Outcomes following Expanded Endonasal Resection of Epidermoid Tumors Involving the Cranial Base: Case Series of Seven Patients

Objective Epidermoid cysts frequently affect the cerebellopontine angle, suprasellar cistern, and cranial base. It is common for these lesions to intimately involve multiple cranial nerves and vascular structures—sometimes with dense adherence. As associated open surgical corridors often involve microdissection through narrow spaces between involved cranial nerves, progressive utilization of expanded endonasal approaches (EEA) for treatment of these lesions has been described. As there is a paucity of data in the literature regarding case series of patients with epidermoid cysts treated via EEA for resection, we sought to describe the clinical presentation and surgical outcomes of seven consecutive patients treated by the senior authors.

Methods The authors reviewed a prospectively acquired database of EEA resections over 8 years at the New York-Presbyterian Hospital, Weill Cornell Medical College (WCMC). All procedures were performed by the senior authors. Standardized clinical and radiological parameters were assessed before and after the surgery.

Results A total of seven patients (four males and three females) underwent eight surgeries that involved EEA for resection of epidermoid cysts involving the cranial base. Prior to treatment at the WCMC, three patients had undergone a total of five surgeries for resection of epidermoid cysts at outside institutions. Tumor volume at the time of initial presentation ranged from 6 to 40 mL. Gross total resection was achieved in four of eight surgeries (50%). Near gross total resection (>95%) was achieved in all remaining procedures. Lumbar drains were used in the vast majority of patients (86%) following surgery. Follow-up has ranged from 3 months to 8 years. Three patients (43%) have noted recurrent growth of residual tumor following surgery; one of these patients returned to the OR for an EEA for gross total resection of a recurrent suprasellar component that had resulted in visual decline. One patient suffered a new cranial nerve III palsy postoperatively. No other new neurologic deficits were encountered. One patient developed new posterior pituitary insufficiency following surgery. Two surgeries (25%) were complicated by the need to return to the OR for repair of CSF leakage.

Conclusion The data presented earlier describe the surgical outcomes in a consecutive series of seven patients treated with EEA for resection of cranial base epidermoid cysts; three patients in this series had failed multiple previous surgeries at outside institutions. These data indicate that EEA for resection of epidermoid cysts involving the cranial base remains a viable alternative for treatment of these rare lesions that should be utilized based on the discretion of the treating surgical team.