Epidermoid cyst of the posterior fossa: A case report of a combined microscopic and endoscopic transcranial approach.

AIM: To show a case of a giant epidermoid cyst of the posterior fossa treated with a combined microscopic and endoscopic transcranial approach. MATERIAL OF STUDY: A 13-years-old girl presented recurrent episodes of convulsions and vision impairment for years. CT scan and MRI revealed a suprasellar cystic lesion. The patient was operated with a combined microscopic and endoscopic transcranial approach. RESULTS: Postoperative MRI demonstrated complete resection of the mass and pathology confirmed the preoperative suspicion of epidermoid cyst. Post procedure, the patient recovered well and was discharged. At the 4 week follow up her symptoms had resolved completely. DISCUSSION: Epidermoid tumors are congenital lesions with a benign nature. They are the most frequent congenital intracranial lesions. Surgical treatment of epidermoid and dermoid cysts may be challenging. In the recent decades endoscopic endonasal approach (EEA) has been commonly used for the treatment of cranial base lesions because it has several advantages compared to open transcranial approach. We decided to do a transcranial approach combining the use of the microscope with the endoscope because EEA was not possible due to the location of the tumor. CONCLUSIONS: Despite the development of innovative techniques such as the EEA, the transcranial approach remains a viable option, especially when more techniques are combined. In fact, the combination of microscope and endoscope grants the advantages of both tools being very useful to assure a complete excision of intracranial tumors. KEY WORDS: Combined Transcranial Approach, Epidermoid Cyst, Posterior Fossa.

Inverted papilloma with bilateral origin. A case report and review of the literature.

AIM: To show a rare case of inverted papilloma with bilateral origin treated with endoscopic approach MATERIAL OF STUDY: The authors reported the unusual case of a 71-year-old male patient with a growing mass occupying both nasal cavities. The patient complained bilateral nasal obstruction associated with thick nasal secretions, anterior and posterior nasal drip, snoring and diffuse nasal pain. The biopsy revealed inverted papilloma. RESULTS: CT Scan and RMI of paranasal sinuses showed a bilateral origin of the tumor with a triple involvement on the left side: middle turbinate axilla, frontal recess posterior wall and ethmoidal sinus roof. Nasal endoscopic surgery approach was performed and the tumoral mass was removed completely. DISCUSSION: Inverted papilloma is an uncommon primary nasal tumor that presents three typical characteristics: a high rate of recurrence, local aggressive behaviour and association with malignancy. Although bilaterality is very rare, in this case the neoplasia occupied both nasal cavities with extension to left frontal, sphenoid and ethmoid sinuses. CONCLUSION: The authors, in line with the literature, showed that endoscopic approach represents once again a safe and efficient technique, even for larger tumors. KEY WORDS: Bilateral origin, Inverted papilloma, Paranasal sinuses.