Intracranial epidermoid lesions: our experience of 38 cases

Rehman, Lal; Bokhari, Iram; Siddiqi, Shamim Ul Haq; Bagga, Veejay; Hussain, Muhammad Masood

doi:10.5137/1019-5149.jtn.21095-17.0

Cited by 12 publications

(22 citation statements)

References 9 publications

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“…Intracranial ECs are slowly growing, congenital anomalies occurring most commonly in the CPA. Due to the gradual mass effect, 3 ECs symptomatize in a wide range of age (between 20 and 60 years) with peak occurrence at around 40 years of age. [5][6][7] In our study, there was a slight female predominance compared with other studies which reported similar incidence in both genders.…”

Section: Discussionmentioning

confidence: 99%

“…2 It may occur in other locations such as the suprasellar and the temporal regions. 3 ECs are slowly growing and may present with symptoms of elevated intracranial pressure (ICP) or symptoms of cerebellar, brainstem, and/or cranial nerves dysfunction. 4 MRI is the investigation of choice with diffusionweighted imaging sequence that distinguishes EC from arachnoid cyst.…”

Section: Introductionmentioning

confidence: 99%

“…The clinical course after surgical resection of EC is however not clearly documented in the literature. 3 The aim of this study was to evaluate the clinical and radiological outcomes of surgically treated EC in the CPA region.…”

Section: Introductionmentioning

confidence: 99%

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Cerebellopontine Angle Epidermoid Cysts: Surgical Treatment Outcome

Refaat

Abdallah

2020

Indian Journal of Neurosurgery

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Background Epidermoid cysts (ECs)are an uncommon slowly growing congenital lesions. The cerebellopontine angle (CPA) is the most common site. Surgical management for these lesions remains challenging due to the high-adherence of the cyst capsule to the surrounding structures and its tendency to present with invasion of multiple cisterns. Objective The aim of this study was to evaluate the clinical and radiological outcome of surgically treated ECs in the CPA region. Materials and Methods This is a retrospective study conducted on patients presenting with symptomatic CPA ECs. Clinical outcome was assessed in terms of improving or worsening of the presenting symptoms. Radiological outcome was assessed by comparing the tumor size, brainstem, and cerebellar compression in the preoperative and postoperative images. Results In this study, 18 patients were included. All cases were operated upon by microsurgical evacuation of the cyst contents and excision of the nonadherent parts of the capsule. On admission, cranial nerve symptoms predominated. Improvement or resolution of preoperative deficits was seen in 15 patients. Preoperative symptoms worsened in two and new postoperative symptoms occurred in one patient. Seven patients needed additional ventriculoperitoneal (VP) shunt in the same setting due to the presence of hydrocephalus. During the follow-up period, symptomatic recurrence occurred in one patient, while asymptomatic recurrence occurred in one patient. Conclusion Surgical management of CPA ECs, leaving remnants of the capsule on cranial nerves and brain stem can be considered as a relatively safe surgical procedure with a good clinical outcome and low-recurrence risks.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cerebellopontine Angle Epidermoid Cysts: Surgical Treatment Outcome

Refaat

Abdallah

2020

Indian Journal of Neurosurgery

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“…3 Although these lesions are slow growing and pliable, they can adhere to or encase adjacent vessels and nerves. 4 Therefore, although a complete resection may offer long-term cure and a normal life expectancy, 22 it can carry a high risk of morbidity. Piece meal reduction in the mass, with gentle teasing of the capsule, is the ideal technique for resection of these lesions.…”

Section: Discussionmentioning

confidence: 99%

“…Magnetic resonance imaging (MRI) is the imaging modality of choice for these lesions, with diffusion-weighted imaging (DWI), which helps differentiate these from their most common differential diagnosis, that is, arachnoid cysts. 4 The treatment of choice for these lesions is radical surgical resection. Although these tumors cross cisternal boundaries, majority of them can be resected with low morbidity, mortality, and recurrence with meticulous microsurgical techniques avoiding dreaded compilations of aseptic meningitis, neural deficits because of manipulation, and vascular injury.…”

Section: Introductionmentioning

confidence: 99%

Surgical Management of Intracranial Epidermoid Tumors—An Institutional Review of 234 Cases

Velho

Bhide

Naik

et al. 2019

IJNS

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Aim To study the demographics, clinical profile, management strategies, and treatment outcomes of intracranial epidermoid lesions. Materials and Methods A single institutional retrospective analysis from a large institute in Western India was done of all patients operated for intracranial epidermoid tumors over a period of 20 years from January 1997 to January 2017. All patients were investigated with a contrast-enhanced computed tomography (CECT) as well as a magnetic resonance imaging (MRI), with a diffusion-weighted imaging to confirm diagnosis of epidermoid tumor. The presenting complaints and the demographics of all patients were recorded, and all patients underwent planned surgery, with or without a cerebrospinal fluid (CSF) diversion procedure as per requirement. Surgery ranged from a gross total resection to a near-total resection depending on the patient, location of the lesion, and involvement of adjacent structures. All patients underwent an immediate postoperative computed tomographic (CT) scan as well as a follow-up MRI. Patients were followed up to note clinical improvement as well as documentation of all complications. Results Total 234 patients of intracranial epidermoid tumors were operated upon in a 20-year span. Males predominated with a total number of 146 (62.4%). The most common age group was the fourth decade. The most common presentations were headache (118 patients) and neuralgia in the trigeminal distribution (82 patients). Infratentorial compartment was the most common location of the tumors (152 patients), with cerebellopontine angle being the predominant site in the posterior fossa (107 patients). Both supra- and infratentorial compartments were involved in 28 cases. Gross total excision could be achieved in 202 patients. Reoperation was required in 12 cases. The mean follow-up period was 68 months. The most common complication encountered was that of postoperative CSF leak (24 patients). We had eight cases of recurrence and six deaths in our series. Conclusion Epidermoid tumors can arise in virtually all intracranial locations. Gross total excision of the tumor is treatment of choice and can be curative for these benign lesions. Large lesions at presentation with involvement of multiple compartments can be difficult to manage and may require bicompartmental or second look surgery. Complete excision of the capsule with preservation of adjacent neuronal and vascular structures is of utmost importance to decrease postoperative morbidity and chances of recurrence. Perioperative steroids, avoidance of intraoperative spillage, and intraoperative endoscopic assistance are recommended in all cases.

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