lesions and are rarely seen in clinical practice. Owing to similarities in imaging findings to those of common cystic lesions, the preoperative diagnosis is rendered challenging. Here, we present a case report of an epidermoid cyst at the right oculomotor nerve, which was initially misdiagnosed as a common cyst. A 14-year-old female child was admitted to our department due to a previous magnetic resonance imaging scan of a cystic lesion on the right side of the saddle that was suspected to be an oculomotor nerve cyst. In our department, this patient underwent a complete surgical resection of the tumor, and the pathology results revealed an epidermoid cyst. This is the first study that reported an epidermoid cyst at the right oculomotor nerve entering the orbit, mimicking a common cyst in imaging. We hope that this study would allow clinicians to consider this type of lesion as a differential diagnosis. Moreover, we suggest that specific diffusion-weighted imaging scan should be performed to aid in the diagnosis.

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Section: Discussionsupporting

confidence: 92%

An unexpected case report of epidermoid cyst at the oculomotor nerve: mimicking a common cyst on MRI

Zhang

2023

Front. Endocrinol.

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“…3,18 The vascularized NSF has probably been the most effective innovation at lower postoperative CSF leaks after anterior skull base surgery. 2,[9][10][11][12][13][14] Factors that increase the risk of CSF include obesity, hypercortisolemia, Cushing's disease, and radiation therapy. 19 NSF dehiscence and inadequate vascularization can give even worse results due to necrosis.…”

Section: Discussionmentioning

confidence: 99%

“…The risk of CSF leak after EEA ranges widely from 1% to 40%. 3,[14][15][16][17] The risk of CSF leak when using free grafts to cover large skull base defects is very high. 3,18 The vascularized NSF has probably been the most effective innovation at lower post-operative CSF leaks after anterior skull base surgery.…”

Section: Discussionmentioning

confidence: 99%

Reuse of Nasoseptal Flaps for Endoscopic Endonasal Skull Base Reconstruction

Bobeff

Mathios

Longo

et al. 2023

J Neurol Surg B Skull Base

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Introduction:Pedicled nasoseptal flap (NSF) placement is a critical component of skull base reconstruction after endoscopic endonasal approaches (EEA). The effectiveness of NSF reuse has not been thoroughly studied. Prior reports using flaps harvested at one center and reused at another may have technical variability bias. Methods:We identified patients who underwent both their initial and NSF-reused surgeries at Weill Cornell Medical College from 2004 to 2022 using a prospective database of all EEAs. Surgical pathology, intraoperative leak grade, use of cerebrospinal fluid (CSF) diversion and skull base coverage were examined. The primary outcome measure was occurrence of CSF leak. Results:Fourteen patients (six women, eight men) underwent 14 first time and 14 revision operations with median age of 36.6 years (IQR 23.9-61.3) at the time of the NSF reuse. The median interval between the first NSF use and reuse was 70.6 months (IQR 16.6-87). Eight patients were operated on for pituitary adenoma. Non-adenomas included three craniopharyngiomas and one case each of epidermoid, ependymoma and chordoma. There were 16 high-flow, 8 low-flow intraoperative leaks and 4 with no leak. CSF diversion was used in 24 operations. There were three postoperative leaks, one after a first operation and two after NSF reuse. All postoperative CSF leaks, whether first or second operations, occurred in cases with both high-flow intraoperative CSF leak and incomplete NSF coverage (p=0.006). Conclusions:NSF reuse is effective at preventing post-operative CSF leak. The primary predictors of leak are high-flow intraoperative leak and inadequate defect coverage with NSF, regardless of the operation number.

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“…There was no relation between cyst location and infection. According to the literature, epidermoid cysts have also been found in various internal organs, including brain, 17 cecum, 18 kidney, 19 and thymus. 20 We also found that there were more patients with fluctuating sensation, itching, and skin breakage in the infected group, but these factors were not included in the prediction model.…”

Section: Discussionmentioning

confidence: 99%

Establishment and Verification of a Prediction Model for Identifying Pathologic Infections Based on the Clinical Characteristics of Epidermoid Cysts

Ren

Xie

et al. 2022

Surgical Infections

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Background: To construct a prediction model based on the clinical characteristics of epidermoid cysts to identify pathologic infections, evaluate the diagnostic accuracy of the model, and conduct preliminary verification. Patients and Methods: We conducted a retrospective analysis of 314 patients diagnosed with epidermoid cysts that had been removed surgically. The clinical and pathologic data of all patients were collected. The patients were divided randomly into modeling group and verification group in a 75:25 ratio. In the modeling group, the multifactor logistic regression method was used to construct a prediction model for identifying epidermoid cyst pathologic infection, and the receiver operating characteristic (ROC) curve was used to evaluate the diagnostic accuracy of the model, which was then validated in the verification group. Results: All 314 patients with epidermoid cysts were divided into non-infected group (183 cases) and infected group (131 cases) according to the pathologic results. Logistic regression analysis showed that the disease course, growth trend, redness, and texture of epidermoid cysts were independent factors affecting pathologic infection. The above four indicators were selected to construct the prediction model of epidermoid cyst pathologic infection. In the modeling group, the prediction model showed an area under the curve (AUC) of 0.898, with the sensitivity of 0.830, specificity of 0.890, positive likelihood ratio of 7.523, and negative likelihood ratio of 0.191. The AUC of the prediction model in the verification group was 0.919, which was not significantly different from that of the modeling group (p = 0.886). Conclusions: The prediction model based on the clinical characteristics of epidermoid cysts had good diagnostic accuracy and high specificity; it can be used to identify pathologic infections of epidermoid cysts.

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Suprasellar Epidermoid Cyst: Case Report of Extended Endoscopic Transsphenoidal Resection and Systematic Review of the Literature

Cited by 9 publications

References 48 publications

An unexpected case report of epidermoid cyst at the oculomotor nerve: mimicking a common cyst on MRI

An unexpected case report of epidermoid cyst at the oculomotor nerve: mimicking a common cyst on MRI

Reuse of Nasoseptal Flaps for Endoscopic Endonasal Skull Base Reconstruction

Establishment and Verification of a Prediction Model for Identifying Pathologic Infections Based on the Clinical Characteristics of Epidermoid Cysts

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