Nasal dermoied cyst with intracranial extension: Which approach?

Dermoied cyst is the most common midline congenital nasal tumor. Intracranial extension is rare but possible, must be suspected and confirmed by a cerebral magnetic resonance imagining (MRI). Only total surgical removal via a combined intracranial/extracranial approach appears to provide a complete resolution and effective protection against late recurrence. We report a case of a 2 years old patient who was operated for a nasal congenital cyst extending to the nasal septum. Anatomopathology showed a dermoied cyst. Five years later, he presented local recurrence of the dermoied cyst with intracranial extension through a bifid crista galli. We conclude that to avoid recurrence, the removal of the nasal cyst and sinus tract must be followed to its dural attachment. A transfacial approach can be associated with frontal craniotomy, which can provide adequate exposure for complete removal of the intracranial component of the cyst and sinus tract. A literature review was performed.Original Abstract: Le kyste dermoiede est la plus frequente des tumeurs nasales medianes. Son extension intracranienne est rare, mais possible, et necessite une recherche systematique par une IRM cerebrale. L'exerese chirurgicale complete, a travers un double abord transfacial et intracranien emportant les reliquats intracraniens, est la seule garantie d'une guerison en prevenant les recidives. Nous rapportons le cas d'une recidive intracranienne, cinq ans plus tard, d'un kyste dermoiede du septum nasal opere a l'age de deux ans et revele par une fistule congenitale de la pointe du nez. Nous concluons que la hantise doit etre de passer a cote de l'extension intracranienne a laquelle il faudra toujours penser. L'abord combine est facile et efficace. Une revue de la litterature a ete realisee.