Transnasal Endoscopic Excision of Midline Nasal Dermoid from the Anterior Cranial Base

Abstract

We recommend that every patient with a midline nasal dermoid be evaluated preoperatively by fine-cut CT scan, in the axial and coronal planes, using both bone and soft-tissue algorithms. Because of CT limitations for assessing soft tissue at the cranial base, a complementary thin-section, high-resolution, multiplanar MRI scan should be considered. Transnasal endoscopic excision of midline nasal dermoid should be used if the dermoid is located within the nasal cavity, and there is minimal or no cutaneous involvement. This approach can be combined with a short vertical midline lenticular excision of a cutaneous punctum. Vertical cutaneous excision should be limited; the best location is the nasal tip. Vertical nasal scars over the bony pyramid invariably widen no matter what intradermal suture is used. Endoscopic removal should be considered even if preoperative radiologic studies show extension to the anterior cranial fossa. Endoscopic excision could also be used to resect a dermoid extending between the dural leaves of anterior fossa. However, a combined intra-extracranial approach is necessary if the dermoid is in the falx cerebri. We agree with other authors that frozen sectioning the superior margin of the specimen should be done to ensure that there is no intracranial extension. Valsalva maneuver during endoscopic visualization of the cranial base is a valuable means of ruling out a cerebral spinal fluid leak.

Nasal Dermal Sinus Cyst and Surgical Approach: Case Report

“…15,16 Weiss ve ark., bilateral interkartilajinöz insizyonu takiben transnazal endoskopik eksizyon uygulamış ve dura uzanımı olsa bile kraniotomi gerekmeden lezyonu çıkardıklarını bildirmişlerdir. 17 Pollock ve ark., cerrahi yaklaşımın kriterlerini; iyi cerrahi görüş, gerektiğinde kafa tabanına ulaşa-bilme, nazal rekonstrüksiyon imkânı sağlama ve kabul edilebilir skar oluşumu olarak bildirmişlerdir. 18 Açık rinoplasti yöntemi, bu kriterleri en iyi karşıla-yan tekniklerden biridir.…”

Congenital Lesions of Tip of Nose: Report of Two Cases with Review

“…The external rhinoplasty approach allows good surgical exposure in combination with a superior cosmetic result [15]. Recently, nasal dermoid cyst has been removed with endoscopic approach [16].…”

Access to the crista galli and the foramen caecum in nasal dermal sinus cysts – lessons learned in a single tertiary care centre

“…Larger published series either combined ectodermal and neuroectodermal masses or they summarized di erent malformations under the label of NDSC (8,9,11) . PubMed searching identi ed only three papers discussing the endoscopic treatment of NDSC (15)(16)(17) , while other articles focused …”

“…However, because of the few cases treated by the minimally in- were proposed by Weiss et al (17) and Schuster et al (15) .…”

“…As standard techniques cause signi cant sequelae like visible scarring and signi cant blood loss especially in children, we have attempted to develop a less invasive technique. The objective of this study is to outline the evolution of the approaches to the crista galli and our e orts to minimize the sequelae (15)(16)(17)(18) . A minimally invasive approach to the crista galli and foramen caecum is described.…”