Chater-Cure George, Hoffman Caitlin, Knopman Jared, Rhee Samuel, Souweidane Mark M
Instituto de Neurociencias, University el Bosque, Bogotá, Colombia.
J Neurosurg Pediatr. 2011 Feb;7(2):161-4. doi: 10.3171/2010.11.PEDS10332.
Surgical treatment for periorbital inclusion cysts typically involves a brow, pterional, or partial bicoronal scalp incision for sufficient exposure. The authors have recently employed an endoscopy-assisted technique as an alternative approach intended to minimize the length of the skin incision and avoid scarring in the brow.
Children having typical clinical findings of a dermoid cyst located on the hairless forehead were selected to undergo endoscopy-assisted cyst removal. For suspected intradiploic lesions, MR imaging was used to assess osseous involvement. After induction of general anesthesia, a 1-2-cm curvilinear incision was made posterior to the hairline. A 30°-angled endoscope (4 mm) was then used for dissection in the subgaleal compartment. Subgaleal dissection was followed by a circumferential periosteal incision in which the authors used an angled needle-tip unipolar cautery. For lesions within the diploe, a high-speed air drill was used to expose the lesion. Complete removal was accomplished with curettage of either the skull or dural surface.
Eight patients (5-33 months of age) underwent outpatient endoscopic resection. Seven cysts were extracranial, and 1 cyst extended through the inner table. In all patients complete excision of the cyst was achieved. There was negligible blood loss, no dural violation, and no postoperative infection. There have been no recurrences at a mean follow-up of 15 months.
Endoscopy-assisted resection of inclusion cysts of the scalp and calvaria is a safe and effective surgical approach. The technique results in negligible incisions with less apparent scarring compared with previously described incisions. This limited-access technique does not appear to be associated with a higher incidence of cyst recurrence.
眶周包涵囊肿的手术治疗通常需要采用眉部、翼点或部分双冠状头皮切口以获得充分暴露。作者最近采用了一种内镜辅助技术作为替代方法，旨在尽量缩短皮肤切口长度并避免眉部瘢痕形成。
选择具有典型临床特征、位于无毛前额的皮样囊肿患儿，接受内镜辅助下囊肿切除术。对于怀疑累及板障内的病变，采用磁共振成像评估骨质受累情况。全身麻醉诱导后，在发际线后方做一个1 - 2厘米的曲线切口。然后使用30°角的4毫米内镜在帽状腱膜下间隙进行分离。帽状腱膜下分离后，进行环形骨膜切开，作者使用角形针尖单极电灼器。对于板障内的病变，使用高速气钻暴露病变。通过刮除颅骨或硬脑膜表面实现完全切除。
8例患者（年龄5 - 33个月）接受了门诊内镜切除术。7个囊肿位于颅外，1个囊肿延伸至内板。所有患者囊肿均完全切除。出血量可忽略不计，无硬脑膜损伤，无术后感染。平均随访15个月无复发。
内镜辅助下切除头皮和颅骨的包涵囊肿是一种安全有效的手术方法。与先前描述的切口相比，该技术切口小且瘢痕不明显。这种有限入路技术似乎与囊肿复发率较高无关。
