Endoscopic Endonasal Surgery of Epidermoid Cysts of the Chiasmatic Region

Fomichev, Dmitry; Kalinin, Pavel; Kutin, Maxim; Sharipov, Oleg

doi:10.1016/j.wneu.2016.08.111

Cited by 7 publications

(14 citation statements)

References 15 publications

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“…11,14 It is also widely used in the resection of other extrasellar extra-axial lesions including craniopharyngiomas, dermoid tumors, meningiomas, and chordomas. [8][9][10]12,13,15,[17][18][19] However, experience with this technique in the treatment of intraaxial lesions with critical neurovascular relationship is limited, so traditionally an open technique is preferred. 14,20 The role of the endoscopic transnasal approach in intra-axial lesions, lesions with intra-axial extension, large tumors, and lesions with peritumoral edema is controversial.…”

Section: Discussionmentioning

confidence: 99%

“…This approach is currently mostly used in pituitary adenomas and other extra-axial lesions such as meningioma, dermoid tumors, and craniopharyngioma. [8][9][10][11][12][13][14] Some published reports recently demonstrated useful utilization of this approach for the resection of intra-axial lesions. 6,[8][9][10][11][12][13][14][15] We present the case of an 18-year-old young woman who underwent a successful endoscopic transnasal resection of a suprasellar teratoma with a mixed germ cell component.…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic Transnasal Resection of Suprasellar Teratoma

Ajlan

Albakr

Alsaleh

et al. 2019

J Neurol Surg A Cent Eur Neurosurg

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Background Intracranial teratomas are rare tumors that usually present during the second decade of life. Among intracranial teratomas, suprasellar germ cell tumors in particular are extremely rare. We present the case of an 18-year-old girl who underwent a successful endoscopic transnasal resection of a suprasellar teratoma with a mixed germ cell component. Case Description An 18-year-old girl presented with progressive visual disturbance, headache, weight loss, and fatigue for 2 weeks. She had decreased vision in her right eye and double vision when looking to the right side. On examination, she had right-side complete abducens nerve palsy and partial oculomotor nerve palsy bilaterally. Brain imaging revealed a large suprasellar lesion consistent with a germ cell tumor. The patient underwent a transnasal endoscopic resection of the lesion. Pathology showed a mixed germ cell tumor (80% mature cystic teratoma, 18% yolk sac tumor, and 2% germinoma). The mature teratomatous elements identified included skin with sebaceous material, hair, cartilage, acini, colonic mucosa, muscle, nerve bundles, and adipose tissue. Postoperative magnetic resonance imaging (MRI) showed residual tumor in the left cavernous sinus and anterior clinoid process superiorly. At a 1-year follow-up, the double vision had resolved, and her vision showed progressive improvement. The patient was maintained on treatment for diabetes insipidus, hypothyroidism, and adrenal insufficiency. Her last MRI showed no signs of tumor progression. Conclusions The present case demonstrates a safe endoscopic transnasal surgical resection of a rare suprasellar tumor, mixed teratoma, with intra-axial extension. The endoscopic transnasal approach can be considered a valid option for a suprasellar lesion.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Endoscopic Transnasal Resection of Suprasellar Teratoma

Ajlan

Albakr

Alsaleh

et al. 2019

J Neurol Surg A Cent Eur Neurosurg

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“…3,34 To date, the only case series dedicated to this topic was provided by Formichev et al, who reported radiological GTR in 5 of 6 patients with chiasmatic-region ECs with no recurrences noted during a mean follow-up of 42 months. 19 Complications in this series included postoperative CSF leak in 1 patient, meningitis in 2 patients, and new anterior pituitary insufficiency in 1 patient. Aside from the series by Fomichev et al, no long-term data on the topic of EEA for resection of ECs in the suprasellar region are available.…”

Section: Traditional Microsurgical Approachesmentioning

confidence: 83%

“…The benefits of the EEA to access various alternative pathologies of the ventral cranial base have been well described. 3,33,34 While isolated case reports and small case series exist that describe the utility of these approaches in the resection of ECs of the cranial base, 11,17,19,35 there is an overall paucity of information in the literature regarding this surgical option, especially regarding ventral ECs of the posterior fossa. Thus, we sought to describe the clinical presentation and surgical outcomes of 7 consecutive patients with ventral ECs of the cranial base treated using the EEA.…”

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confidence: 99%

Endoscopic endonasal resection of epidermoid cysts involving the ventral cranial base

