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Ergen A, Caklili M, Uzuner A, Kurnaz Ozbek S, Cabuk B, Anik I, Ceylan S. Endoscopically operated 15 ventral skull-base dermoid and epidermoid cysts: Outcomes of a case series and technical note. Neurochirurgie 2023; 69:101424. [PMID: 36868134 DOI: 10.1016/j.neuchi.2023.101424] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 12/09/2022] [Accepted: 12/22/2022] [Indexed: 03/05/2023]
Abstract
BACKGROUND Epidermoid and dermoid tumors in the sellar region are rare. These cystic lesions are a surgical challenge, as the thin capsule adheres firmly to nearby structures. A case series of 15 patients is presented. METHODS The patients were operated on in our clinic between April 2009 and November 2021. The endoscopic transnasal approach (ETA) was used. Lesions were located in the ventral skull base. In addition, the literature was reviewed to compare clinical features and outcomes of ventral skull-base epidermoid/dermoid tumors operated on via ETA. RESULTS In our series, removal of cystic contents and tumor capsule (gross total resection: GTR) was achieved in 3 patients (20%). GTR was not possible for the others, because of adhesions to vital structures. Near total resection (NTR) was achieved in 11 patients (73.4%), and subtotal resection (STR) in 1 (6.6%). At a mean follow-up of 55±26.27 months, there were no cases of recurrence requiring surgery. CONCLUSION Our series demonstrates that ETA is suitable for resection of epidermoid and dermoid cysts in the ventral skull base. GTR cannot always be the absolute clinical aim, because of inherent risks. In patients with expected long-term survival, the aggressiveness of surgery should be weighed on an individual risk/benefit basis.
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Affiliation(s)
- A Ergen
- Department of Neurosurgery and Pituitary Research Center, Kocaeli University, School of Medicine, Kocaeli, Turkey.
| | - M Caklili
- Department of Neurosurgery and Pituitary Research Center, Kocaeli University, School of Medicine, Kocaeli, Turkey.
| | - A Uzuner
- Department of Neurosurgery and Pituitary Research Center, Kocaeli University, School of Medicine, Kocaeli, Turkey.
| | - S Kurnaz Ozbek
- Department of Histology and Embryology, Kocaeli University, School of Medicine, Kocaeli, Turkey.
| | - B Cabuk
- Department of Neurosurgery and Pituitary Research Center, Kocaeli University, School of Medicine, Kocaeli, Turkey.
| | - I Anik
- Department of Neurosurgery and Pituitary Research Center, Kocaeli University, School of Medicine, Kocaeli, Turkey.
| | - S Ceylan
- Department of Neurosurgery and Pituitary Research Center, Kocaeli University, School of Medicine, Kocaeli, Turkey.
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Combined endoscopic and exoscopic resection of intracranial epidermoid cysts. World Neurosurg 2022; 168:e28-e33. [PMID: 36055616 DOI: 10.1016/j.wneu.2022.08.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/20/2022] [Accepted: 08/22/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This article aims at introducing an endoscopic-exoscopic technique for the resection of epidermoid cysts. METHODS We retrospectively analyzed the intracranial epidermoid cysts patients who received whole course combined endoscopic and exoscopic resection between 2017 and 2020 at our institution, to explore the benefit of combined endoscopic and exoscopic resection of intracranial epidermoid cysts and evaluated the clinical utility of endoscopic-exoscopic technique. RESULTS A total of 17 patients were enrolled in the study. Of all patients, 6 patients (6/17, 35.3%) underwent total resection, 10 patients (10/17, 58.8%) underwent subtotal resection (residual capsule and/or) and 1 patient (1/17, 5.9%) underwent partial resection. Postoperative surgical complications were seen in 3 patients (3/17, 17.6%), including intracranial infection in 2 patients (2/17, 11.8%) , and a delayed postoperative hematoma observed in the seventh day after operation for 1 patient (1/17, 5.9%), who was treated in a conservative manner and recovered smoothly from the hemorrhage. The median follow-up time was 33.3 months (range 14.5-54.5 months). During the follow-up period, there was no recurrence of the tumors that received total resection. 2 patients developed residual tumor regrowth but did not show any symptom therefore no further surgery was required. CONCLUSIONS Endoscopic-exoscopic technique is safe and efficient in the resection of intracranial epidermoid cysts with panoramic views and superior maneuverability. With further development and accumulation of practical experiences, the endoscopic-exoscopic technique can also be applied in the resection of other intracranial tumors.
