Combined Endoscopic Endonasal Transtubercular and Transclival Approaches for Large Neurenteric Cyst in Posterior Cranial Fossa: A Case Report and Literature Review

Overview

Journal Surg Neurol Int

Specialty Neurology

Date 2021 Dec 8

PMID 34877040

Authors

Daisuke Sato

Hirotaka Hasegawa

Masahiro Shin

Kenji Kondo

Nobuhito Saito

Affiliations

Soon will be listed here.

Abstract

Background: Intracranial neurenteric cysts (NCs) are extremely rare tumors that more commonly involve the posterior fossa than any other cranial part. While transcranial skull base surgery has been the mainstay of treatment, the utility of endoscopic transnasal surgery (ETS) remains to be established.

Case Description: We report a case of a large posterior fossa NC extensively involving the suprasellar region, cerebellopontine angle, and prepontine cistern, which we successfully resected with ETS through a combination of transtubercular and transclival routes. Before surgery, the patient presented with abducens nerve and pseudobulbar palsies, which resolved within 2 weeks postoperatively. The patient remained free from recurrence for 3 years postoperatively.

Conclusion: Extended ETS may offer a minimally invasive option for the posterior fossa NC, extensively occupying the ventral space of the brainstem.

References

Chaynes P, Thorn-Kany M, Sol J, Arrue P, Lagarrigue J, Manelfe C . Imaging in neurenteric cysts of the posterior cranial fossa. Neuroradiology. 1998; 40(6):374-6. DOI: 10.1007/s002340050602. View

Shin M, Kondo K, Kin T, Suzukawa K, Saito N . Endoscopic transnasal interseptal approach for invasive clival tumors: development of an approach method regarding maximal preservation of the nasal anatomy. Neurol Med Chir (Tokyo). 2015; 55(4):336-44. PMC: 4628181. DOI: 10.2176/nmc.oa.2014-0280. View

Prevedello D, Fernandez-Miranda J, Gardner P, Madhok R, Sigounas D, Snyderman C . The transclival endoscopic endonasal approach (EEA) for prepontine neuroenteric cysts: report of two cases. Acta Neurochir (Wien). 2009; 152(7):1223-9. DOI: 10.1007/s00701-009-0563-3. View

Medhi G, Saini J, Pandey P, Mahadevan A, Prasad C . T1 Hyperintense Prepontine Mass with Restricted Diffusion--A White Epidermoid or a Neuroenteric Cyst?. J Neuroimaging. 2015; 25(5):841-3. DOI: 10.1111/jon.12226. View

Lee W, Tseng H, Lin M, Chuang S . Neurenteric cyst at craniocervical junction: report of a case. J Formos Med Assoc. 1992; 91(7):722-4. View

Lin J, Feng H, Li F, Chen Z, Wu G . Ventral brainstem enterogenous cyst: an unusual location. Acta Neurochir (Wien). 2004; 146(4):419-20. DOI: 10.1007/s00701-004-0227-2. View

Patel S, Liu J . Staged bilateral far-lateral approach for bilateral cervicomedullary junction neurenteric cysts in a 10-year-old girl. J Neurosurg Pediatr. 2013; 12(3):274-80. DOI: 10.3171/2013.5.PEDS13100. View

Todeschini A, Montaser A, Hardesty D, Carrau R, Prevedello D . The limits of the endoscopic endonasal transclival approach for posterior fossa tumors. J Neurosurg Sci. 2018; 62(3):322-331. DOI: 10.23736/S0390-5616.18.04411-9. View

Filho F, Tatagiba M, Carvalho G, Weichhold W, Klekamp J, Samii M . Neurenteric cyst of the craniocervical junction. Report of three cases. J Neurosurg. 2001; 94(1 Suppl):129-32. DOI: 10.3171/spi.2001.94.1.0129. View

10.

Ohba S, Akiyama T, Kanai R, Onozuka S, Kawase T . Endodermal cyst of the cranio-cervical junction. Acta Neurochir (Wien). 2008; 150(3):257-63. DOI: 10.1007/s00701-007-1395-7. View

11.

Al-Ahmed I, Boughamoura M, Dirks P, Kulkarni A, Rutka J, Drake J . Neurosurgical management of neurenteric cysts in children. J Neurosurg Pediatr. 2013; 11(5):511-7. DOI: 10.3171/2013.1.PEDS1290. View

12.

Shi W, Cui D, Shi J, Gu Z, Ju S, Chen J . Microsurgical excision of the craniocervical neurenteric cysts by the far-lateral transcondylar approach: case report and review of the literature. Skull Base. 2011; 20(6):435-42. PMC: 3134815. DOI: 10.1055/s-0030-1265823. View

13.

Fomichev D, Kalinin P, Gavrushin A . Endoscopic Transnasal Transclival Resection of Endodermal Cyst on Ventral Surface of Brainstem. World Neurosurg. 2016; 97:756.e7-756.e11. DOI: 10.1016/j.wneu.2016.10.024. View

14.

Suri V, Tatke M, Sinha S . Intracranial neurenteric cysts: a report of two cases. Br J Neurosurg. 2002; 16(2):185-8. DOI: 10.1080/026886902317384544. View

15.

Gomez-Amador J, Alberto Ortega-Porcayo L, Palacios-Ortiz I, Perdomo-Pantoja A, Nares-Lopez F, Vega-Alarcon A . Endoscopic endonasal transclival resection of a ventral pontine cavernous malformation: technical case report. J Neurosurg. 2016; 127(3):553-558. DOI: 10.3171/2016.8.JNS161137. View

16.

Cobb W, Makosch G, Anand V, Schwartz T . Endoscopic transsphenoidal, transclival resection of an enterogenous cyst located ventral to the brainstem: case report. Neurosurgery. 2010; 67(2 Suppl Operative):522-6. DOI: 10.1227/NEU.0b013e3181fa24f4. View

17.

Wang L, Zhang J, Wu Z, Jia G, Zhang L, Hao S . Diagnosis and management of adult intracranial neurenteric cysts. Neurosurgery. 2010; 68(1):44-52. DOI: 10.1227/NEU.0b013e3181fc5ee0. View

18.

Lonser R, Glenn G, Walther M, Chew E, Libutti S, Linehan W . von Hippel-Lindau disease. Lancet. 2003; 361(9374):2059-67. DOI: 10.1016/S0140-6736(03)13643-4. View

19.

Harris C, Dias M, Brockmeyer D, Townsend J, Willis B, Apfelbaum R . Neurenteric cysts of the posterior fossa: recognition, management, and embryogenesis. Neurosurgery. 1991; 29(6):893-7; discussion 897-8. DOI: 10.1097/00006123-199112000-00015. View

20.

Umezu H, Aiba T, Unakami M . Enterogenous cyst of the cerebellopontine angle cistern: case report. Neurosurgery. 1991; 28(3):462-5; discussion 465-6. DOI: 10.1097/00006123-199103000-00025. View