Forbes

Banu

Lehner

et al. 2019

Journal of Neurosurgery

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OBJECTIVE Epidermoid cysts (ECs) commonly extend to involve the ventral cisterns of the cranial base. When present, symptoms arise due to progressive mass effect on the brainstem and adjacent cranial nerves. Historically, a variety of open microsurgical approaches have been used for resection of ECs in this intricate region. In recent years, the endoscopic endonasal approach (EEA) has been proposed as an alternative corridor that avoids crossing the plane of the cranial nerves. To date, there is a paucity of data in the literature regarding the safety and efficacy of the EEA in the treatment of ECs of the ventral cranial base. METHODS The authors reviewed a prospectively acquired database of EEAs for resection of ECs over 8 years at Weill Cornell, NewYork-Presbyterian Hospital. All procedures were performed by the senior authors. Standardized clinical and radiological parameters were assessed before and after surgery. Statistical tests were used to determine the impact of previous surgery and tumor volume on extent of resection and recurrence as well as the method of closure on rate of CSF leak. RESULTS Between January 2009 and February 2017, 7 patients (4 males and 3 females; age range 16-70 years) underwent a total of 8 surgeries for EC resection utilizing the EEA. Transplanum and transclival extensions were performed in 3 and 5 patients, respectively. Methods of closure incorporated a gasket seal in 6 of 8 procedures and a nasoseptal flap in 7 of 8 procedures. Gross-total resection (GTR) was achieved in 43% of patients, and near-total resection (> 95%) was obtained in another 43%. Complications included diabetes insipidus (n = 2), postoperative CSF leak (n = 2), transient third cranial nerve palsy (n = 1), and epistaxis (n = 1). With a mean follow-up of 43.5 months, recurrence has been observed in 2 of 7 patients. In 1 case, reoperation for recurrence was required 71 months following the initial surgery. Use of the gasket-seal technique with nasoseptal flap coverage significantly correlated with the absence of postoperative CSF leakage (p = 0.018). GTR was achieved in 25% of the patients who had prior surgeries and in 50% of patients without previous resections. The mean volume of cysts in which GTR was achieved (4.3 ± 1.8 cm) was smaller than that in which subtotal or near-total resection was achieved (12.2 ± 11 cm, p = 0.134). CONCLUSIONS The EEA for resection of ECs of the ventral cranial base is a safe and effective operative strategy that avoids crossing the plane of the cranial nerves. In the authors' experience, gasket-seal closure with nasoseptal flap coverage has been associated with a decreased risk of postoperative CSF leakage.

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“…The process corresponds to $ 0.2 to 1.8% of all primary intracranial tumors and are 4 to 9 times as common as dermoid cysts. [1][2][3][4] Most ECs compromising the central nervous system (CNS) are extraaxial, leptomeningeal lesions, with the cerebellopontine angle (40-50% of patients) being the most common location. Epidermoid cysts can also be found in the 4 th ventricle (17%), in the sellar/parasellar region (10-15%), in the cerebral hemispheres, in the brainstem, in the skull, and in the spine.…”

Section: Introductionmentioning

confidence: 99%

Physiopathological Aspects of Sellar Epidermoid Cyst Determining Endocrine Disturbances: A Case Report

et al. 2019

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Epidermoid cysts (ECs) of the central nervous system (CNS) constitute benign circumscribed lesions that are more common in lateral than in midline sites. Epidermoid cysts of the CNS arise more frequently in the cerebellopontine angle, around the pons, near the sella, within the temporal lobe, in the diploe, and in the spinal canal. Most common tumoral lesion of sellar region is pituitary adenoma, and sellar cystic epithelial masses may be difficult to differentiate based only on clinical and imaging findings. Epidermoid cysts are covered by keratinized squamous epithelium and are usually filled with keratin lamellae. The process is, for the most part, maldevelopmental in origin, presumably arising from trapped surface ectodermal elements in association with the developing CNS during the closure of the neural groove or formation of the secondary cerebral vesicles. In the present study, the authors describe a case of sellar epidermoid cyst producing endocrine alterations and visual disturbance in a 35 years woman, and review the physiopathological and diagnostic criteria of this lesion.

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Endoscopic Endonasal Surgery of Epidermoid Cysts of the Chiasmatic Region

Cited by 7 publications

References 15 publications

Endoscopic Transnasal Resection of Suprasellar Teratoma

Endoscopic Transnasal Resection of Suprasellar Teratoma

Endoscopic endonasal resection of epidermoid cysts involving the ventral cranial base

Physiopathological Aspects of Sellar Epidermoid Cyst Determining Endocrine Disturbances: A Case Report

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