Endoscopic Endonasal Resection of a Recurrent Prepontine Neurenteric Cyst: 2-Dimensional Operative Video

Neurenteric cysts (NCs) are benign lesions originating from mucus-secreting epithelial cells1 that most commonly occur in the spine.2 NCs do, however, present within the skull base and comprise 0.01% of intracranial lesions,2,3 making them extremely rare. Surgical management of NCs varies by lesion location, with complete resection always being the goal to prevent recurrence.2 Reported operative strategies for skull base and prepontine NC resection include retrosigmoid and far-lateral skull base approaches.4 The authors present a surgical video demonstrating a rare case of surgical resection of a prepontine recurrent NC in a 10-year-old girl using the endoscopic endonasal approach. The patient presented with headache and sporadic fever; MRI revealed a T1-hyperintense lesion just anterior to the pons, indicative of a recurrent NC. The endoscopic endonasal approach was chosen as the most direct corridor to maximize the chance of gross total resection and decrease the possibility of recurrence. The patient's parents consented to the procedure. The patient tolerated the procedure well but did develop a cerebrospinal fluid leak in the postoperative period necessitating a reoperation. After leak repair, the patient went on to have an uncomplicated course with complete resolution of her symptoms. Postoperative MRI delineated gross total resection of the NC. On her last follow-up visit, the patient was doing well with no symptoms. The patient and her parents consented for the use of all video and images presented in this case.