Epidermoid cyst of the brain stem symptomatic in childhood

Abstract

We suggest that the symptoms of this present case appeared very early due to liquefaction of the cyst content with compression and displacement of the brain stem caudally. The recent infection process may predispose the pathological condition.

Clinical characteristics and diagnostic imaging of epidermoid tumors

“…1 While spontaneous remission of symptoms has been known to occur secondary to cystic rupture and decompression, this provides only temporary relief. 44,[76][77][78] Subtotal resection may lead to tumor recurrence, estimated to occur during an interval equal to the patient's age at initial symptom presentation plus nine months. 79,80 Earlier epidermoid recurrence is thought to derive from multiple residual clonogenic cells, chronic inflammation resulting in increased proliferation as occurs in normal skin, 79,81 or malignant transformation.…”

Pure Intrinsic brain stem epidermoid cyst: Case report, review of the literature and new classification

“…4,14,24,43 Migration of embryonic ectodermal remnants along the Virchow-Robin spaces around the brain microvasculature. 11,13,43 This hypothesis can explain the occurrence of intrinsic brain stem epidermoid tumors even in the later part of the life.17,43,45 Ziyal et al 45 reported that the tumor extends from the cisternal space into the brain stem, and is usually demonstrated as an exophytic lesion in the ventral brain stem cisterns. Over a period, the brain parenchyma may cover the cyst contents and may give the appearance that the lesion is intra axial.…”

“…4,24,31,43,45 The proliferation of pluripotent embryonic remnants along the otic and optic cerebral vesicles can explain the occurrence of the majority of cranial epidermoids either in Cerebello pontine angle (CPA) or sellar areas. 4,14,24,43 Migration of embryonic ectodermal remnants along the Virchow-Robin spaces around the brain microvasculature.…”

“…Epidermoid cysts are pearly white congenital tumors that account for 0.2 to 1.8% of all primary brain stem tumors. 45 They usually develop in the basal subarachnoid spaces like cerebello pontine angle 21 and juxta sellar areas. 4,29,38 They are exceptionally slow growing tumors, commonly occur between second to the fourth decades, and appear to proliferate along the open cisternal spaces rather than infi ltrating tissue parenchyma.…”

“…Key words: Brainstem, Classifi cation, Epidermoid, Intrinsic cyst, telo-velo-tonsillar approach of pure intrinsic brain stem lesions, 12,13,27,29,33,35,44 and the juxta brain stem lesion either infi ltrated from surrounding cisternal spaces, 5,13,17,18,20,24,45 or extending into surrounding cisternal spaces8, [22][23][24][30][31][32]36. There is some amount of controversy prevailing in the pathogenesis morphological classifi cation13,24,43, author demarcated four different anatomical types of these tumors based on the epicentre of the tumor.…”