• Ernest Jan Bobeff, Cristina Sánchez-Viguera, Cinta Arráez-Manrique, and Miguel Ángel Arráez-Sánchez.
• Department of Neurosurgery, University of Malaga, Carlos Haya University Hospital, Malaga, Spain; Department of Neurosurgery and Neuro-Oncology, Medical University of Lodz, Barlicki University Hospital, Lodz, Poland. Electronic address: ernestbobeff@gmail.com.
• World Neurosurg. 2019 Aug 1; 128: 514-526.

BackgroundSuprasellar epidermoid cysts (SECs) constitute a large portion of so-called pearly tumors. Despite their insidious development and infiltration into vital neurovascular structures, they have a friable consistency, which particularly facilitates their resection; the only alternative to surgery is wait-and-see policy. We present a case of SEC in a patient with bitemporal hemianopia and no other significant symptoms and results of analysis of data on surgical treatment of 71 similar cases reported in the last 4 decades.Case DescriptionA 29-year-old man presented with 1 year blurred vision. Bitemporal hemianopia was detected by perimetry. The patient was otherwise fit and well, with no significant past medical history. Magnetic resonance imaging showed an extra-axial suprasellar lesion with expansion toward the prepontine cistern, which showed restricted diffusion. The patient was operated on via a binostril endoscopic transtuberculum-transplanum endonasal approach. Pathologic examination confirmed the diagnosis of epidermoid cyst. The postoperative course was complicated by third cranial nerve palsy, rhinorrhea, which required reoperation, and diabetes insipidus. Otherwise, the patient made a good recovery and reported subjective improvement of visual acuity. Gradually, the left third cranial nerve function improved and there was neither any long-term complication nor recurrence on 6 months follow-up study.ConclusionsA suprasellar location frequently impedes the gross total resection of epidermoid cysts. Endoscopic endonasal approaches might be more effective in resection of lesions that do not extend laterally beyond the cranial nerves. The introduction of magnetic resonance imaging and surgical endoscopy were fundamental achievements in SEC management. There is a constant need for quality case reports on the management of these intracranial tumors.Copyright © 2019 Elsevier Inc. All rights reserved.

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