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Transnasal approach with endoscopic assistance in treatment of midline nasal dermoids with intracranial extension
Kiersten C. Woodyard MPH. Douglas Dembinski MD. Jesse Skoch MD. Brian S. Pan MD.
University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center.
2023-02-10
Presenter: Kiersten C. Woodyard
Affidavit:
Kiersten collected and analyzed data, and performed the writing tasks for this project. Kiersten is not a resident in our training program however, she is a medical student.
Director Name: Ann R. Schwentker
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Background: Nasal dermoid cysts with intracranial extension in the form of dermal sinus tracts require complete resection to prevent recurrence. Resection techniques necessitate adequate intracranial exposure, but morbidity associated with historical resection approaches has presented unique multidisciplinary challenges for surgeons.
Methods: We primarily employed a transnasal approach through a midline nasal incision, utilizing endoscopic or microscopic access through the lateral cartilages for resection of nasal dermoid cysts with intracranial extension. A retrospective review was completed for patients treated for nasal dermoid cysts at our pediatric tertiary referral center from 2016-2022. Data collection included demographics, comorbidities, perioperative data, pre- and post-operative imaging, surgical outcomes, and complications.
Results: 16 patients with nasal dermoid sinus cysts with possible or confirmed intracranial extension were surgically treated from 2016-2022. 13 were treated with resection performed via midline transnasal approach with endoscopic assistance, achieving successful total resection while avoiding nasal osteotomy or frontal craniotomy. One patient had slow CSF leak from an operative durotomy, successfully treated with a lumbar drain. No other complications occurred. Incision length and post-operative scar burden were less than approaches that used osteotomies or craniotomies, and demonstrated excellent cosmetic results. No patients have had cyst recurrence and no patients have required reoperation.
Conclusions: A transnasal approach via midline incision with endoscopic assistance is an effective approach for resection of nasal dermoid cysts with intracranial extension, but utility may vary with cyst size and complexity. This approach leverages appropriate exposure for resection with decreased morbidity and decreased incision length via avoidance of osteotomies.
