Download PDF
J Neurol Surg A Cent Eur Neurosurg 2019; 80(04): 320-324
DOI: 10.1055/s-0038-1676624
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Endoscopic Transnasal Resection of Suprasellar Teratoma

Abdulrazag M. Ajlan
1   Division of Neurosurgery, Department of Surgery, King Saud University, Riyadh, Riyadh Province, Saudi Arabia
2   Neurosurgery Department, Stanford University, Stanford, California, United States
,
Abdulrahman Albakr
1   Division of Neurosurgery, Department of Surgery, King Saud University, Riyadh, Riyadh Province, Saudi Arabia
,
Saad Alsaleh
3   Department of Otolaryngology-Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
,
Hisham Alkhalidi
4   Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
› Author Affiliations
Further Information

Publication History

27 December 2017

07 August 2018

Publication Date:
01 February 2019 (online)

    Permissions and Reprints

Corrected by:

Erratum: Endoscopic Transnasal Resection of Suprasellar TeratomaJ Neurol Surg A Cent Eur Neurosurg 2019; 80(04): e1-e1
DOI: 10.1055/s-0039-3400464

Abstract

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.

Keywords

endoscopic transnasal surgery - teratoma - transsphenoidal surgery
 

  • References

  • 1 Matsutani M, Sano K, Takakura K. , et al. Primary intracranial germ cell tumors: a clinical analysis of 153 histologically verified cases. J Neurosurg 1997; 86 (03) 446-455
    CrossrefPubMedGoogle Scholar
  • 2 Louis DN. , International Agency for Research on Cancer. WHO Classification of Tumours of the Central Nervous System. 4th ed. Lyon, France: International Agency for Research on Cancer; 2007
    Google Scholar
  • 3 Ostrom QT, Gittleman H, Xu J. , et al. CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2009–2013. Neuro Oncol 2016; 18 (Suppl_5): v1-v75
    CrossrefPubMedGoogle Scholar
  • 4 Noudel R, Vinchon M, Dhellemmes P, Litré CF, Rousseaux P. Intracranial teratomas in children: the role and timing of surgical removal. J Neurosurg Pediatr 2008; 2 (05) 331-338
    CrossrefPubMedGoogle Scholar
  • 5 Sweiss RB, Shweikeh F, Sweiss FB, Zyck S, Dalvin L, Siddiqi J. Suprasellar mature cystic teratoma: an unusual location for an uncommon tumor. Case Rep Neurol Med 2013; 2013: 180497
    PubMedGoogle Scholar
  • 6 Ajayi O, Chakravarthy V, Hanna G, DeLos Reyes K. Surgical technique: endoscopic endonasal transphenoidal resection of a large suprasellar mixed germ cell tumor. Cureus 2016; 8 (02) e503
    PubMedGoogle Scholar
  • 7 Murray MJ, Bartels U, Nishikawa R, Fangusaro J, Matsutani M, Nicholson JC. Consensus on the management of intracranial germ-cell tumours. Lancet Oncol 2015; 16 (09) e470-e477
    CrossrefPubMedGoogle Scholar
  • 8 Kasemsiri P, Carrau RL, Ditzel Filho LF. , et al. Advantages and limitations of endoscopic endonasal approaches to the skull base. World Neurosurg 2014; 82 (6, Suppl): S12-S21
    CrossrefPubMedGoogle Scholar
  • 9 Shin M, Kondo K, Saito N. Current status of endoscopic endonasal surgery for skull base meningiomas: review of the literature. Neurol Med Chir (Tokyo) 2015; 55 (09) 735-743
    CrossrefPubMedGoogle Scholar
  • 10 Komotar RJ, Starke RM, Raper DM, Anand VK, Schwartz TH. Endoscopic endonasal compared with microscopic transsphenoidal and open transcranial resection of craniopharyngiomas. World Neurosurg 2012; 77 (02) 329-341
    CrossrefPubMedGoogle Scholar
  • 11 Shou X, Shen M, Zhang Q. , et al. Endoscopic endonasal pituitary adenomas surgery: the surgical experience of 178 consecutive patients and learning curve of two neurosurgeons. BMC Neurol 2016; 16 (01) 247
    CrossrefPubMedGoogle Scholar
  • 12 Fomichev D, Kalinin P, Kutin M, Sharipov O. Endoscopic endonasal surgery of epidermoid cysts of the chiasmatic region. World Neurosurg 2016; 96: 159-164
