Double intracranial tumours of maldevelopmental origin - teratoma at the pineal region and an epidermoid cyst in the fourth ventricle

Abstract

A 21-year-old man with double intracranial tumours of maldevelopmental origin, teratoma at the pineal region and an epidermoid cyst in the fourth ventricle, is reported. The tumours were removed totally by multiple operations; the epidermoid cyst was resected by suboccipital craniectomy with the patient in prone position and the teratoma was removed via occipital transtentorial approach with the patient in sitting position. Maldevelopmental tumours located within the cranial cavity with different histological types such as the present case have not sofar been described. Histogenesis of these tumours is confusing because teratoma often contains tissues of epidermoid cyst. Etiological considerations for these tumours are presented and appropriate operative procedures for tumours simultaneously occurring in the pineal and the fourth ventricle are also discussed.

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“…These tumors should be removed with the aim of radical resection without compromising the patient's neurological condition. Although the cyst content can be aspirated easily [28], radical removal of the total tumor is not always possible because capsule is usually adherent to surrounding neurovascular structures [1, 13,19,20,22,25,26,30]. Treatment of intrinsic brain stem epidermoid cysts consists of simple aspiration or subtotal excision of the tumor and may be performed due to adherence of the tumor capsule to the surrounding vital brainstem An aggressive approach may lead to disastrous complications [12,21].…”

“…[7,9,11,14,31,49,51]. Good long-term outcomes with minor morbidity have been achieved with a more conservative approach to difficult cases [19]. Although radical resection will prevent recurrence, in view of very thin firmly adherent capsule to brainstem, it is not always possible to do complete resection capsule without any neurological deficits.…”

“…The usual locations of epidermoid tumor are parasellar region and cerebellopontine angle and is less commonly sylvian fissure, suprasellar region, cerebral and cerebellar hemispheres [7,8,9,10,11,12,14,15,16,17,18] and lateral and fourth ventricles. Epidermoid cysts located in the posterior fossa usually arise in the lateral subarachnoid cisterns [9, 14,19] and those located in the brain stem are rare [1,4,19,20,21,22]. Growth rate of epidermoid tumors is similar to epidermal cells of the skin and they grow along the cisternal spaces with very few exceptions of infiltrating the surrounding parenchyma of brain [37].…”

Brainstem epidermoid cyst: An update

“…[ 2 3 4 5 6 7 ] The usual locations of epidermoid tumor are parasellar region and cerebellopontine angle[ 7 8 9 10 11 ] and is less commonly located in sylvian fissure, suprasellar region, cerebral[ 12 13 14 ] and cerebellar hemispheres,[ 12 14 15 ] and lateral and fourth ventricles. [ 7 12 14 15 16 17 18 ] Epidermoid cysts located in the posterior fossa usually arise in the lateral subarachnoid cisterns,[ 9 14 19 ] and those located in the brain stem are rare. [ 2 5 19 20 21 22 ] As far as our literature search, there were only 22 cases of epidermoid tumors reported[ 5 13 19 20 21 22 23 24 25 26 27 28 30 31 32 33 34 35 36 ] Growth rate of epidermoid tumors was similar to epidermal cells of the skin and they grow along the cisternal spaces with very few exceptions of infiltrating the surrounding parenchyma of brain.…”

“…[2][3][4][5][6][7] The usual locations of epidermoid tumor are parasellar region and cerebellopontine angle [7][8][9][10][11] and is less commonly located in sylvian fissure, suprasellar region, cerebral [12][13][14] and cerebellar hemispheres, [12,14,15] and lateral and fourth ventricles. [7,12,[14][15][16][17][18] Epidermoid cysts located in the posterior fossa usually arise in the lateral subarachnoid cisterns, [9,14,19] and those located in the brain stem are rare. [2,5,[19][20][21][22] As far as our literature search, there were only 22 cases of epidermoid tumors reported [5,13,[19][20][21][22][23][24][25][26][27][28][30][31][32]…”