{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T13:25:51Z","timestamp":1781184351163,"version":"3.54.1"},"reference-count":24,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"13","license":[{"start":{"date-parts":[[2023,3,27]],"date-time":"2023-03-27T00:00:00Z","timestamp":1679875200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,3,27]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Intracranial epidermoid cysts are benign, slow-growing malformations that most commonly arise at the skull base. Maximizing resection of the cyst contents and the capsule reduces long-term recurrence but can be made difficult by cyst wall adherence to critical neurovascular structures. Expanded endonasal approaches (EEAs) offer an alternative to traditional open transcranial approaches for accessible epidermoid cysts. In this case report, the authors demonstrate a transclival EEA for a large, ventral brainstem epidermoid cyst.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 41-year-old woman who presented with progressive headaches, diplopia, malaise, and fatigue was found to have a 4.7-cm midline, ventral brainstem epidermoid cyst. She underwent an expanded endonasal transclival approach that exposed the brainstem from the level of the dorsum sella to the tip of the basion. A near-total resection was completed with removal of all cyst contents and most of the capsular wall. Reconstruction was completed with Duragen, an autologous fat graft, and a nasoseptal flap. Postoperatively, she had a partial left cranial nerve VI palsy that remained stable 8 weeks after surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>The expanded endoscopic transclival approach can facilitate effective resection of midline, ventral epidermoid cysts.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case22538","type":"journal-article","created":{"date-parts":[[2023,3,27]],"date-time":"2023-03-27T16:10:17Z","timestamp":1679933417000},"source":"Crossref","is-referenced-by-count":2,"title":["Endoscopic endonasal transclival approach for a ventral brainstem epidermoid cyst: illustrative case"],"prefix":"10.3171","volume":"5","author":[{"given":"Blake M.","family":"Hauser","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Brigham and Women\u2019s Hospital, Boston, Massachusetts; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saksham","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brigham and Women\u2019s Hospital, Boston, Massachusetts; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tejas S.","family":"Athni","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brigham and Women\u2019s Hospital, Boston, Massachusetts; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J.","family":"Segar","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brigham and Women\u2019s Hospital, Boston, Massachusetts; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ravindra","family":"Uppaluri","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Otolaryngology\u2013Head and Neck Surgery, Brigham and Women\u2019s Hospital, Dana Farber Cancer Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar","family":"Arnaout","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brigham and Women\u2019s Hospital, Boston, Massachusetts; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Case Rep Radiol","first-page":"528632","article-title":"Atypical intracranial epidermoid cysts: rare anomalies with unique radiological features","volume":"2015","author":"Law EK","year":"2015","unstructured":"Law EK, Lee RK, Ng AW, Siu DY, Ng HK. Atypical intracranial epidermoid cysts: rare anomalies with unique radiological features. Case Rep Radiol. 2015;2015:528632.25667778"},{"issue":"4","key":"b2","series-title":"Neurol Med Chir (Tokyo)","first-page":"216","article-title":"Multiple epidermoid cysts located in the pineal and extracranial regions treated by neuroendoscopy","volume":"45","author":"Kurosaki K","year":"2005","unstructured":"Kurosaki K, Hayashi N, Hamada H, Hori E, Kurimoto M, Endo S. Multiple epidermoid cysts located in the pineal and extracranial regions treated by neuroendoscopy. Neurol Med Chir (Tokyo). 