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Bobeff EJ, Sánchez-Viguera C, Arráez-Manrique C, Arráez-Sánchez MÁ. Suprasellar Epidermoid Cyst: Case Report of Extended Endoscopic Transsphenoidal Resection and Systematic Review of the Literature. World Neurosurg 2019; 128:514-526. [DOI: 10.1016/j.wneu.2019.05.100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 05/10/2019] [Accepted: 05/11/2019] [Indexed: 12/14/2022]
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Forbes JA, Banu M, Lehner K, Ottenhausen M, La Corte E, Alalade AF, Ordóñez-Rubiano EG, Greenfield JP, Anand VK, Schwartz TH. Endoscopic endonasal resection of epidermoid cysts involving the ventral cranial base. J Neurosurg 2018; 130:1599-1608. [PMID: 29882703 DOI: 10.3171/2017.12.jns172575] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 12/19/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Epidermoid cysts (ECs) commonly extend to involve the ventral cisterns of the cranial base. When present, symptoms arise due to progressive mass effect on the brainstem and adjacent cranial nerves. Historically, a variety of open microsurgical approaches have been used for resection of ECs in this intricate region. In recent years, the endoscopic endonasal approach (EEA) has been proposed as an alternative corridor that avoids crossing the plane of the cranial nerves. To date, there is a paucity of data in the literature regarding the safety and efficacy of the EEA in the treatment of ECs of the ventral cranial base. METHODS The authors reviewed a prospectively acquired database of EEAs for resection of ECs over 8 years at Weill Cornell, NewYork-Presbyterian Hospital. All procedures were performed by the senior authors. Standardized clinical and radiological parameters were assessed before and after surgery. Statistical tests were used to determine the impact of previous surgery and tumor volume on extent of resection and recurrence as well as the method of closure on rate of CSF leak. RESULTS Between January 2009 and February 2017, 7 patients (4 males and 3 females; age range 16-70 years) underwent a total of 8 surgeries for EC resection utilizing the EEA. Transplanum and transclival extensions were performed in 3 and 5 patients, respectively. Methods of closure incorporated a gasket seal in 6 of 8 procedures and a nasoseptal flap in 7 of 8 procedures. Gross-total resection (GTR) was achieved in 43% of patients, and near-total resection (> 95%) was obtained in another 43%. Complications included diabetes insipidus (n = 2), postoperative CSF leak (n = 2), transient third cranial nerve palsy (n = 1), and epistaxis (n = 1). With a mean follow-up of 43.5 months, recurrence has been observed in 2 of 7 patients. In 1 case, reoperation for recurrence was required 71 months following the initial surgery. Use of the gasket-seal technique with nasoseptal flap coverage significantly correlated with the absence of postoperative CSF leakage (p = 0.018). GTR was achieved in 25% of the patients who had prior surgeries and in 50% of patients without previous resections. The mean volume of cysts in which GTR was achieved (4.3 ± 1.8 cm3) was smaller than that in which subtotal or near-total resection was achieved (12.2 ± 11 cm3, p = 0.134). CONCLUSIONS The EEA for resection of ECs of the ventral cranial base is a safe and effective operative strategy that avoids crossing the plane of the cranial nerves. In the authors' experience, gasket-seal closure with nasoseptal flap coverage has been associated with a decreased risk of postoperative CSF leakage.
