Operative Treatment of Intracranial Epidermoid Cysts and Cholesterol Granulomas: Report of 21 Cases

Abstract

Thirteen patients had operations to remove intracranial epidermoid cysts, and long-term follow-up was obtained. Total or nearly total tumor and capsule removal was accomplished in 7 patients during the initial operation. This group required no additional operations. The other 6 underwent subtotal tumor removal and required multiple operations for symptomatic tumor recurrence. This latter group had a poorer neurological outcome. We conclude that initial total or near-total tumor resection is highly desirable in treating intracranial epidermoid cysts, particularly in physiologically young individuals. Five patients were followed after operations to remove pure cholesterol granulomas of the petroclival bone, and 3 additional patients were followed after operations to remove tumors with combined histopathological features of both an epidermoid cyst and cholesterol granuloma. Four patients with some component of a cholesterol granuloma had concurrent middle ear infections, and 4 did not. Intracranial subtotal excision and drainage of these lesions was the initial operative management in 7 patients. 5 of whom have required multiple operations for symptomatic tumor recurrence. Therefore, we conclude that subtotal excisional procedures for tumors with histopathological features of cholesterol granulomas are not usually successful in establishing long-term cures. Total excision, as recommended for epidermoid cysts, tumors frequently confused with cholesterol granulomas when occupying the petroclival region, may be warranted for these tumors as well. We postulate that when a congenital epidermoid cyst occurs in the petroclival bone, it may incite a local inflammatory reaction, producing lesions which have the histological features of both epidermoid cysts and cholesterol granulomas.

Reversible Bilateral Vestibular Impairment Caused by Fourth Ventricle Epidermoid Tumor-Case Report-

“…Epidermoids of the brain are rare tumors, accounting for approximately 1% of all brain tumors, [1][2][3]13,22) and are usually located in the cerebellopontine angle 1,5,10,14,15,17,18) and parasellar region. 1,21) Epidermoid tumors of the fourth ventricle account for between 5% and 31.4% of all intracranial epidermoid tumors.…”

“…1,21) Epidermoid tumors of the fourth ventricle account for between 5% and 31.4% of all intracranial epidermoid tumors. 7,9,13,15,16,19,20) The clinical symptoms vary depending on the location, extension, and degree of adhesion to vital structures.…”

Inferior vena cava filters in patients with cancer and venous thromboembolism (VTE): patterns of use and outcomes

“…The high frequency of IVCF placement in these patients, despite lack of contraindication to anticoagulation in most, may reflect an overall perception that brain tumors have a higher propensity for intracranial hemorrhage while on anticoagulation. While brain tumors are highly vascular, retrospective studies have suggested the actual risk of intracranial bleeding while on anticoagulation in patients with primary brain tumors is not significantly increased [38][39][40]. Several studies have also revealed high rates of complications with IVCF use in brain tumor patients [41,42].…”

Quiste epidermoide intradiploico infratentorial gigante

“…Entre los diagnósticos diferenciales podemos citar a los colesteatomas (antecedentes de infección otológicas) 1 , los quistes dermoides (poseen contenidos dérmicos y se localizan frecuentemente en la línea mediana), el granuloma eosinófilo (pacientes jóvenes y bordes óseos no escleróticos) y Quiste epidermoide intradiploico infratentorial gigante las metástasis de la calota craneana (bordes irregulares).…”

“…El tratamiento de los QE es la exéresis completa del tumor y de su cápsula en la medida de lo posible, implicando esto un buen pronóstico 1,9,11 . En las lesiones intradurales las adherencias a estructuras vasculo-nerviosas no permiten, a veces, realizar una resección completa.…”