Lee Keng Siang, Kalyal Nida, Mthunzi Engelbert, Marchi Francesco, Elhag Ali, Bodi Istvan, Bhangoo Ranjeev, Vergani Francesco, Ashkan Keyoumars, Gullan Richard, Lavrador Jose Pedro
Department of Neurosurgery, King's College Hospital Foundation Trust, London SE5 9RS, United Kingdom.
Department of Basic and Clinical Neurosciences, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London SE5 9RX, United Kingdom.
J Surg Case Rep. 2025 Feb 19;2025(2):rjaf066. doi: 10.1093/jscr/rjaf066. eCollection 2025 Feb.
Intracranial dermoid cysts are benign lesions that may be diagnosed incidentally or present symptomatically due to mass effect-focal neurological deficits, seizures and/or hydrocephalus-or chemical meningitis secondary to spontaneous rupture. The use of tubular retractors in minimally invasive parafascicular surgery (tsMIPS) has been described extensively as a technique to preserve neurological function whilst safely maximizing the extent of resection. The authors present the first use of the tsMIPS approach for removal of a dermoid cyst in a 68-year-old female who presented with abulia and seizures due to a large Sylvian fissure dermoid cyst. This approach minimized trauma to surrounding cortical-subcortical structures, as supported by connectome analyses, without sacrificing visualization of the operative field. Additionally, itavoided manipulation of the lenticulostriate arteries attached to the walls of the dermoid cyst. The use of an endoscope ensured complete drainage of the cyst components and therefore the effectiveness of the procedure.
颅内皮样囊肿是良性病变，可偶然被诊断出来，也可能因占位效应（局灶性神经功能缺损、癫痫发作和/或脑积水）或自发性破裂继发化学性脑膜炎而出现症状。在微创束旁手术（tsMIPS）中使用管状牵开器已被广泛描述为一种在安全最大限度扩大切除范围的同时保留神经功能的技术。作者首次采用tsMIPS方法为一名68岁女性切除皮样囊肿，该女性因大脑外侧裂巨大皮样囊肿出现意志缺失和癫痫发作。如连接组分析所示，这种方法将对周围皮质 - 皮质下结构的创伤降至最低，同时不影响手术视野的可视化。此外，它避免了对附着在皮样囊肿壁上的豆纹动脉的操作。使用内窥镜确保了囊肿内容物的完全引流，从而保证了手术的有效性。
