Advertisement

Meet in the middle: a technique for resecting nasocranial dermoids—technical note and review of the literature

Abstract

Introduction

Nasal dermoids with intracranial extension are benign lesions that can have life-threatening consequences, as a nasal punctum may serve as a portal of entry for infection into the central nervous system. The surgical management of these lesions can be challenging, as the extracranial and intracranial cysts and sinus tract must be resected to prevent recurrence, and the surgery must be carried out with an acceptable esthetic result.

Technique

The authors present a technique for the resection of nasocranial dermoids that eliminates the need to remove and replace the frontonasal segment. Working through a small frontal craniotomy enables the surgeon to drill out the sinus tract through the foramen cecum and inferiorly into the nose. This exposure eliminates the need to enter the frontal sinus, if it is present.

Conclusion

The extracranial punctum and tract are resected from below in a minimally invasive fashion that permits removal of the lesion without a disfiguring scar.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

Subscribe to journal

Immediate online access to all issues from 2019. Subscription will auto renew annually.

US$ 199

This is the net price. Taxes to be calculated in checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

References

  1. 1.

    Amir R, Dunham ME (2001) Bilateral choanal atresia associated with nasal dermoid cyst and sinus: a case report and review of the literature. Int J Pediatr Otorhinolaryngol 58:81–85

  2. 2.

    Aryan HE, Jandial R, Farin A, Chen JC, Granville R, Levy ML (2006) Intradural cranial congenital dermal sinuses: diagnosis and management. Childs Nerv Syst 22:243–247; discussion 248

  3. 3.

    Bartlett SP, Lin KY, Grossman R, Katowitz J (1993) The surgical management of orbitofacial dermoids in the pediatric patient. Plast Reconstr Surg 91:1208–1215

  4. 4.

    Bilkay U, Gundogan H, Ozek C, Tokat C, Gurler T, Songur E et al (2001) Nasal dermoid sinus cysts and the role of open rhinoplasty. Ann Plast Surg 47:8–14

  5. 5.

    Blake WE, Chow CW, Holmes AD, Meara JG (2006) Nasal dermoid sinus cysts: a retrospective review and discussion of investigation and management. Ann Plast Surg 57:535–540

  6. 6.

    Bland-Sutton J (1922) Tumours: innocents and malignants. Cassel, London

  7. 7.

    Bloom DC, Carvalho DS, Dory C, Brewster DF, Wickersham JK, Kearns DB (2002) Imaging and surgical approach of nasal dermoids. Int J Pediatr Otorhinolaryngol 62:111–122

  8. 8.

    Blythe JN, Revington PJ, Nelson R (2007) Anterior cranial fossa dermoid cyst: case report. Br J Oral Maxillofac Surg 45:661–663

  9. 9.

    Bostroem E (1897) Ueber die pialen epidermoide, dermoide und lipome und duralen dermoide. Centralbl F Allg Path U Path Anat 8:1–98

  10. 10.

    Bradley PJ (1983) The complex nasal dermoid. Head Neck Surg 5:469–473

  11. 11.

    Brydon HL (1992) Intracranial dermoid cysts with nasal dermal sinuses. Acta Neurochir 118:185–188

  12. 12.

    Caldarelli M, Massimi L, Kondageski C, Di Rocco C (2004) Intracranial midline dermoid and epidermoid cysts in children. J Neurosurg 100:473–480

  13. 13.

    Cheng J, Kazahaya K (2013) Management of pediatric nasal dermoids with intracranial extension by direct excision. Otolaryngol Head Neck Surg 148:694–696

  14. 14.

    Chtira K, Elallouchi Y, Zahrou F, Assamadi M, El Qadi AA, Ghannane H et al (2019) Nasofrontal surgical reconstruction by external table flap of frontal bone following removal of a dermoid cyst revealed by a fistula: a case report and review of the literature. GMS Interdiscip Plast Reconstr Surg DGPW 8:Doc01

  15. 15.

    Critchley M, Ferguson F (1928) The cerebrospinal epidermoids. Brain 51:334–384

  16. 16.

    Dandy W (1945) Surgery of the brain. W.F. Prior, Hagerstown, MD

  17. 17.

    De Maio PN, Mikulis DJ, Kiehl TR, Guha A (2012) AIRP best cases in radiologic-pathologic correlation: spinal conus dermoid cyst with lipid dissemination. Radiographics 32:1215–1221

  18. 18.

