1
|
Nair I, Zammit A, Williamson T, Sadasivan AP. Complete resection of a giant epidermoid cyst of the occipital bone: case report and systematic review. CNS Oncol 2024; 13:2415279. [PMID: 39561245 PMCID: PMC11581160 DOI: 10.1080/20450907.2024.2415279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Accepted: 10/08/2024] [Indexed: 11/21/2024] Open
Abstract
Epidermoid cysts are uncommon accounting for less than 1% of all intracranial tumors. Among them, giant intradiploic epidermoid cysts of the posterior fossa i.e. those exceeding 5 cm are an even rarer entity. Here we report on the complete resection of a 7 cm posterior fossa epidermoid cyst involving the occipital bone in a 32-year-old female presenting with an acute on chronic exacerbation of headaches and vertigo. Complete resection including the cyst wall is crucial in preventing recurrence and malignant transformation. We add to limited existing data by reporting on the first systematic review to date assessing 25 cases of giant epidermoid cysts of the posterior fossa to discuss presentation, clinical and radiographic features and definitive management strategies.
Collapse
Affiliation(s)
- Ishwarya Nair
- Department of Neurosurgery, Princess Alexandra Hospital, Brisbane, QLD 4102, Australia
| | - Adrian Zammit
- Department of Neurosurgery, Princess Alexandra Hospital, Brisbane, QLD 4102, Australia
| | - Timothy Williamson
- Department of Neurosurgery, Princess Alexandra Hospital, Brisbane, QLD 4102, Australia
| | | |
Collapse
|
2
|
Yufeng Z, Xiaoqing J, Lulu X, Pei H, Shengwu L, Zhongsheng L. Giant epidermoid cyst penetrating the skull: a case report and literature review. Br J Neurosurg 2023; 37:1693-1698. [PMID: 34320894 DOI: 10.1080/02688697.2021.1950635] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
Abstract
Intracranial epidermoid cyst is a rare pseudotumor of the nervous system, accounting for 0.2%-1.8% of all intracranial tumors. It is usually located in the cerebellopontine Angle or parasellar area, with insipid onset, slow growth and usually less than 2 cm in diameter. Giant epidermoid cysts that invade the bone have rarely been reported in the literature. Herein, we report a case of giant ECs extradural to the parietal bone, penetrating the skull and continuing to expand outward. In addition, a systematic search of four authoritative databases was conducted to collect the relevant reports of giant epidermoid cyst with diameter > 5cm for the first time, and to discuss the clinical and radiographic features of patients with giant epidermoid cyst and the influence of treatment options.
Collapse
Affiliation(s)
- Zhu Yufeng
- Department of Graduate School, Qinghai University, Xining, China
| | - Jin Xiaoqing
- Department of neurosurgery, Qinghai Provincial People's Hospital, Xining, China
| | - Xu Lulu
- Department of Geriatric Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Han Pei
- Department of neurosurgery, Qinghai Provincial People's Hospital, Xining, China
| | - Lin Shengwu
- Department of Graduate School, Qinghai University, Xining, China
| | - Lu Zhongsheng
- Department of neurosurgery, Qinghai Provincial People's Hospital, Xining, China
| |
Collapse
|
3
|
Vitta P, Abraham AP, Panicker TV, Das J, Joseph V. Intracranial posterior fossa proliferating trichilemmal tumor: first case report. Acta Neurochir (Wien) 2023; 165:1671-1674. [PMID: 37093288 DOI: 10.1007/s00701-023-05597-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 04/10/2023] [Indexed: 04/25/2023]
Abstract
Proliferating trichilemmal tumors (PTT) are rare benign lesions that predominantly occur in elderly women and usually affect the scalp. They originate from the outer root sheath of hair shafts and have trichilemmal differentiation on histopathological examination. Compared to trichilemmal cysts, PTTs show increased cell proliferation and variable cytological atypia. We report the first case of a patient with an intracranial PTT in the posterior fossa. The clinicoradiological presentation and surgical management of the patient as well as the possible pathogenesis of this tumor are discussed.
Collapse
Affiliation(s)
- Pradeep Vitta
- Department of Neurological Sciences, Christian Medical College, Vellore, India
| | - Ananth P Abraham
- Department of Neurological Sciences, Christian Medical College, Vellore, India
| | - Tony V Panicker
- Department of Neurological Sciences, Christian Medical College, Vellore, India
| | - Jonali Das
- Department of Pathology, Christian Medical College, Vellore, India
| | - Vivek Joseph
- Department of Neurological Sciences, Christian Medical College, Vellore, India.
| |
Collapse
|
4
|
Poyuran R, Kalaparti VSVG, Thomas B, Kesavapisharady K, Narasimhaiah D. Nonneoplastic and noninfective cysts of the central nervous system: A histopathological study. Neuropathology 2022. [PMID: 36210745 DOI: 10.1111/neup.12867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 11/28/2022]
Abstract
Nonneoplastic epithelial cysts involving the central nervous system are diverse and are predominantly developmental in origin. This study represents a surgical series describing the histopathological features of 507 such epithelial cysts with clinical and imaging correlation. Age at surgery ranged from 7 months to 72 years (mean: 33 years) affecting 246 male and 261 female patients. Colloid cyst was the most frequently resected cyst, followed by epidermoid cyst, arachnoid cyst, Rathke cleft cyst, dermoid cyst, neurenteric cyst, Tarlov cyst, and choroid plexus cyst. Diagnosis was based on the location of the cysts and the nature of the lining epithelium. Rathke cleft cyst showed the highest propensity for squamous metaplasia, significant inflammation, and xanthogranulomatous reaction. Ulceration of lining epithelium and calcification were most frequent in dermoid cyst. Radiopathological concordance was maximal for colloid cyst, followed by epidermoid and arachnoid cysts. Epidermoid and dermoid cysts exhibited the highest propensity for local tumor progression, followed by Rathke cleft cyst.
