Endoscopic lateral transorbital approach for resection of a recurrent middle cranial fossa epidermoid cyst: Two-dimensional operative video.
- 1Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Mexico City, Mexico.
- 2Department of Neurosurgery, Hospital General Dr. Manuel Gea Gonzalez, Mexico City, Mexico.
Abstract
Background
Middle cranial fossa epidermoid cysts are uncommon. The endoscopic lateral transorbital approach (ELTOA) may provide a direct, less invasive alternative to transcranial surgery in selected cases.Case description
A 55-year-old woman with a recurrent left middle cranial fossa epidermoid cyst, 21 years after subtotal resection through a pterional approach, developed medically refractory trigeminal neuralgia involving V1-V3. Magnetic resonance imaging (MRI) demonstrated a nonenhancing diffusion-restricting lesion extending into Meckel's cave and the tentorial incisura. ELTOA was selected to provide a direct anterolateral trajectory, minimize temporal lobe manipulation, and avoid re-entering the previously operated corridor. Through a superior eyelid incision, the lateral orbital wall and roof were drilled. After division of the meningo-orbital band and dural opening, the lesion was internally decompressed endoscopically. The tentorial incisural component was addressed using ring curettes under endoscopic visualization. The capsule was sharply dissected where safely feasible, and a small portion densely adherent to neurovascular structures was intentionally preserved, resulting in near-total resection. Multilayer reconstruction used a dural substitute, autologous fat, and inlay/onlay fascia lata grafts. Trigeminal neuralgia resolved immediately, and medications were discontinued immediately postoperatively. A transient trochlear nerve palsy resolved by 3 months, while hemifacial hypoesthesia persisted without functional impairment. No cerebrospinal fluid leak or ophthalmological complications occurred. Six-month MRI showed no radiographically detectable residual epidermoid or diffusion restriction, consistent with a favorable short-term postoperative radiographic outcome.Conclusion
ELTOA offers a less invasive alternative for selected recurrent middle cranial fossa epidermoid cysts and expands the skull base armamentarium. Long-term surveillance remains necessary.
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BibTeX
@article{gomezamador2026endoscopic,
title = {{Endoscopic lateral transorbital approach for resection of a recurrent middle cranial fossa epidermoid cyst: Two-dimensional operative video.}},
author = {Juan Luis Gómez-Amador and Rodolfo Villalobos-Diaz and Andrea García-Bitar and Alejandra Ahtziri Mendoza-Sandoval and Tania Montserrat Jimenez-Molina and Lilian Zavala-Romero and Javier Alfonso Martínez-Acosta and Luis Alberto Rodriguez-Hernandez and Gerardo Yoshiaki Guinto-Nishimura},
journal = {Surgical neurology international},
year = {2026},
month = oct,
doi = {10.25259/sni_927_2026},
url = {https://europepmc.org/article/MED/42974587},
note = {CC BY-NC-SA},
}
RIS
TY - JOUR
TI - Endoscopic lateral transorbital approach for resection of a recurrent middle cranial fossa epidermoid cyst: Two-dimensional operative video.
AU - Juan Luis Gómez-Amador
AU - Rodolfo Villalobos-Diaz
AU - Andrea García-Bitar
AU - Alejandra Ahtziri Mendoza-Sandoval
AU - Tania Montserrat Jimenez-Molina
AU - Lilian Zavala-Romero
AU - Javier Alfonso Martínez-Acosta
AU - Luis Alberto Rodriguez-Hernandez
AU - Gerardo Yoshiaki Guinto-Nishimura
PY - 2026
DA - 2026/10/30
JO - Surgical neurology international
DO - 10.25259/sni_927_2026
UR - https://europepmc.org/article/MED/42974587
AB - Background Middle cranial fossa epidermoid cysts are uncommon. The endoscopic lateral transorbital approach (ELTOA) may provide a direct, less invasive alternative to transcranial surgery in selected cases.Case description A 55-year-old woman with a recurrent left middle cranial fossa epidermoid cyst, 21 years after subtotal resection through a pterional approach, developed medically refractory trigeminal neuralgia involving V1-V3. Magnetic resonance imaging (MRI) demonstrated a nonenhancing diffusion-restricting lesion extending into Meckel's cave and the tentorial incisura. ELTOA was selected to provide a direct anterolateral trajectory, minimize temporal lobe manipulation, and avoid re-entering the previously operated corridor. Through a superior eyelid incision, the lateral orbital wall and roof were drilled. After division of the meningo-orbital band and dural opening, the lesion was internally decompressed endoscopically. The tentorial incisural component was addressed using ring curettes under endoscopic visualization. The capsule was sharply dissected where safely feasible, and a small portion densely adherent to neurovascular structures was intentionally preserved, resulting in near-total resection. Multilayer reconstruction used a dural substitute, autologous fat, and inlay/onlay fascia lata grafts. Trigeminal neuralgia resolved immediately, and medications were discontinued immediately postoperatively. A transient trochlear nerve palsy resolved by 3 months, while hemifacial hypoesthesia persisted without functional impairment. No cerebrospinal fluid leak or ophthalmological complications occurred. Six-month MRI showed no radiographically detectable residual epidermoid or diffusion restriction, consistent with a favorable short-term postoperative radiographic outcome.Conclusion ELTOA offers a less invasive alternative for selected recurrent middle cranial fossa epidermoid cysts and expands the skull base armamentarium. Long-term surveillance remains necessary.
SN - 2229-5097
SN - 2152-7806
ER -