Craniocerebral epidermoid and dermoid tumours: a review of 32 cases

Abstract

We reviewed 22 epidermoid and 10 dermoid tumours of the skull and brain from patients operated on consecutively at Henry Ford Hospital between 1975 and 1991. There were 19 intradural (16 epidermoid, 3 dermoid) and 13 extradural (6 epidermoid, 7 dermoid) lesions. The average age at presentation was 35 years for patients with epidermoids and 15 years for those with dermoids. Common clinical presentations for patients with intradural lesions included headache, visual deficits, and seizures, whereas patients with extradural lesions harbored asymptomatic scalp masses. All patients with intradural lesions were investigated with computed tomography (CT) and cerebral angiography, and 8 patients underwent magnetic resonance imaging (MRI). Total resection was possible in 12 (92%) of 13 extradural tumours, all with excellent outcomes. Eight (42%) of the intradural tumours were completely resected. Overall, with the intradural tumours we had good to excellent results in 17 patients (90%), poor results in 1 (5%), and 1 death (5%). Re-operation was needed in 5 intradural recurrences (26%) with deterioration in only one patient's neurologic status postoperatively. From a review of ours and others' data, we conclude that 1) these tumours have an insidious onset despite significant size and mass effect as demonstrated by imaging studies; 2) CT, angiography, and particularly MRI help to define the extent of subarachnoid tumour spread and involvement of neurovascular structures, thus permitting better surgical planning; 3) a significant number of intradural tumours are difficult to excise because of their adherence to neurovascular structures, and thus are related to higher morbidity and mortality; and 4) because of extremely slow growth, complete tumour resection should not be the goal at the risk of injury to neurovascular structures.

Frontal dermoid cyst coexisting with suprasellar craniopharyngioma: a spectrum of ectodermally derived epithelial-lined cystic lesions?

“…21,22 They are most commonly encountered in the posterior fossa cisterns, parasellar cisterns, and fourth ventricle. 10 Their occurrence inside the brain parenchyma is not commonly encountered. 8,9,24,29 In a recent review of all intraaxial dermoid cysts, the authors found only 4 cases of frontal dermoid cysts, emphasizing the novelty of our case.…”

Epidermoid cyst of the posterior fossa: a case report

“…Rarely, epidermoid cysts arise in the cranial diploe of the middle ear region or frontal bone, where they present as a lytic defect. Unlike dermoid cysts, epidermoid cysts often occur laterally, without a preference for midline sites (1,4,8,10,13) .…”

“…The lining epithelium of epidermoid cyst is immunoreactive for cytokeratins and epithelial membrane antigen (EMA). In contrast to cysts of neuroglial origin there is no immunoreactivity of the lining epithelium with antibodies to glial fibrillary acidic protein (GFAP) (2,4,6,8,13,14) .…”

“…The lesions grows to encase vessels and nerves, and is interior consists of layered anucleate squames produced by a well-differentiated squamous epithelium, often with keratohyaline granules. These cysts may rupture to cause an exuberant inflammatory reaction in the surrounding parenchyma (4,8,11,14) .…”

Thoracic Spinal Intradural Intramedullary Epidermoid Cyst: Case Report

“…Epidermoid cyst is frequently associated with developmental abnormalities such as spina bifida, dermal sinus, meningomyelocele, diastematomyelia and enterogenous cysts or one or more of the mesodermal malformations, particularly those involving the vertebrae (e.g., hemivertebrae, absent vertebrae, fused vertebrae, butterfly vertebrae, midline bony spurs). 6,11,18 Acquired epidermoid cysts have been found years after single or multiple lumbar spinal punctures or meningomyelocele repairs and are thought to result from iatrogenic penetration of skin fragments. 12 The epidermoid cyst is lined by simple stratified squamous epithelium resting on an outer layer of connective tissue.…”