Resseção microcirúrgica de um tumor epidermoide suprasselar em paciente pediátrico: vídeo cirúrgico

Abstract

Introduction: Suprasellar epidermoid tumors are rare benign congenital lesions that account for less than 1% of all intracranial tumors and present unique surgical challenges due to their proximity to critical neurovascular structures. These lesions are particularly uncommon in the pediatric population, with visual field deficits being a common presenting symptom. Surgical resection remains the definitive treatment, with the extent of resection and preservation of surrounding structures being key determinants of outcome. Case Report: We present the case of a 14-year-old male who presented with visual field loss. Preoperative MRI demonstrated a suprasellar lesion with imaging characteristics consistent with an epidermoid tumor. The patient underwent microsurgical resection via a right pterional craniotomy and transsylvian approach. Following careful dissection of the Sylvian fissure and coagulation of bridging veins, a white, pearly lesion with a glioma-like appearance was encountered. Upon entering the tumor, hair-like contents were visualized, confirming the diagnosis of epidermoid tumor. The tumor was debulked using standard aspiration techniques without requiring ultrasonic aspiration. Meticulous dissection was performed to separate the tumor from the optic nerves, optic chiasm, and pituitary stalk. Special attention was given to identifying and preserving the pituitary infundibulum throughout the resection. Complete tumor removal was achieved while maintaining the anatomical integrity of all critical neurovascular structures. Results: Postoperative imaging confirmed successful tumor resection with preservation of the pituitary stalk and infundibulum. The patient experienced immediate postoperative improvement in visual function and has been followed closely by the surgical team over ten years without complications. Conclusion: This case demonstrates that complete microsurgical resection of suprasellar epidermoid tumors in pediatric patients can be safely achieved via the pterional transsylvian approach with preservation of critical structures including the pituitary stalk. Careful identification and protection of the pituitary infundibulum is essential to prevent postoperative endocrinopathy. The transsylvian approach provides excellent visualization of the suprasellar region and allows for safe dissection of tumor from vital neurovascular structures, resulting in favorable visual and endocrine outcomes.