    Denoyelle F, Ducroz V, Roger G, Garabedian EN (1997) Nasal dermoid sinus cysts in children. Laryngoscope 107:795–800

  19. 19.

    Duz B, Secer HI, Tosun F, Gonul E (2007) Endoscopic endonasal resection of a midline intradural frontobasal dermoid tumour. Minim Invasive Neurosurg 50:363–366

  20. 20.

    El-Fattah AM, Naguib A, El-Sisi H, Kamal E, Tawfik A (2016) Midline nasofrontal dermoids in children: a review of 29 cases managed at Mansoura University Hospitals. Int J Pediatr Otorhinolaryngol 83:88–92

  21. 21.

    Fawcitt R, Isherwood I (1977) Intracranial epidermoid and dermoid tumours. In: du Boulay G, Moseley I (eds) Computerised axial tomography in clinical practice. Springer Verlag, Berlin Heidelberg, pp 94–101

  22. 22.

    Flamm ES (1973) The neurology of Jean Cruveilhier. Med Hist 17:343–355

  23. 23.

    Frassanito P, Tamburrini G, Caldarelli M (2017) Brain abscess and unusual nasal pimple in a child. World Neurosurg 101:811 e5

  24. 24.

    Gandhi A, Sundar IV, Sharma A, Mittal RS, Gandhi S (2016) Nasofrontal dermoid with sinus tract upto the tip of the nose: a case report with review of the literature. Asian J Neurosurg 11:178

  25. 25.

    Gilbert R, Brockmeyer D, Park AH (2004) A new approach to the reconstruction of extensive congenital midline nasal defects. Laryngoscope 114:1861–1863

  26. 26.

    Grunwald L (1910) Beitragez ur Kenntnis kongenitaler Geschwulste und Missbildungen an Ohr und Nase. Zstchr F Ohrenh 60:270–280

  27. 27.

    Guidetti B, Gagliardi FM (1977) Epidermoid and dermoid cysts. Clinical evaluation and late surgical results. J Neurosurg 47:12–18

  28. 28.

    Hamilton JG (1960) A case of dermal sinus of the nose with frontal suppuraton. J Neurol Neurosurg Psychiatry 23:239–241

  29. 29.

    Hartley BE, Eze N, Trozzi M, Toma S, Hewitt R, Jephson C et al (2015) Nasal dermoids in children: a proposal for a new classification based on 103 cases at Great Ormond Street Hospital. Int J Pediatr Otorhinolaryngol 79:18–22

  30. 30.

    Hedlund G (2006) Congenital frontonasal masses: developmental anatomy, malformations, and MR imaging. Pediatr Radiol 36:647–662; quiz 726–7

  31. 31.

    Herrington H, Adil E, Moritz E, Robson C, Perez-Atayde A, Proctor M et al (2016) Update on current evaluation and management of pediatric nasal dermoid. Laryngoscope 126:2151–2160

  32. 32.

    Heywood RL, Lyons MJ, Cochrane LA, Hayward R, Hartley BE (2007) Excision of nasal dermoids with intracranial extension - anterior small window craniotomy approach. Int J Pediatr Otorhinolaryngol 71:1193–1196

  33. 33.

    Hughes GB, Sharpino G, Hunt W, Tucker HM (1980) Management of the congenital midline nasal mass: a review. Head Neck Surg 2:222–233

  34. 34.

    Huisman TA, Schneider JF, Kellenberger CJ, Martin-Fiori E, Willi UV, Holzmann D (2004) Developmental nasal midline masses in children: neuroradiological evaluation. Eur Radiol 14:243–249

  35. 35.

    Karandikar M, Yellon RF, Murdoch G, Greene S (2013) Coexistence of dermal sinus tract, dermoid cyst, and encephalocele in a patient presenting with nasal cellulitis. J Neurosurg Pediatr 11:91–94

  36. 36.

    Kellman RM, Goyal P, Rodziewicz GS (2004) The transglabellar subcranial approach for nasal dermoids with intracranial extension. Laryngoscope 114:1368–1372

  37. 37.

    Kelly JH, Strome M, Hall B (1982) Surgical update on nasal dermoids. Arch Otolaryngol 108:239–242

  38. 38.

