Tubular retractor-assisted minimally invasive parafascicular approach for dermoid cyst

TL;DR

This paper describes a new minimally invasive surgical technique using a tubular retractor to safely remove a brain dermoid cyst while preserving surrounding brain structures.

Contribution

The first reported use of tubular retractor-assisted minimally invasive parafascicular approach for dermoid cyst removal.

Findings

The tsMIPS approach minimized trauma to cortical–subcortical structures without sacrificing visualization.

The procedure avoided manipulation of lenticulostriate arteries attached to the cyst walls.

Endoscope use ensured complete drainage of cyst components.

Abstract

Intracranial dermoid cysts are benign lesions that may be diagnosed incidentally or present symptomatically due to mass effect—focal neurological deficits, seizures and/or hydrocephalus—or chemical meningitis secondary to spontaneous rupture. The use of tubular retractors in minimally invasive parafascicular surgery (tsMIPS) has been described extensively as a technique to preserve neurological function whilst safely maximizing the extent of resection. The authors present the first use of the tsMIPS approach for removal of a dermoid cyst in a 68-year-old female who presented with abulia and seizures due to a large Sylvian fissure dermoid cyst. This approach minimized trauma to surrounding cortical–subcortical structures, as supported by connectome analyses, without sacrificing visualization of the operative field. Additionally, itavoided manipulation of the lenticulostriate arteries attached to the walls of the dermoid cyst. The use of an endoscope ensured complete drainage of the cyst components and therefore the effectiveness of the procedure.

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