Endoscopic endonasal treatment of Meckel's cave epidermoid cysts: case series and systematic review

Meckel’s cave (MC) epidermoid cysts (EC) are rare lesions. Extended endoscopic endonasal approaches (EEA) to the ventral skull base recently opened a minimally invasive corridor to MC. The aim of this study was to report our surgical experience and review the concerning literature. Our institutional registry was retrospectively reviewed, and patients who underwent an endoscopic endonasal approach for MC EC from 1998 to 2025 were included. Cases involving alternative surgical approaches or lesions with different histological diagnoses were excluded. A PRISMA systematic review of the literature was performed. The cohort consisted of 4 patients who underwent 6 endoscopic endonasal procedures (one patient experienced two recurrences and underwent two additional EEAs). Complete resection of the cyst content was achieved in 4 procedures (66.7%). Mean surgical time was 111.3 ± 57 min. Mean post-operative hospital length of stay (LOS) was 5.2 ± 1.9 days. Main complications consisted in 2 cases of temporary post-operative worsening of V2 hypoesthesia and 1 CSF leak. The systematic review retrieved 17 papers reporting 17 patients who underwent surgical treatment of MC EC. The reported approach exploited a transcranial route in 12 cases (70.6%) and an endoscopic endonasal route in 5 cases (29.4%). ECs primarily arising from MC are rare lesions with only few cases reported in literature. EEA provides a valid corridor to perform an effective and safe resection, while its reduced invasiveness allows a fast recovery with a shorter LOS. Further studies, with larger caseloads, are warranted to confirm these results.