Yonsei Med J.  2012 Nov;53(6):1216-1219. 10.3349/ymj.2012.53.6.1216.

Endoscope-Assisted Microsurgical Removal of an Epidermoid Tumor within the Cavernous Sinus

• Chung JC
• Kim SM
• Sade B
• Kim HK
• Park MS
• Chung SY
• Park KS

• KMID: 1414267
• DOI: http://doi.org/10.3349/ymj.2012.53.6.1216

Abstract

Epidermoid tumor of the cavernous sinus is rare. The aim of this case report is to discuss the role of neuroendoscopes in the removal of such lesions. A 21-year-old man presented with 6-year history of progressive headache, diplopia, and visual disturbance. Work-up revealed an epidermoid tumor located in the right cavernous sinus. An extradural transcavernous approach was utilized via a traditional frontotemporal craniotomy with endoscopic assistance. The postoperative course was uneventful with immediate improvement of the patient's headache. Postoperative magnetic resonance imaging demonstrated complete removal of the tumor. There were no signs of recurrence during a 2-year follow-up period. The endoscope is a useful tool for removing epidermoid tumors from the cavernous sinus and enhances visualization of areas that would otherwise be difficult to visualize with microscopes alone. Endoscopes also help minimize the retraction of neurovascular structures.

Keyword

Epidermoid tumor; cavernous sinus; endoscope-assisted microsurgery

MeSH Terms

Adult
Cavernous Sinus/*pathology/*surgery
Endoscopy/*methods
Epidermal Cyst/*pathology/*surgery
Humans
Male
Microsurgery/*methods
Young Adult

Figure

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  Fig. 1 (A) The extradural transcavernous approach, peeling the outer dural layer away from the lateral wall of the cavernous sinus. (B and C) Exposure of the yellowish-white tumor following a small incision in the membranous layer of the lateral wall of the cavernous sinus. (D) The advancement of a 4 mm rigid neuroendoscope inside the cavernous sinus through the small incision. (E) 0°-angled endoscopic visualization of a glistening white cauliflower-like mass adherent to the inner layer of the wall. (F) Following removal of the tumor, the cavernous segment of the internal carotid artery became visible, under a 30°-angled view. SOF, superior orbital fissure; FD, frontal dura; TD, temporal dura; IL, inner membranous layer of lateral cavernous sinus wall; T, epidermoid tumor; E, shaft of neuroendoscope; S, shaft of suction; P, anterior petroclinoidal fold; C, thinned trochlear nerve (dotted lines); I, cavernous segment of the internal carotid artery (dashed lines).

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  Fig. 2 (A) Preoperative magnetic resonance image demonstrates space-occupying slight hyper signal intensity within the right cavernous sinus and more bright lesions on diffusion-weighted images. (B) Magnetic resonance imaging performed on the first postoperative day showing complete removal of the tumor and signal change.

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  Fig. 3 Histopathologic examination revealed a cystic tumor lined with simple stratified keratinizing squamous epithelium.

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