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Updated: Mar 19, 2026

Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
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Minimally Invasive Posterolateral Transcavernous Transtentorial Approach for Giant Epidermoid Cysts: Case Series.

Sophie Scheel1,2,3,4,5, Francisco Rivera6, Cristobal C Silva3,5

  • 1Department of Neurosurgery, Barros Luco-Trudeau Hospital, Santiago, Chile.

Operative Neurosurgery (Hagerstown, Md.)
|March 18, 2026
PubMed
Summary

The minimally invasive posterolateral transcavernous transtentorial approach (MIPLATTA) is effective for resecting giant epidermoid cysts, offering good outcomes with acceptable morbidity. This technique provides a versatile corridor for complex brain tumor surgeries.

Keywords:
Cavernous sinusEpidermoid cystMIPLATTAMicroneurosurgeryMiddle cranial fossaMini-pretemporalOperative technique

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Area of Science:

  • Neurosurgery
  • Surgical Oncology
  • Cranial Surgery

Background:

  • Giant epidermoid cysts in the middle and posterior fossae pose surgical challenges due to adherence to neurovascular structures.
  • Conventional surgical approaches may involve significant morbidity.

Purpose of the Study:

  • To evaluate the efficacy and safety of the minimally invasive posterolateral transcavernous transtentorial approach (MIPLATTA) for resecting giant transtentorial epidermoid cysts.
  • To assess surgical outcomes, including extent of resection, complications, and functional recovery.

Main Methods:

  • Retrospective analysis of 10 patients with histopathologically confirmed giant epidermoid cysts treated with MIPLATTA (2019-2023).
  • Inclusion criteria: lesions extending supra- and infratentorially, pre- and postoperative imaging, and ≥6 months follow-up.
  • Outcomes assessed by extent of resection, complications, and modified Rankin Scale (mRS) scores.

Main Results:

  • Six gross total resections and four subtotal resections were achieved.
  • Mean operative time was 10.8 hours.
  • At 6-month follow-up, 3 patients had cranial nerve deficits, 3 hydrocephalus, 1 CSF fistula, and 2 chemical meningitis; all patients had mRS ≤2.

Conclusions:

  • MIPLATTA offers a versatile surgical corridor for giant transtentorial epidermoid cysts, enabling extensive exposure while preserving neurovascular structures.
  • The approach demonstrated favorable surgical outcomes with acceptable morbidity.
  • Further comparative studies are needed to establish MIPLATTA's efficacy against conventional methods.