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Endoscopic endonasal approach for resection of ventral skull base keratinaceous cysts
Author(s) -
McCoul Edward D.,
Chow Samuel,
Lee Dennis L.Y.,
Anand Vijay K.,
Schwartz Theodore H.
Publication year - 2011
Publication title -
international forum of allergy and rhinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.503
H-Index - 46
eISSN - 2042-6984
pISSN - 2042-6976
DOI - 10.1002/alr.21005
Subject(s) - medicine , cerebrospinal fluid leak , skull , endoscopic endonasal surgery , surgery , endoscopy , base of skull , magnetic resonance imaging , radiology , cerebrospinal fluid , pathology
Background: Epidermoid and dermoid cysts are uncommon entities that belong in the differential diagnosis of ventral skull base lesions. The endoscopic endonasal approach is an attractive option for management of these lesions with limited morbidity. The clinical characteristics and management course from our experience is reviewed along with the relevant literature. Methods: A prospective database of endoscopic endonasal skull base cases performed since 2003 at a tertiary referral center was reviewed for cases involving keratinaceous lesions. Data on the pathology, radiology and management of the disease was reviewed. A search of pertinent literature using Medline was performed to complement the discussion. Results: Three cases of intracranial keratinaceous cysts successfully managed with the endoscopic endonasal approach. All cases presented with headache, and 1 case presented with bitemporal hemianopsia. Characteristic appearance on magnetic resonance imaging was seen in each case. All lesions were intradural with variable involvement of the suprasellar, prepontine, and premedullary cisterns. Total resection was achieved in 2 cases and near total resection in 1 case. Postoperative cerebrospinal fluid leak occurred in one case, which was controlled after revision surgery using the “gasket‐seal” technique. There were no cranial nerve palsies or vascular events. Conclusion: The endoscopic endonasal approach allows the rhinologic surgeon to access the ventral midline skull base for the successful management of keratinaceous cysts without major complications. © 2011 ARS‐AAOA, LLC.