Introduction: Dermoid and epidermoid tumors are congenital lesions representing about 1% of all intracranial tumors. Surgical resection is the only effective treatment. Nonetheless, it may be challenging given the propensity of these lesions to adhere to neurovascular structures. The goal of this study is to review our experience in managing these lesions, comparing endoscopic endonasal with retrosigmoid approaches and emphasizing outcomes and complications.
Methods: The patient database of the Center for Cranial Base Surgery at our institution was searched for surgical procedures involving the intracranial resection of dermoid and epidermoid tumors. Retrospective chart review and updated clinical consultations were performed for data collection.
Results: From January 2001 to January 2013, 30 patients (16 male, 14 female) with a mean age of 30.5 years (2-69) were identified. 17 retrosigmoid (5 for tumor recurrences) and 20 endonasal approaches (two staged procedures) were performed for resection of 21 epidermoid and nine dermoid tumors. Headache was the most prevalent symptom (11 patients). Operative time, hospital stay and cyst volume was similar in both groups. Postoperatively, four patients developed cranial nerve deficits; CSF leak was observed in six (4 endonasal, 2 retrosigmoid) and infection in seven (4 endonasal, 3 retrosigmoid). Complete resection was achieved in eleven cases (36.67%), 7 endonasal and 4 retrosigmoid. Extradural location and smaller size were associated with complete resection. There was a trend associating incomplete resection and infection (p=0.07). The mean follow-up period was 42 months (3-128). The shorter follow-up (mean 12 months, ranging from 3-67) in the endoscopic group may explain, partially, the lack of recurrences.
Conclusions: The treatment of dermoid and epidermoid tumors of the cranial base may be challenging. Surgical outcome and complication rates are comparable between the endoscopic endonasal and the retrosigmoid approaches. Incomplete resection may be associated with postoperative infection regardless of the approach.
Patient Care: Recognition of factors associated with adverse outcomes and comprehension of the role of the endoscopic endonasal approaches in a relative large series of cranial base dermoid and epidermoid tumors will provide relevant data for improved presurgical planning. Therefore, a new and necessary insight about the advantages and limitations of treating these tumors through an endonasal corridor can be gained and it may reinforce the concept that such approach, by itself, is not a risk factor for postoperative intracranial infection, especially when complete surgical resection is the expected surgical outcome.
Learning Objectives: By the conclusion of this session, participants should be able to recognize the factors that may affect the surgical outcome and the complication rate following the resection of cranial base dermoid and epidermoid tumors. They should also be able to understand the role of the endoscopic endonasal approaches in their management and recognize that the occurrence of postoperative infection is not related to endonasal approach.