    Klein O, Simon E, Coffinet L, Joud A, Ghetemme C, Marchal JC (2014) Nasal dermal sinus in children: a review based on a series of 6 cases. Neurochirurgie 60:27–32

  39. 39.

    Livingstone DM, Brookes J, Yunker WK (2018) Endoscope-assisted nasal dermoid excision with an open rhinoplasty approach. Int J Pediatr Otorhinolaryngol 109:101–103

  40. 40.

    MacMahon P, Iacob S, Bach SE, Elwood ET, Lin JJ, Avellino AM (2017) Neurosurgical management of a rare congenital supratentorial neurenteric cyst with associated nasal dermal sinus: case report. J Neurosurg Pediatr 20:521–525

  41. 41.

    Makhdoom N, El Ezz TAA, Abdel-Haleem M (2017) Management of midline nasal dermoid lesions in children by external rhinoplasty. J Taibah Univ Med Sci 12:324–328

  42. 42.

    Matson DD, Ingraham FD (1951) Intracranial complications of congenital dermal sinuses. Pediatrics 8:463–474

  43. 43.

    McQuown SA, Smith JD, Gallo AE Jr (1983) Intracranial extension of nasal dermoids. Neurosurgery 12:531–535

  44. 44.

    Meher R, Singh I, Aggarwal S (2005) Nasal dermoid with intracranial extension. J Postgrad Med 51:39–40

  45. 45.

    Morimoto K, Takemoto O, Nishikawa M, Umegaki M, Nishino A (2002) Nasal dermal sinus with a dermoid cyst. Pediatr Neurosurg 36:218–219

  46. 46.

    Moses MA, Green BC, Cugno S, Hayward RD, Jeelani NU, Britto JA et al (2015) The management of midline frontonasal dermoids: a review of 55 cases at a tertiary referral center and a protocol for treatment. Plast Reconstr Surg 135:187–196

  47. 47.

    Mount LA (1949) Congenital dermal sinuses as a cause of meningitis, intraspinal abscess and intracranial abscess. J Am Med Assoc 139:1263–1268

  48. 48.

    Ogle JW (1865) Cases illustrating the formation of morbid growths, deposits, tumours, cysts, &c., in Connexion with the brain and spinal cord, and their investing membranes. With observations. Br Foreign Med Chir Rev 36:491–521

  49. 49.

    Opsomer D, Allaeys T, Alderweireldt AS, Baert E, Roche N (2019) Intracranial complications of midline nasal dermoid cysts. Acta Chir Belg 119:125–128

  50. 50.

    Paradis J, Koltai PJ (2015) Pediatric teratoma and dermoid cysts. Otolaryngol Clin N Am 48:121–136

  51. 51.

    Pennybacker J, Tytus JS (1956) Pearly tumours in relation to the central nervous system. J Neurol Neurosurg Psychiatry 19:241–259

  52. 52.

    Pensler JM, Bauer BS, Naidich TP (1988) Craniofacial dermoids. Plast Reconstr Surg 82:953–958

  53. 53.

    Pfaff MJ, Bickerton S, DiLuna M, Steinbacher DM (2013) Transcranial nasoethmoidal dermoids: a review and rationale for approach. J Plast Reconstr Aesthet Surg 66:1725–1731

  54. 54.

    Phelan AL, Jones CM, Ceschini AS, Henry CR, Mackay DR, Samson TD (2017) Sparing a craniotomy: the role of intraoperative methylene blue in management of midline dermoid cysts. Plast Reconstr Surg 139:1445–1451

  55. 55.

    Pollock RA (1983) Surgical approaches to the nasal dermoid cyst. Ann Plast Surg 10:498–501

  56. 56.

    Posnick JC, Bortoluzzi P, Armstrong DC, Drake JM (1994) Intracranial nasal dermoid sinus cysts: computed tomographic scan findings and surgical results. Plast Reconstr Surg 93:745–754; discussion 755–6

  57. 57.

    Pratt LW (1965) Midline cysts of the nasal dorsum: embryologic origin and treatment. Laryngoscope 75:968–980

  58. 58.

    Rahbar R, Shah P, Mulliken JB, Robson CD, Perez-Atayde AR, Proctor MR et al (2003) The presentation and management of nasal dermoid: a 30-year experience. Arch Otolaryngol Head Neck Surg 129:464–471

  59. 59.