2005;45(4):216\u2013219.15849462"},{"issue":"1","key":"b3","series-title":"J Bras Patol Med Lab","first-page":"79","article-title":"Epidermoid cyst of the posterior fossa: a case report","volume":"47","author":"Cambruzzi E","year":"2011","unstructured":"Cambruzzi E, Presa K, Silveira LC, Perondi GE. Epidermoid cyst of the posterior fossa: a case report. J Bras Patol Med Lab. 2011;47(1):79\u201382."},{"issue":"3","key":"b4","series-title":"Asian J Neurosurg","first-page":"194","article-title":"Brainstem epidermoid cyst: an update","volume":"11","author":"Patibandla MR","year":"2016","unstructured":"Patibandla MR, Yerramneni VK, Mudumba VS, Manisha N, Addagada GC. Brainstem epidermoid cyst: an update. Asian J Neurosurg. 2016;11(3):194\u2013200.27366244"},{"issue":"4","key":"b5","series-title":"J Neurosurg","first-page":"743","article-title":"Giant intracranial epidermoids: is total removal feasible?","volume":"122","author":"Aboud E","year":"2015","unstructured":"Aboud E, Abolfotoh M, Pravdenkova S, Gokoglu A, Gokden M, Al-Mefty O. Giant intracranial epidermoids: is total removal feasible? J Neurosurg. 2015;122(4):743\u2013756.25594324"},{"key":"b6","series-title":"Neurosurgery","first-page":"150","article-title":"Endoscopic endonasal minimal access approach to the clivus: case series and technical nuances","volume":"67","author":"Fraser JF","year":"2010","unstructured":"Fraser JF, Nyquist GG, Moore N, Anand VK, Schwartz TH. Endoscopic endonasal minimal access approach to the clivus: case series and technical nuances. Neurosurgery. 2010;67(3 Suppl):150\u2013158."},{"issue":"7","key":"b7","series-title":"Acta Neurochir (Wien)","first-page":"1223","article-title":"The transclival endoscopic endonasal approach (EEA) for prepontine neuroenteric cysts: report of two cases","volume":"152","author":"Prevedello DM","year":"2010","unstructured":"Prevedello DM, Fernandez-Miranda JC, Gardner P,  The transclival endoscopic endonasal approach (EEA) for prepontine neuroenteric cysts: report of two cases. Acta Neurochir (Wien). 2010;152(7):1223\u20131229.19997946"},{"issue":"5","key":"b8","series-title":"J Laryngol Otol","first-page":"468","article-title":"Reconstructive challenges in the extended endoscopic transclival approach","volume":"129","author":"Kamat A","year":"2015","unstructured":"Kamat A, Lee JY, Goldstein GH,  Reconstructive challenges in the extended endoscopic transclival approach. J Laryngol Otol. 2015;129(5):468\u2013472.25827753"},{"issue":"5","key":"b9","series-title":"J Neurosurg","first-page":"1599","article-title":"Endoscopic endonasal resection of epidermoid cysts involving the ventral cranial base","volume":"130","author":"Forbes JA","year":"2019","unstructured":"Forbes JA, Banu M, Lehner K,  Endoscopic endonasal resection of epidermoid cysts involving the ventral cranial base. J Neurosurg. 2019;130(5):1599\u20131608."},{"issue":"2","key":"b10","series-title":"J Neurosurg","first-page":"368","article-title":"Endoscopic endonasal surgery for epidermoid and dermoid cysts: a 10-year experience","volume":"130","author":"Vaz-Guimaraes F","year":"2019","unstructured":"Vaz-Guimaraes F, Koutourousiou M, de Almeida JR,  Endoscopic endonasal surgery for epidermoid and dermoid cysts: a 10-year experience. J Neurosurg. 2019;130(2):368\u2013378."},{"key":"b11","series-title":"Cavernous Sinus: Developments and Future Perspectives","first-page":"75","article-title":"Extended endoscopic endonasal Transsphenoidal Approach to Supra-parasellar Tumors","author":"de Divitiis E","year":"2009","unstructured":"de Divitiis E, Esposito F, Cappabianca P, Cavallo LM, de Divitiis O. Extended endoscopic endonasal Transsphenoidal Approach to Supra-parasellar Tumors. Dolenc VV, Rogers L, eds. Cavernous Sinus: Developments and Future Perspectives. Springer Vienna; 2009:75\u201386."