Surgical treatment of intracranial dermoid and epidermoid cysts in children

Fornari, Maurizio; Solero, C. L.; Lasio, Giovanni; Lodrini, S.; Balestrini, M. R.; Cimino, C.; Visintini, Sergio; Pluchino, F.

doi:10.1007/bf00307923

Cited by 39 publications

(25 citation statements)

References 14 publications

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“…7,13,44 There is no alter- native to surgery for epidermoid cysts, 18,51,56,57 especially in younger patients. 2,20,42 Since the squamous stratified epithelium that constitutes the capsule is the real disease, total removal of the capsule is acknowledged to be the ultimate treatment. 8,18,51,57 Because the capsule adheres to the brainstem, CNs, and perforating arteries, however, a conservative attitude toward removal has prevailed, 6,22,40,44,46,51,56 and many surgeons leave part of the capsule behind, accepting a higher risk of recurrence, especially for tumors extending into multiple sites.…”

Section: Discussionmentioning

confidence: 99%

Giant intracranial epidermoids: is total removal feasible?

Aboud¹,

Abolfotoh

Pravdenkova³

et al. 2015

JNS

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OBJECT Epidermoid tumors arise from misplaced squamous epithelium and enlarge through the accumulation of desquamated cell debris. Optimal treatment consists of total removal of the capsule; therefore, giant and multicompartmental tumors are particularly challenging. A conservative attitude in handling the tumor capsule is common given concerns about capsule adherence to neurovascular structures, and thus the possibility of recurrence is accepted with the intent of minimizing complications. This study focuses on the outcome of surgery in patients with giant epidermoid tumors for which total capsule removal was the aim. METHODS The authors conducted a retrospective analysis of all patients with giant epidermoid tumors treated by the senior author (O.A.), who pursued total removal of the capsule through skull base approaches. Patients were divided into 2 groups: one including patients with de novo tumors and the other consisting of patients who presented with recurrent tumors. RESULTS Thirty-four patients had undergone 46 operations, and the senior author performed 38 of these operations in the study period. The average tumor dimensions were 55 × 36 mm, and 25 tumors had multicompartmental extensions. Total removal of the tumor and capsule was achieved with the aid of the microscope in 73% of the 26 de novo cases but in only 17% of the 12 recurrent tumor cases. The average follow-up among all patients was 111 months (range 10–480 months), and the average postsurgical follow-up was 56.8 months (range 6–137 months). There were 4 recurrences in the de novo group, and every case had had a small piece of tumor capsule left behind. One patient died after delayed rupture of a pseudoaneurysm. In the de novo group, the average preoperative Karnofsky Performance Scale (KPS) score was 71.42%, which improved to 87.14% on long-term follow-up. In the group with recurrences, the KPS score also improved on long-term follow-up, from 64.54% to 84.54%. In the de novo group, 3 cases (11.5%) had permanent cranial nerve deficits, and 4 cases (15.4%) had a CSF leak. In the recurrence group, 3 cases (25%) had new, permanent cranial nerve deficits, and 1 (8.3%) had a CSF leak. Two patients in this group developed hydrocephalus and required a shunt. CONCLUSIONS Total removal of the capsule of giant epidermoid tumors was achieved in 73% of patients with de novo tumors and was associated with improved function, low morbidity and mortality, and a lower risk of recurrence. Surgery in patients with recurrent tumors was associated with higher morbidity and persistence of the disease.

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Section: Discussionmentioning

confidence: 99%

Giant intracranial epidermoids: is total removal feasible?

Aboud¹,

Abolfotoh

Pravdenkova³

et al. 2015

JNS

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“…However, the pineal region is an extremely rare site for epidermoid tumors to occur (11,12,15,17,25 Epidermoid tumors are inclusion tumors of the central nervous system. They are thought to originate from ectodermal cells misplaced during the division of the neural and cutaneous ectoderm during the third or fourth week of intrauterine development (3,8,32). They consist of a capsule of stratified squamous epithelium containing desquamated epithelial cells, keratin and cholesterol.…”

Section: Discussionmentioning

confidence: 99%

Pineal epidermoid tumors – report of five cases

Dinç

İplikçioğlu²,

Özek³

2012

Turkish Neurosurgery

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AIm: The aim of this study was to retrospectively analyse the clinical, radiological features and surgical outcome of pineal epidermoid tumors treated at a single neurosurgical department. mAterIAl and methOds: We performed surgery on five patients with pineal region epidermoid tumors at a single neurosurgical department between the years 1998 and 2006. Headache, diplopia and ataxia were the most common presenting findings. Parinaud's syndrome was found in three patients. Hydrocephalus was demonstrated radiologically in two patients.results: Two patients were operated on with the occipital-transtentorial approach, two were operated on with the infratentorialsupracerebellar approach and one was operated on with van Wagenen's approach. Recurrence of tumor was observed in one patient. One patient died at the first postoperative month due to ventriculitis. BulGulAr: İki hasta oksipital-transtentoryal yaklaşımla, iki hasta infratentoryal-supraserebellar yaklaşımla ve bir hasta van Wagenen yaklaşımı ile ameliyat edildi. Tümör nüksü bir hastada görüldü. Bir hasta ventrikülit nedeniyle postoperatif birinci ayda kaybedildi. sOnuÇ: Epidermoid tümörlerin total çıkarılması klinik iyileşme sağlayabilir ve nüks ve şant yerleştirilmesi olasılığını azaltabilir.

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“…To our knowledge, the pediatric occurrence of a supratentorial dorsal cistern EC has been reported only by Mohanty et al [21] in 1981, in an 8-year-old boy with a frontal location. However, in the literature there are some EC cases in which the age of occurrence and the exact location were not detailed [2,4,6,12]. Guidetti and Gagliardi [2] in their series reported 6 EC patients with ages ranging between 0 and 19 years old, and 3 of these cases were characterized by intraparenchymal localizations.…”

Section: Natural History Incidence and Locationmentioning

confidence: 99%

Supratentorial Dorsal Cistern Epidermoid Cyst in Childhood

Caruso

Germanò²,

Caffo³

et al. 1998

Pediatr Neurosurg

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Epidermoid cysts (ECs) are rare developmental lesions occurring anywhere along the central nervous system. Usually affecting adult patients, the occurrence of supratentorial dorsal cistern ECs has been reported in only 1 certain case of pediatric age. An additional pediatric case is presented. An 11-year-old boy had an 8-year history of petit mal seizures. Neurologic examination on admission was negative. T1-weighted magnetic resonance images demonstrated homogenous, hypointense, intradural, extracerebral, right frontal, precentral, parasagittal mass with relatively high signal intensity on T2-weighted images. The lesion was completely removed using a microneurosurgical technique with special care taken with regard to the adjacent nervous and vascular structures. Histologically, an EC was diagnosed. The patient had no recurrence for 2 years and seizures were significantly reduced. This case suggests the need to include ECs in the differential diagnosis of intradural supratentorial extracerebral lesions in childhood.

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Surgical treatment of intracranial dermoid and epidermoid cysts in children

Cited by 39 publications

References 14 publications

Giant intracranial epidermoids: is total removal feasible?

Giant intracranial epidermoids: is total removal feasible?

Pineal epidermoid tumors – report of five cases

Supratentorial Dorsal Cistern Epidermoid Cyst in Childhood

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