Endoscopic endonasal approach for resection of ventral skull base keratinaceous cysts.
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.


CONCLUSIONS
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.
Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College and New York Presbyterian Hospital, 772 Park Avenue, New York, NY 10021, USA.
Edward D
ED
McCoul
Samuel
S
Chow
Dennis L Y
DL
Lee
Vijay K
VK
Anand
Theodore H
TH
Schwartz
D000328:Adult; D001847:Bone Diseases / Q000601:surgery*; D003884:Dermoid Cyst / Q000601:surgery*; D004724:Endoscopy / Q000379:methods*; D004814:Epidermal Cyst / Q000601:surgery*; D005260:Female; D020773:Headache Disorders / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity / Q000601:surgery; D019291:Skull Base / Q000601:surgery*; D019292:Skull Base Neoplasms / Q000601:surgery