},{"issue":"2","key":"b12","series-title":"J Neurosurg","first-page":"359","article-title":"Pontine encephalocele and abnormalities of the posterior fossa following transclival endoscopic endonasal surgery","volume":"121","author":"Koutourousiou M","year":"2014","unstructured":"Koutourousiou M, Filho FV, Costacou T,  Pontine encephalocele and abnormalities of the posterior fossa following transclival endoscopic endonasal surgery. J Neurosurg. 2014;121(2):359\u2013366.24506240"},{"key":"b1","series-title":"Case Rep Radiol","first-page":"528632","article-title":"Atypical intracranial epidermoid cysts: rare anomalies with unique radiological features","volume":"2015","author":"Law EK","year":"2015","unstructured":"Law EK, Lee RK, Ng AW, Siu DY, Ng HK. Atypical intracranial epidermoid cysts: rare anomalies with unique radiological features. 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J Bras Patol Med Lab. 2011;47(1):79\u201382."},{"issue":"3","key":"b4","series-title":"Asian J Neurosurg","first-page":"194","article-title":"Brainstem epidermoid cyst: an update","volume":"11","author":"Patibandla MR","year":"2016","unstructured":"Patibandla MR, Yerramneni VK, Mudumba VS, Manisha N, Addagada GC. Brainstem epidermoid cyst: an update. Asian J Neurosurg. 2016;11(3):194\u2013200.27366244"},{"issue":"4","key":"b5","series-title":"J Neurosurg","first-page":"743","article-title":"Giant intracranial epidermoids: is total removal feasible?","volume":"122","author":"Aboud E","year":"2015","unstructured":"Aboud E, Abolfotoh M, Pravdenkova S, Gokoglu A, Gokden M, Al-Mefty O. Giant intracranial epidermoids: is total removal feasible? J Neurosurg. 2015;122(4):743\u2013756.25594324"},{"key":"b6","series-title":"Neurosurgery","first-page":"150","article-title":"Endoscopic endonasal minimal access approach to the clivus: case series and technical nuances","volume":"67","author":"Fraser JF","year":"2010","unstructured":"Fraser JF, Nyquist GG, Moore N, Anand VK, Schwartz TH. Endoscopic endonasal minimal access approach to the clivus: case series and technical nuances. Neurosurgery. 2010;67(3 Suppl):150\u2013158."},{"issue":"7","key":"b7","series-title":"Acta Neurochir (Wien)","first-page":"1223","article-title":"The transclival endoscopic endonasal approach (EEA) for prepontine neuroenteric cysts: report of two cases","volume":"152","author":"Prevedello DM","year":"2010","unstructured":"Prevedello DM, Fernandez-Miranda JC, Gardner P,  The transclival endoscopic endonasal approach (EEA) for prepontine neuroenteric cysts: report of two cases. 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J Neurosurg. 2019;130(5):1599\u20131608."},{"issue":"2","key":"b10","series-title":"J Neurosurg","first-page":"368","article-title":"Endoscopic endonasal surgery for epidermoid and dermoid cysts: a 10-year experience","volume":"130","author":"Vaz-Guimaraes F","year":"2019","unstructured":"Vaz-Guimaraes F, Koutourousiou M, de Almeida JR,  Endoscopic endonasal surgery for epidermoid and dermoid cysts: a 10-year experience. J Neurosurg. 2019;130(2):368\u2013378."},{"key":"b11","series-title":"Cavernous Sinus: Developments and Future Perspectives","first-page":"75","article-title":"Extended endoscopic endonasal Transsphenoidal Approach to Supra-parasellar Tumors","author":"de Divitiis E","year":"2009","unstructured":"de Divitiis E, Esposito F, Cappabianca P, Cavallo LM, de Divitiis O. Extended endoscopic endonasal Transsphenoidal Approach to Supra-parasellar Tumors. Dolenc VV, Rogers L, eds. Cavernous Sinus: Developments and Future Perspectives. Springer Vienna; 2009:75\u201386."},{"issue":"2","key":"b12","series-title":"J Neurosurg","first-page":"359","article-title":"Pontine encephalocele and abnormalities of the posterior fossa following transclival endoscopic endonasal surgery","volume":"121","author":"Koutourousiou M","year":"2014","unstructured":"Koutourousiou M, Filho FV, Costacou T,  Pontine encephalocele and abnormalities of the posterior fossa following transclival endoscopic endonasal surgery. 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