Endoscopic Endonasal Resection of a Midline Intradural Frontobasal Dermoid Tumour

Abstract

Dermoid and epidermoid cysts are congenital, slowly growing tumours that usually become symptomatic when patients reach the middle of their third decade. An otherwise healthy 20-year-old man presented with an epileptic attack. Imaging studies including computed tomography and magnetic resonance imaging revealed an intradural cystic lesion located in the anterior subfrontal region. Choices of traditional approaches for such a lesion are a bicoronal craniotomy or a transfacial procedure. Taking the advantage of the endoscope, the authors decided to remove the lesion via an endonasal route. After a fully endoscopic endonasal operation, gross total resection of the dermoid tumour was achieved. We have not observed cerebrospinal fluid leakage or any infectious complication after the operation. In this report the technique of operation and reconstruction method are described. The endoscopic endonasal approach offers a good option for lesions located in the anterior skull base. Carefully piecemeal resection of the tumour while preserving the underlying neural and vascular structures should be the main strategy of the operation. Reconstruction is very important after the surgery and a carefully planned pedicled graft technique may help in the prevention of cerebrospinal fluid leakage.

Key words

dermoid cyst - endoscopy - reconstruction

References

• 1 Berger MS, Wilson CB. Epidermoid cysts of the posterior fossa.  J Neurosurg. 1985;  62 214-219
• 2 Conley FK. Epidermoid and dermoid tumors: clinical features and surgical management. In: Wilkins RH, Rengachary SS (eds). Neurosurgery. New York, McGraw-Hill 1985: 668-673
• 3 Maroon JC. Skull base surgery: past, present, and future trends.  Neurosurg Focus. 2005;  19 ((1))
• 4 Kassam A, Snyderman CH, Mintz A, Gardner P, Carrau RL. Expanded endonasal approach: the rostrocaudal axis. Part I. Crista galli to the sella turcica.  Neurosurg Focus. 2005;  19 ((1))
• 5 Caldarelli M, Massimi L, Kondageski C, Di Rocco C. Intracranial midline dermoid and epidermoid cysts in children.  J Neurosurg. 2004;  100 ((5 Suppl Pediatrics)) 473-480
• 6 Yasargil MG, Abernathey CD, Sarioglu AC. Microneurosurgical treatment of intracranial dermoid and epidermoid tumors.  Neurosurgery. 1989;  24 561-567
• 7 Samii M, Tatagiba M, Piquer J. et al . Surgical treatment of epidermoid cysts of the cerebellopontine angle.  J Neurosurg. 1996;  84 14-19
• 8 Kassam A, Carrau RL, Snyderman CH, Gardner P, Mintz A. Evolution of reconstructive techniques following endoscopic expanded endonasal approaches.  Neurosurg Focus. 2005;  19 ((1))

Correspondence