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Affiliation(s)
- Jonathan A Forbes
- 1Department of Neurological Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - Matei Banu
- 2Department of Neurological Surgery, Columbia Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - Kurt Lehner
- 3Hofstra-Northwell Health School of Medicine, New York, New York
| | - Malte Ottenhausen
- 1Department of Neurological Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - Emanuele La Corte
- 4University of Milan and Department of Neurosurgery, Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy
| | - Andrew F Alalade
- 5Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Edgar G Ordóñez-Rubiano
- 1Department of Neurological Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
- 6Department of Neurological Surgery, Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital de San José, Bogotá, Colombia
| | - Jeffrey P Greenfield
- 1Department of Neurological Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - Vijay K Anand
- 7Department of Otolaryngology, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York; and
| | - Theodore H Schwartz
- 1Department of Neurological Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
- 7Department of Otolaryngology, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York; and
- 8Department of Neuroscience, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
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Singh I, Rohilla S, Kumar P, Krishana G. Combined microsurgical and endoscopic technique for removal of extensive intracranial epidermoids. Surg Neurol Int 2018. [PMID: 29527394 PMCID: PMC5838849 DOI: 10.4103/sni.sni_392_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Intracranial epidermoid tumors are challenging lesions because they grow along the subarachnoid spaces around delicate neurovascular structures and often extend from one compartment to another. The purpose of this study was to determine the usefulness of endoscopic assistance in the microsurgical resection of these lesions, in which total resection is therapy of choice. Methods A total of 48 cases of intracranial epidermoids were treated by combined microscopic and endoscopic techniques. Initially, the tumor was removed under the microscope and after ensuring maximum excision, the endoscope was used to find out and excise any residual tumor. Results Out of these 48 cases complete excision was achieved in 44 cases and subtotal excision in four patients. Postoperative complications were seen in 17 patients, but none of the complications was attributed to the use of endoscope. Overall use of endoscope benefited 79% of cases. Conclusion We recommend combined microsurgical and endoscopic approach to achieve complete/maximum resection of extensive intracranial epidermoid tumors.
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Affiliation(s)
- Ishwar Singh
- Department of Neurosurgery, Pt. B. D. Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Seema Rohilla
- Department of Radiodiagnosis, Pt. B. D. Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Prashant Kumar
- Department of Anaesthesiology and Critical Care, Pt. B. D. Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Gopal Krishana
- Department of Neurosurgery, Pt. B. D. Sharma University of Health Sciences, Rohtak, Haryana, India
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Endoscopic resection of cystic pontine tumour: three case reports and a proposal for minimally invasive dual-endoscopic surgery. Acta Neurochir (Wien) 2014; 156:1145-50. [PMID: 24740348 DOI: 10.1007/s00701-014-2085-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Accepted: 03/25/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE AND IMPORTANCE We describe a new endoscopic technique, the dual-endoscopic method, in which two independent endoscopic systems are simultaneously used in the subtemporal space and intraparenchymal field for patients with pontine cystic tumours. Tumours were successfully removed through a sheath placed in the brainstem via the subtemporal keyhole approach, with safety ensured by the second subtemporal endoscope. CLINICAL PRESENTATION A purely endoscopic subtemporal approach was performed in three cases of pontine cystic tumour, including two low-grade gliomas and a recurrent chordoma. The gliomas showed nodules. Recurrent chordoma consisted of a mucinous component. TECHNIQUE Using a keyhole subtemporal approach and a 4.0-mm rigid endoscope with a high-definition camera, a transparent puncture needle containing a 2.7-mm rigid endoscope was inserted into the cyst. The tumour was removed using suction, biopsy forceps, and scissors simultaneously placed with the 2.7-mm endoscope in a transparent sheath. CONCLUSION Since the 4.0-mm endoscope placed in the subtemporal space monitored all procedures of the 2.7-mm endoscope, tumour removal was performed safely without damaging the pons, cranial nerves, or vessels. We safely and successfully removed a cystic pontine tumour using a dual-endoscopic method. This new method ensures the safety of deep-seated endoscopic procedures via a minimally invasive transcranial approach.
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