Large Suprasellar Dermoid Cyst Excision Through an Endoscopic Transsphenoidal Approach: 2-Dimensional Operative Video

Abstract

Intracranial dermoid cysts are slow-growing, benign congenital lesions that arise from the entrapment of totipotent ectodermal elements along the lines of embryonic closure.1 These lesions usually occur along the midline, most commonly in the sellar/parasellar region and the posterior fossa.2 They are lined by stratified squamous epithelium with mature skin appendages; often, they are associated with dermal sinus tract and other neural tube closure defects, although dermal sinus tract is absent in sellar/parasellar dermoids.3 Owing to gradual accumulation of desquamated cell debris deriving from their capsule, these lesions can grow to be symptomatic or rupture and possibly present with serious complications such as CNS infection, aseptic meningitis, mass effect on surrounding structures, and hydrocephalus.4-6 Surgery remains the only effective treatment modality, and radical resection should be performed, when feasible, to avoid tumor recurrence.7,8 However, in cases where the cyst capsule is firmly adherent to vital neurovascular structures, subtotal resection is recommended.9-11 We report the case of a middle-aged female patient who presented with a 2-week history of right eye blurry vision and headaches. MRI of the brain revealed a large suprasellar multilobulated lesion with mass effect on the lateral ventricles that was hyperintense on T1-weighted sequence, concerning for possible suprasellar dermoid cyst. Surgical treatment with an endoscopic endonasal approach was offered (7 cases with the same approach have been reported12-17), and informed consent was obtained. The patient consented to the publication of her image. Successful debulking of the mass was performed. The patient tolerated the procedure well and was discharged with no postoperative deficits.