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Endoscopy-assisted removal of periorbital inclusion cysts in children
George Chater-Cure1, Caitlin Hoffman, Jared Knopman
1Instituto de Neurociencias, University el Bosque, Bogotá, Colombia.
Insights
Endoscopy-assisted surgery offers a minimally invasive option for removing scalp and calvarial inclusion cysts in children. This technique provides excellent cosmetic results with no increased risk of recurrence.
Area of Science:
- Pediatric Neurosurgery
- Minimally Invasive Surgery
- Craniofacial Surgery
Background:
- Traditional surgical approaches for periorbital inclusion cysts require extensive incisions.
- These methods can lead to significant scarring, particularly in the brow area.
- Minimizing surgical invasiveness is a key goal in pediatric surgery.
Purpose of the Study:
- To evaluate the efficacy and safety of an endoscopy-assisted technique for inclusion cyst removal.
- To compare the cosmetic outcomes of this technique with traditional open approaches.
- To assess the recurrence rates associated with the endoscopy-assisted method.
Main Methods:
- Eight pediatric patients with inclusion cysts underwent endoscopy-assisted resection.
- A small incision posterior to the hairline allowed for endoscopic dissection.
- Specialized instruments were used for cyst removal, with high-speed drills for deeper lesions.
- Magnetic Resonance (MR) imaging was used to assess osseous involvement in suspected intradiploic lesions.
Main Results:
- Complete cyst excision was achieved in all eight patients.
- The procedure was performed on an outpatient basis with negligible blood loss.
- No dural violations or postoperative infections were reported.
- Follow-up at a mean of 15 months showed no cyst recurrences.
Conclusions:
- Endoscopy-assisted resection is a safe and effective surgical option for scalp and calvarial inclusion cysts.
- This technique significantly reduces incision length and improves cosmetic outcomes.
- The limited-access approach does not appear to increase the risk of cyst recurrence.
Object:
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.
Methods:
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.
Results:
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.
Conclusions:
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.
