Total resection of sellar and suprasellar epidermoid cyst by using endoscopic endonasal approach: a case report

Abstract

Epidermoid cysts (EC) are benign lesions resulting from incomplete separation of the neuroectoderm during embryonic development. The investigation of choice for EC is magnetic resonance imaging (MRI). Surgical resection is the treatment of choice. Full resection of EC including the cyst wall to prevent recurrence and malignant transformation should be considered when possible. Two main approaches were described in the literature and included craniotomy and endoscopic endonasal approach (EEA). Using of EEA to accomplish total resection could be challengeable. To best of our knowledge, only 6 manuscripts (with a total of eight patients) reported total resection of EC by using EEA. Our case should be the ninth such cases in the literature. In this paper, we reported a case of sellar and suprasellar epidermoid cyst which was resected completely by using EEA. We revealed the safety and efficacy of this approach in management of such cases.

The Endoscopic Resection of Sellar and Suprasellar Epidermoid Cyst in a Pediatric Patient: A Case Report and Review of the Literature

“…An epidermoid cyst is a rare congenital benign cystic lesion that occurs due to the proliferation of multipotent embryonic stem cells or lateral displacement of ectodermal cells [5]. The incomplete separation of the epidermal and neural ectoderm occurs between the third and fifth gestational week, resulting in the inclusion of epiblast in the neural tube that closes during the gestational period [4,6]. An epidermoid cyst is filled with keratin laminae, water, and lipids structures in its wall and covered by mature keratinized squamous epithelium [4,7].…”

“…The incomplete separation of the epidermal and neural ectoderm occurs between the third and fifth gestational week, resulting in the inclusion of epiblast in the neural tube that closes during the gestational period [4,6]. An epidermoid cyst is filled with keratin laminae, water, and lipids structures in its wall and covered by mature keratinized squamous epithelium [4,7]. The accumulation of keratin and cholesterol, which are breakdown products, can increase their tendency to grow [7].…”

“…MRI can assess the depth extension and mass effect of the tumor on the neurovascular structures without interfering with the density of the skull base. Grossly, it is a welldelineated lesion that appears pale-uninoculated, and translucent with an irregular nodular shiny surface; focal calcification may also be present [4,12]. The cyst is filled with soft waxy material that is rich in cholesterol crystals.…”

“…Between 40 and 50% of intracranial epidermoid cysts affect the cerebellopontine cisterns, and 10-15% affect suprasellar spaces or the middle cranial fossa [3]. Because of the slow-growing nature of these tumors, sellar epidermoid cysts are usually asymptomatic in pediatric patients [4]. Surgical intervention is considered the ideal treatment method for sellar/suprasellar cysts, and multiple options are available including the endoscopic endonasal approach (EEA) or open technique [4].…”

“…Because of the slow-growing nature of these tumors, sellar epidermoid cysts are usually asymptomatic in pediatric patients [4]. Surgical intervention is considered the ideal treatment method for sellar/suprasellar cysts, and multiple options are available including the endoscopic endonasal approach (EEA) or open technique [4]. However, the procedure can be challenging due to the involvement of vital neurovascular structures [1].…”