Nasofrontal dermoid cysts: clinical manifestations, diagnostic methods and surgical treatment

INTRODUCTION. Nasofrontal dermoid cysts (NFDC) are rare developmental abnormalities with a frequency of 1 case per 20 000–40 000 newborns. Differential diagnosis of NFDC is performed with congenital malformations located along the midline, including an epidermoid cyst, encephalocele, nasal glioma, and pericranial sinus. Taking into account the topographical diversity of the NFDC, patients with similar diseases are treated in the departments of ENT pathology, maxillofacial surgery, and only with intracranial spread or in cases of complex differential diagnosis with other neurosurgical diseases, they become the object of attention of a neurosurgeon. Due to the rarity of the occurrence of the disease, as well as the low awareness of neurosurgeons, difficulties often arise with the diagnosis of NFDC.

AIM. To conduct a retrospective analysis of patients with NFDC and compare their own treatment results with literature data.

MATERIALS AND METHODS. A retrospective analysis of clinical manifestations, CT, MRI and results of surgical treatment of 6 patients (3 boys and 3 girls) aged (36.83±58.61) (7–156) months operated in the period from 2017 to 2023 at the National Medical Research Center for Neurosurgery named after Academician N. N. Burdenko. The follow up was (55.97±62.68) months.

RESULTS. The article presents typical clinical manifestations of NFDC, justifies the use of CT and MRI studies in this group of patients, presents the main pathognomonic radiological signs, describesthe pathomorphological picture of NFDC. Various topographic variants of the nasofrontal DC are considered from the standpoint of embryological mechanisms of their development. Surgical treatment options are presented taking into account the topography of the NFDC with the analysis of own and literary data.

CONCLUSION. A detailed clinical examination of the patient with the detection of a dermal sinus fistula in the nasal region, as well as anamnesis data indicating infectious and inflammatory processes in the DC area with multimodal neuroimaging (CT, MRI) will allow with a high degree of probability to make the correct diagnosis and determine the optimal tactics of surgical intervention. The access and scope of surgical treatment depends on the topography of the DC as well as the location of the dermal sinus tract. In observations with intracranial DC arrangement, the use of combined intra-extracranial approaches has been shown to allow for their radical excision.

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