    Raveh J, Vuillemin T, Sutter F (1988) Subcranial management of 395 combined frontobasal-midface fractures. Arch Otolaryngol Head Neck Surg 114:1114–1122

  60. 60.

    Raveh J, Laedrach K, Speiser M, Chen J, Vuillemin T, Seiler R et al (1993) The subcranial approach for fronto-orbital and anteroposterior skull-base tumors. Arch Otolaryngol Head Neck Surg 119:385–393

  61. 61.

    Ray CN, Betteridge BC, Demke JC (2018) Infected nasal dermoid cyst/sinus tract presenting with bilateral subperiosteal supraorbital abscesses: the midline nasal tuft of hair, an overlooked finding. Ophthalmic Plast Reconstr Surg 34:e31–e34

  62. 62.

    Re M, Tarchini P, Macri G, Pasquini E (2012) Endonasal endoscopic approach for intracranial nasal dermoid sinus cysts in children. Int J Pediatr Otorhinolaryngol 76:1217–1222

  63. 63.

    Rodrigues J, Caselhos S, Mexedo A, Fonseca R (2017) Nasofrontal dermoid sinus. BMJ Case Rep 2017

  64. 64.

    Rogers GF, Proctor MR, Greene AK, Mulliken JB (2005) Frontonasal osteotomy to facilitate removal of an intracranial nasal dermoid. J Craniofac Surg 16:731–736

  65. 65.

    Rohrich RJ, Lowe JB, Schwartz MR (1999) The role of open rhinoplasty in the management of nasal dermoid cysts. Plast Reconstr Surg 104:2163–2170; quiz 2171

  66. 66.

    Sanchez-Mejia RO, Limbo M, Tihan T, Galvez MG, Woodward MV, Gupta N (2006) Intracranial dermoid cyst mimicking hemorrhage. Case report and review of the literature. J Neurosurg 105:311–314

  67. 67.

    Schuster D, Riley KO, Cure JK, Woodworth BA (2011) Endoscopic resection of intracranial dermoid cysts. J Laryngol Otol 125:423–427

  68. 68.

    Sessions RB (1982) Nasal dermal sinuses--new concepts and explanations. Laryngoscope 92:1–28

  69. 69.

    Skolnik EM, Campbell JM, Meyers RM (1971) Dermoid cysts of the nose. Laryngoscope 81:1632–1637

  70. 70.

    Tatar EC, Selcuk OT, Saylam G, Ozdek A, Korkmaz H (2009) The management of rare nasal mass-nasal dermoid sinus cysts: open rhinoplasty. Rare Tumors 1:e40

  71. 71.

    van Aalst JA, Luerssen TG, Whitehead WE, Havlik RJ (2005) “Keystone” approach for intracranial nasofrontal dermoid sinuses. Plast Reconstr Surg 116:13–19

  72. 72.

    Van Gilder JC, Schwartz HG (1967) Growth of dermoids from skin implants to the nervous system and surrounding spaces of the newborn rat. J Neurosurg 26:14–20

  73. 73.

    Virchow R (1855) Uber perlgeschwulste. Virchow’s Arch Path Anat 8:371

  74. 74.

    Walker A, Bucy P (1934) Congenital dermal sinuses: a source of spinal meningeal infection and subdural abscesses. Brain 57:401–421

  75. 75.

    Wardinsky TD, Pagon RA, Kropp RJ, Hayden PW, Clarren SK (1991) Nasal dermoid sinus cysts: association with intracranial extension and multiple malformations. Cleft Palate Craniofac J 28:87–95

  76. 76.

    Weiss DD, Robson CD, Mulliken JB (1998) Transnasal endoscopic excision of midline nasal dermoid from the anterior cranial base. Plast Reconstr Surg 102:2119–2123

Download references

Author information

Correspondence to Alan R. Cohen.

Ethics declarations

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(DOCX 16 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Hidalgo, J., Redett, R.J., Soares, B.P. et al. Meet in the middle: a technique for resecting nasocranial dermoids—technical note and review of the literature. Childs Nerv Syst (2020). https://doi.org/10.1007/s00381-020-04499-5

Download citation

Keywords

  • Dermoid
  • Dermal sinus
  • Nasal lesions
  • Skull base