    CrossrefPubMedGoogle Scholar
  • 13 Yadav YR, Nishtha Y, Vijay P, Shailendra R, Yatin K. Endoscopic endonasal trans-sphenoid management of craniopharyngiomas. Asian J Neurosurg 2015; 10 (01) 10-16
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Lobo B, Heng A, Barkhoudarian G, Griffiths CF, Kelly DF. The expanding role of the endonasal endoscopic approach in pituitary and skull base surgery: a 2014 perspective. Surg Neurol Int 2015; 6: 82
    CrossrefPubMedGoogle Scholar
  • 15 Ali ZS, Henn RE, Adappa ND, Palmer JN, Lee JYK, Storm PB. Pediatric endoscopic endonasal skull base surgery: the Children's Hospital of Philadelphia experience. J Neurol Surg B Skull Base 2015; 76: 57 Abstract available at: https://www.thieme-connect.de/DOI/DOI?10.1055/s-0035-1546524
    PubMedGoogle Scholar
  • 16 Anazawa T, Miyata H, Gotoh M. Cancer registries in Japan: national clinical database and site-specific cancer registries. Int J Clin Oncol 2015; 20 (01) 5-10
    CrossrefPubMedGoogle Scholar
  • 17 Paluzzi A, Fernandez-Miranda JC, Pinheiro-Neto C. , et al. Endoscopic endonasal infrasellar approach to the sellar and suprasellar regions: technical note. Skull Base 2011; 21 (05) 335-342
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Somma T, Solari D, Beer-Furlan A. , et al. Endoscopic endonasal management of rare sellar lesions: clinical and surgical experience of 78 cases and review of the literature. World Neurosurg 2017; 100: 369-380
    CrossrefPubMedGoogle Scholar
  • 19 Zoli M, Marucci G, Milanese L. , et al. Suction filter in endoscopic endonasal surgery: a technical note. World Neurosurg 2016; 95: 464-468
    CrossrefPubMedGoogle Scholar
  • 20 Dehdashti AR, Ganna A, Witterick I, Gentili F. Expanded endoscopic endonasal approach for anterior cranial base and suprasellar lesions: indications and limitations. Neurosurgery 2009; 64 (04) 677-687 ; discussion 687–689
    CrossrefPubMedGoogle Scholar
  • 21 Arbolay OL, González JG, González RH, Gálvez YH. Extended endoscopic endonasal approach to the skull base. Minim Invasive Neurosurg 2009; 52 (03) 114-118
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 de Divitiis E, Cavallo LM, Cappabianca P, Esposito F. Extended endoscopic endonasal transsphenoidal approach for the removal of suprasellar tumors: Part 2. Neurosurgery 2007; 60 (01) 46-58 ; discussion 58–59
    CrossrefPubMedGoogle Scholar
  • 23 Kassam A, Thomas AJ, Snyderman C. , et al. Fully endoscopic expanded endonasal approach treating skull base lesions in pediatric patients. J Neurosurg 2007; 106 (2, Suppl): 75-86
    PubMedGoogle Scholar
  • 24 Koutourousiou M, Gardner PA, Kofler JK, Fernandez-Miranda JC, Snyderman CH, Lunsford LD. Rare infundibular tumors: clinical presentation, imaging findings, and the role of endoscopic endonasal surgery in their management. J Neurol Surg B Skull Base 2013; 74 (01) 1-11
    PubMedGoogle Scholar
  • 25 He SM, Wang Y, Zhao TZ. , et al. Endoscopic endonasal approach to mesencephalic cavernous malformations. World Neurosurg 2016; 90: 701.e7-701.e10
    CrossrefPubMedGoogle Scholar
  • 26 Sanborn MR, Kramarz MJ, Storm PB, Adappa ND, Palmer JN, Lee JY. Endoscopic, endonasal, transclival resection of a pontine cavernoma: case report. Neurosurgery 2012; 71 (1, Suppl Operative): 198-203
    PubMedGoogle Scholar
  • 27 Awad AJ, Mohyeldin A, El-Sayed IH, Aghi MK. Sinonasal morbidity following endoscopic endonasal skull base surgery. Clin Neurol Neurosurg 2015; 130: 162-167
    CrossrefPubMedGoogle Scholar
  • 28 Little AS, Kelly D, Milligan J. , et al. Predictors of sinonasal quality of life and nasal morbidity after fully endoscopic transsphenoidal surgery. J Neurosurg 2015; 122 (06) 1458-1465
    CrossrefPubMedGoogle Scholar