Moses Mike A, Green Ben C, Cugno Sabrina, Hayward Richard D, Jeelani Noor U Owase, Britto Jonathan A, Bulstrode Neil W, Dunaway David J
London, United Kingdom From the Craniofacial Unit, Great Ormond Street Hospital for Children.
Plast Reconstr Surg. 2015 Jan;135(1):187-196. doi: 10.1097/PRS.0000000000000833.
The incidence of midline frontonasal dermoid cysts is one in 20,000 to one in 40,000. These lesions may have intracranial extension. This is explained by the anatomy and embryology of nasofrontal development. Skin involvement may also be extensive. Incomplete excision frequently leads to recurrence. The authors report their experience and pathway for management of midline dermoids.
Databases were searched to identify patients who had undergone surgery for removal of a dermoid cyst. Preoperative imaging and indications for surgery were reviewed. Cases were grouped according to surgical approach, and outcomes and complications were identified.
Fifty-five patients were treated. Magnetic resonance imaging or computed tomography was used to delineate the anatomy, and surgical excision was expedited if there was a history of infection, especially if imaging suggested intracranial extension. Twelve patients were treated endoscopically (one was converted to open). Eleven required transcranial approaches for intracranial extension (20 percent). Of these, one lesion breached the dura. The remaining 32 patients had dermoids excised with an open approach (direct, bicoronal, or rhinoplasty). There were no recurrences in the open group and there was one recurrence in the transcranial group. This was treated by reexcision.
Midline dermoid cysts are relatively uncommon. However, knowledge of the pathogenesis of these lesions together with the authors' experience over 15 years has allowed them to develop a protocol-driven approach, with a low incidence of complications.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
中线额鼻皮样囊肿的发病率为两万分之一至四万分之一。这些病变可能向颅内扩展。这可通过鼻额部发育的解剖学和胚胎学来解释。皮肤受累也可能广泛。不完全切除常导致复发。作者报告了他们处理中线皮样囊肿的经验和方法。
检索数据库以识别接受过皮样囊肿切除术的患者。回顾术前影像学检查和手术指征。根据手术入路对病例进行分组，并确定结果和并发症。
共治疗了55例患者。使用磁共振成像或计算机断层扫描来描绘解剖结构，如果有感染史，特别是影像学提示有颅内扩展时，则加快手术切除。12例患者接受了内镜治疗（1例转为开放手术）。11例因颅内扩展需要经颅入路（20%）。其中，1个病变穿透了硬脑膜。其余32例患者通过开放手术（直接、双冠状或鼻整形术）切除皮样囊肿。开放手术组无复发，经颅手术组有1例复发，通过再次切除进行了治疗。
中线皮样囊肿相对少见。然而，基于对这些病变发病机制的了解以及作者15年的经验，他们制定了一种方案驱动的方法，并发症发生率较低。
临床问题/证据水平：治疗性，IV级。
