Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Child's Nervous System
Published in: Child's Nervous System 3/2020

01-03-2020 | Craniotomy | Review Article

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

Authors: Joaquin Hidalgo, Richard J. Redett III, Bruno P. Soares, Alan R. Cohen

Published in: Child's Nervous System | Issue 3/2020

Login to get access

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.
Appendix
Available only for authorised users
Literature
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 58:81–85CrossRefPubMed
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 248CrossRefPubMed
3.
Bartlett SP, Lin KY, Grossman R, Katowitz J (1993) The surgical management of orbitofacial dermoids in the pediatric patient. Plast Reconstr Surg 91:1208–1215CrossRefPubMed
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 47:8–14CrossRefPubMed
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 57:535–540CrossRefPubMed
6.
Bland-Sutton J (1922) Tumours: innocents and malignants. Cassel, London
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 62:111–122CrossRefPubMed
8.
Blythe JN, Revington PJ, Nelson R (2007) Anterior cranial fossa dermoid cyst: case report. Br J Oral Maxillofac Surg 45:661–663CrossRefPubMed
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.
11.
Brydon HL (1992) Intracranial dermoid cysts with nasal dermal sinuses. Acta Neurochir 118:185–188CrossRefPubMed
12.
Caldarelli M, Massimi L, Kondageski C, Di Rocco C (2004) Intracranial midline dermoid and epidermoid cysts in children. J Neurosurg 100:473–480PubMed
13.
Cheng J, Kazahaya K (2013) Management of pediatric nasal dermoids with intracranial extension by direct excision. Otolaryngol Head Neck Surg 148:694–696CrossRefPubMed
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:Doc01PubMedPubMedCentral
15.
Critchley M, Ferguson F (1928) The cerebrospinal epidermoids. Brain 51:334–384CrossRef
16.
Dandy W (1945) Surgery of the brain. W.F. Prior, Hagerstown, MD
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 32:1215–1221CrossRefPubMed
18.
Denoyelle F, Ducroz V, Roger G, Garabedian EN (1997) Nasal dermoid sinus cysts in children. Laryngoscope 107:795–800CrossRefPubMed
19.
Duz B, Secer HI, Tosun F, Gonul E (2007) Endoscopic endonasal resection of a midline intradural frontobasal dermoid tumour. Minim Invasive Neurosurg 50:363–366CrossRefPubMed
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 83:88–92CrossRefPubMed
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 94–101CrossRef
22.
23.
Frassanito P, Tamburrini G, Caldarelli M (2017) Brain abscess and unusual nasal pimple in a child. World Neurosurg 101:811 e5CrossRefPubMed
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 11:178CrossRefPubMedPubMedCentral
25.
Gilbert R, Brockmeyer D, Park AH (2004) A new approach to the reconstruction of extensive congenital midline nasal defects. Laryngoscope 114:1861–1863CrossRefPubMed
26.
Grunwald L (1910) Beitragez ur Kenntnis kongenitaler Geschwulste und Missbildungen an Ohr und Nase. Zstchr F Ohrenh 60:270–280
27.
Guidetti B, Gagliardi FM (1977) Epidermoid and dermoid cysts. Clinical evaluation and late surgical results. J Neurosurg 47:12–18CrossRefPubMed
28.
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 79:18–22CrossRefPubMed
30.
Hedlund G (2006) Congenital frontonasal masses: developmental anatomy, malformations, and MR imaging. Pediatr Radiol 36:647–662; quiz 726–7CrossRefPubMed
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 126:2151–2160CrossRefPubMed
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 71:1193–1196CrossRefPubMed
33.
Hughes GB, Sharpino G, Hunt W, Tucker HM (1980) Management of the congenital midline nasal mass: a review. Head Neck Surg 2:222–233CrossRefPubMed
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 14:243–249CrossRefPubMed
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 11:91–94CrossRefPubMed
36.
Kellman RM, Goyal P, Rodziewicz GS (2004) The transglabellar subcranial approach for nasal dermoids with intracranial extension. Laryngoscope 114:1368–1372CrossRefPubMed
37.
Kelly JH, Strome M, Hall B (1982) Surgical update on nasal dermoids. Arch Otolaryngol 108:239–242CrossRefPubMed
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 60:27–32CrossRefPubMed
39.
Livingstone DM, Brookes J, Yunker WK (2018) Endoscope-assisted nasal dermoid excision with an open rhinoplasty approach. Int J Pediatr Otorhinolaryngol 109:101–103CrossRefPubMed
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 20:521–525CrossRefPubMed
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 12:324–328PubMedPubMedCentral
42.
