Diencephalic syndrome due to a suprasellar epidermoid cyst. Case report

The Endoscopic Resection of Sellar and Suprasellar Epidermoid Cyst in a Pediatric Patient: A Case Report and Review of the Literature

Epidermoid cysts are benign congenital tumors that originate from the ectodermal tissue. The sellar/suprasellar region is an infrequent location for epidermoid cysts and such cases are rarely reported in pediatric patients, as these become symptomatic only when they reach 30 years of age. Surgical intervention is considered the ideal treatment option in patients with suprasellar epidermoid cysts, either via open or endonasal approach. We discuss a case of a 12-year-old male who presented with left visual impairment and was treated with successful resection through an endoscopic endonasal approach (EEA). We also engage in a literature review of the use of EEA in the management of sellar/suprasellar epidermoid cysts in the pediatric age group.

Suprasellar keratinous cyst: A case report and review on its radiological features and treatment outcome

BACKGROUND

Keratinous or epidermoid cysts (ECs) are encapsulated lesions lined by squamous cell epithelium. They comprise approximately 1% of intracranial lesions. Contrary to dermoid cysts, they lack dermal elements such as sebaceous or apocrine glands and hair follicles. The sellar region is the second most common intracranial site following the cerebellopontine angle. Here, we report a case of EC in a patient who complained of endocrine disturbances. We also performed a systematic review on previously published cases to analyze clinical and radiological characteristics and report the treatment outcomes of suprasellar ECs.

CASE DESCRIPTION

A 42-year-old woman presented with a one-year history of amenorrhea, weight gain, severe headache, and visual disturbances for 6 months. Work-up identified an elevated prolactin level and a temporal field defect of the right eye. Magnetic resonance imaging (MRI) showed a cystic suprasellar lesion pushing on the optic chiasm. She underwent endoscopic trans-sphenoidal surgery, which confirmed a keratinous cyst on histology. Postoperatively, complete resection was confirmed on imaging. She did well although her hospital stay was prolonged due to diabetes insipidus and hypocortisolism.

CONCLUSION

Chronic endocrine disturbances can be the presenting complaints of a suprasellar EC, whose T1-weighted MRI appearance can be non-specific, mimicking other differential diagnoses, such as a Rathke's cleft cyst. However, the T2-weighted MRI appearances of ECs are generally hyper-intense and lesions show diffusion restriction. Treatment is surgical and yields good outcomes in most cases reported.