Endoscope-Assisted Microsurgical Removal of an Epidermoid Tumor within the Cavernous Sinus

Abstract

Epidermoid tumor of the cavernous sinus is rare. The aim of this case report is to discuss the role of neuroendoscopes in the removal of such lesions. A 21-year-old man presented with 6-year history of progressive headache, diplopia, and visual disturbance. Work-up revealed an epidermoid tumor located in the right cavernous sinus. An extradural transcavernous approach was utilized via a traditional frontotemporal craniotomy with endoscopic assistance. The postoperative course was uneventful with immediate improvement of the patient's headache. Postoperative magnetic resonance imaging demonstrated complete removal of the tumor. There were no signs of recurrence during a 2-year follow-up period. The endoscope is a useful tool for removing epidermoid tumors from the cavernous sinus and enhances visualization of areas that would otherwise be difficult to visualize with microscopes alone. Endoscopes also help minimize the retraction of neurovascular structures.

Endoscopic endonasal surgery for nonadenomatous, nonmeningeal pathology involving the cavernous sinus

“…Review of the literature (Table 5) revealed 7 publications, 10,27,29,33,45,56,68 4 of which focus on endoscopic CS biopsy. 27,29,45,68 One is a case report of endoscope-assisted microsurgery on a CS epidermoid.…”

“…27,29,45,68 One is a case report of endoscope-assisted microsurgery on a CS epidermoid. 10 The other 2 are mixed series that also include pituitary adenomas and meningiomas. 33,56 Hence, the current report is the largest systematic study on the results of endoscopic endonasal surgery of lesions other than adenomas and meningiomas within the CS to our knowledge to date.…”

“…2,7,15,23,32,38 Clinical reports on endonasal CS surgery have mostly concerned removal of soft pituitary tumors or biopsies of various other lesions. 8,10,21,23,29,33,45,49,56,57,68,77 In this study we expand on prior reports by analyzing a series of endonasal endoscopic surgeries for nonpituitary, nonmeningioma tumors with significant extension within the CS, focusing on the feasible extent of resection and neurological outcome in association with Knosp-Steiner (KS) grade and degree of cavernous carotid artery (CCA) encasement.…”

Epidermoid cysts of the cavernous sinus: clinical features, surgical outcomes, and literature review

“…Intracranial epidermoid cysts are an uncommon finding, 5,21,31 and epidermoid cysts of the CS are even rarer, accounting for only 2% of all intracranial epidermoid tumors. 31 At our center, lesions of the CS account for 4.3% of all epidermoid cysts.…”

Above the Sphenoid in to Dermoid-Expanded Endoscopic Two Nostrils Four Hand Technique: A Case Report

“…Endoscopes also help to minimise the retraction of neuro vascular structures. Fries and Perneczky described the advantages of the endoscopes as an adjunct tool in micro surgery including reduced surgical trauma, especially in a vascular lesions such as epidermoid tumor [5]. Expanded endonasal transsphenoidal approach has advantages of no incisions, faster recovery, early devascularisation of tumour, no brain retraction, minimal manipulation of optic apparatus, avoids craniotomy, less post operative discomfort and no loss of olfaction.…”