Matson DD, Ingraham FD (1951) Intracranial complications of congenital dermal sinuses. Pediatrics 8:463–474PubMed
43.
McQuown SA, Smith JD, Gallo AE Jr (1983) Intracranial extension of nasal dermoids. Neurosurgery 12:531–535CrossRefPubMed
44.
Meher R, Singh I, Aggarwal S (2005) Nasal dermoid with intracranial extension. J Postgrad Med 51:39–40PubMed
45.
Morimoto K, Takemoto O, Nishikawa M, Umegaki M, Nishino A (2002) Nasal dermal sinus with a dermoid cyst. Pediatr Neurosurg 36:218–219CrossRefPubMed
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 135:187–196CrossRefPubMed
47.
Mount LA (1949) Congenital dermal sinuses as a cause of meningitis, intraspinal abscess and intracranial abscess. J Am Med Assoc 139:1263–1268CrossRefPubMed
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 36:491–521PubMedPubMedCentral
49.
Opsomer D, Allaeys T, Alderweireldt AS, Baert E, Roche N (2019) Intracranial complications of midline nasal dermoid cysts. Acta Chir Belg 119:125–128CrossRefPubMed
50.
Paradis J, Koltai PJ (2015) Pediatric teratoma and dermoid cysts. Otolaryngol Clin N Am 48:121–136CrossRef
51.
52.
53.
Pfaff MJ, Bickerton S, DiLuna M, Steinbacher DM (2013) Transcranial nasoethmoidal dermoids: a review and rationale for approach. J Plast Reconstr Aesthet Surg 66:1725–1731CrossRefPubMed
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 139:1445–1451CrossRefPubMed
55.
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 755–6CrossRefPubMed
57.
Pratt LW (1965) Midline cysts of the nasal dorsum: embryologic origin and treatment. Laryngoscope 75:968–980CrossRefPubMed
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 129:464–471CrossRefPubMed
59.
Raveh J, Vuillemin T, Sutter F (1988) Subcranial management of 395 combined frontobasal-midface fractures. Arch Otolaryngol Head Neck Surg 114:1114–1122CrossRefPubMed
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 119:385–393CrossRefPubMed
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–e34CrossRefPubMed
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 76:1217–1222CrossRefPubMed
63.
Rodrigues J, Caselhos S, Mexedo A, Fonseca R (2017) Nasofrontal dermoid sinus. BMJ Case Rep 2017
64.
Rogers GF, Proctor MR, Greene AK, Mulliken JB (2005) Frontonasal osteotomy to facilitate removal of an intracranial nasal dermoid. J Craniofac Surg 16:731–736CrossRefPubMed
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 2171CrossRefPubMed
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 105:311–314PubMed
67.
Schuster D, Riley KO, Cure JK, Woodworth BA (2011) Endoscopic resection of intracranial dermoid cysts. J Laryngol Otol 125:423–427CrossRefPubMed
68.
69.
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:e40PubMedPubMedCentral
71.
van Aalst JA, Luerssen TG, Whitehead WE, Havlik RJ (2005) “Keystone” approach for intracranial nasofrontal dermoid sinuses. Plast Reconstr Surg 116:13–19CrossRefPubMed
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 26:14–20CrossRefPubMed
73.
74.
Walker A, Bucy P (1934) Congenital dermal sinuses: a source of spinal meningeal infection and subdural abscesses. Brain 57:401–421CrossRef
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 28:87–95CrossRefPubMed
76.
Weiss DD, Robson CD, Mulliken JB (1998) Transnasal endoscopic excision of midline nasal dermoid from the anterior cranial base. Plast Reconstr Surg 102:2119–2123CrossRefPubMed
Metadata
Title
Meet in the middle: a technique for resecting nasocranial dermoids—technical note and review of the literature
Authors
Joaquin Hidalgo
Richard J. Redett III
Bruno P. Soares
Alan R. Cohen
Publication date
01-03-2020
Publisher
Springer Berlin Heidelberg
Keyword
Craniotomy
Published in
Child's Nervous System / Issue 3/2020
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI
https://doi.org/10.1007/s00381-020-04499-5

Other articles of this Issue 3/2020

Child's Nervous System 3/2020 Go to the issue

Original Article

Does ventricular volume affect the neurodevelopmental outcome in infants with intraventricular hemorrhage?

Original Article

Endoscopic third ventriculostomy inpatient failure rates compared with shunting in post-hemorrhagic hydrocephalus of prematurity

Case-Based Review

Melanotic neuroectodermal tumor of infancy arising from the skull: report of an unusual case, review of the literature, and a diagnostic approach

Original Article

Surgical intervention for hydrocephalus in infancy; etiology, age and treatment data in a Dutch cohort

Original Article

Proton therapy for newly diagnosed pediatric diffuse intrinsic pontine glioma

Case Report

A primary third ventricle mixed germ cell tumor with leptomeningeal dissemination of immature teratoma component