Endoscopic Endonasal Surgery of Epidermoid Cysts of the Chiasmatic Region

BackgroundDespite the rarity of epidermoid cysts in the chiasmatic region, their surgical treatment is particularly complicated because of the tendency toward massive dissemination of the epidermoid masses along cerebrospinal fluid pathways and significant deviation of the tumor from the midline.ObjectiveThe purpose of the present work is evaluation of the role of extended transsphenoidal endoscopic endonasal approaches in the surgery of epidermoid cysts.MethodsThe study included 6 patients with epidermoid cysts in the chiasmatic region who were operated on at the Burdenko Neurosurgery Institute in the last 5 years using an anterior extended transsphenoidal endoscopic endonasal approach.ResultsThe epidermoid masses were totally removed in 5 patients, but in no patient was it possible to completely remove the epidermoid cyst capsule. Visual deterioration was not noted in any patient, nor did new focal neurologic symptoms appear. One of the patients developed hypopituitary disorders in the postoperative period. No recurrence of the epidermoid cysts was observed during the follow-up period.ConclusionsRemoval of epidermoid cysts in the chiasmatic region using an anterior extended transsphenoidal endoscopic approach may be an alternative to transcranial microsurgery operations. This technique is widely accepted as an approach to this area.