Collapse
Affiliation(s)
- Rajalakshmi Poyuran
- Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, India
| | | | - Bejoy Thomas
- Department of Imaging Sciences & Intervention Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, India
| | - Krishnakumar Kesavapisharady
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, India
| | - Deepti Narasimhaiah
- Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, India
| |
Collapse
|
5
|
Catapano JS, Singh R, Lawton MT, Stevens SM, Porter RW. Rare Giant Infected Intradiploic Skull Epidermoid Cysts. Cureus 2022; 14:e29375. [PMID: 36299917 PMCID: PMC9586716 DOI: 10.7759/cureus.29375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2022] [Indexed: 11/08/2022] Open
Abstract
Infections associated with giant intradiploic cranial epidermoid cysts are rare. This case report describes the successful surgical management of a 71-year-old diabetic man with a giant intradiploic cranial epidermoid cyst associated with a secondary infection. The patient underwent successful resection of the infected lesion with washout, debridement, and obliteration of the eustachian canal and external auditory canal. At the six-month follow-up, the infection was resolved and the patient was doing well clinically. Intradiploic epidermoid cysts are rare, and the presence of a superimposed otogenic infection is exceptionally rare and infrequently reported in the neurosurgical literature.
Collapse
|
6
|
Kumar A, Maurya VP, Kanjilal S, Bhaisora KS, Sardhara J, Das KK, Mehrotra A, Srivastava AK, Jaiswal AK, Behari S. Clinicoradiological Features and Treatment Outcome of Supratentorial Intraparenchymal Epidermoid Cyst: A Report of Five Cases and Literature Review. J Neurosci Rural Pract 2021; 12:571-580. [PMID: 34295114 PMCID: PMC8289516 DOI: 10.1055/s-0041-1730125] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objectives
Intraparenchymal epidermoid cysts (IECs) are rare lesions. They represent less than 1% of the intracranial epidermoid cysts. The supratentorial IEC is a clinically and prognostically distinct subset. Given the rarity, most of the articles are case reports. We present a series of five cases of supratentorial IEC to characterize their clinical presentation and outcome, with emphasis on the surgical features.
Materials and Methods
We searched our database for all cases of intracranial epidermoid cysts operated between January 2005 and January 2020. Five patients were identified having IEC from the hospital information system and the neurosurgical operation record book. Standard craniotomy and decompression of the lesion were performed in all these patients. Standard postoperative care includes computed tomography scan of head on the day of surgery and magnetic resonance imaging of brain after 6 weeks to look for the residual lesion, if any. Subsequent follow-up visits in outpatient department to look for resolution of the presurgical symptoms.
Results
The mean age of the patients in our series was 28.8 years (range: 28–40 years.). All the five patients were male. Four patients had IEC involving frontal lobe and one in parietal lobe with a small occipital lobe extension. Seizure was the most common presenting complaint followed by headache. Complete excision was achieved in all the cases. All the three patients with seizure attained seizure freedom postlesionectomy. Focal neurological deficits resolved gradually in postoperative period. There was no recurrence of lesion during follow-up.
Conclusion
Supratentorial IEC most commonly affects young males, involve frontal lobe and present clinically with seizure. Complete surgical excision offers best outcome in the form of remission of seizure disorder.
Collapse
Affiliation(s)
- Ashutosh Kumar
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ved Prakash Maurya
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Soumen Kanjilal
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kamlesh Singh Bhaisora
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Jayesh Sardhara
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kuntal Kanti Das
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anant Mehrotra
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Arun Kumar Srivastava
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Awadhesh Kumar Jaiswal
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjay Behari
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| |
Collapse
|
7
|
Pagkou D, Del Maestro M, Luzzi S, Morbini P, Foroglou N, Galzio RJ. Acute-onset diplopia from intracranial hypertension due to torcular herophili obstruction by an hemorrhagic intradiploic epidermoid cyst. Surg Neurol Int 2021; 12:100. [PMID: 33880205 PMCID: PMC8053460 DOI: 10.25259/sni_578_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 02/19/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Epidermoid cysts are benign slow-growing congenital lesions, constituting approximately 1% of all cranial tumors. Most of these lesions are located intradurally, while about 10-25% of them are located within the diploic spaces. Intradiploic epidermoid cysts are usually discovered incidentally and may remain asymptomatic for many years, but in rare instances, they may grow intracranially and produce brain compression. Sometimes, intradiploic epidermoid cysts may occlude the main cranial venous sinuses causing intracranial hypertension. CASE DESCRIPTION We present the case of a 24-year-old male harboring a paramedian right occipital intradiploic cyst with erosion of both outer and inner bony tables, which occluded the torcular herophili producing a worsening symptomatology with acute-onset diplopia from right sixth cranial nerve palsy; the patient also presented bilateral papilledema, but only reported mild headache and dizziness. Neuroradiological studies evidentiated a lesion compatible with intradiploic epidermoid cyst with intralesional hemorrhagic component, overlying and almost completely occluding the torcular herophili. Considering the fast worsening of symptomatology and the evidence of intracranial hypertension, the patient was operated on immediately after completion of clinical and radiological assessment. The lesion was radically removed with almost immediate reversal of signs and symptoms. Histopathology confirmed the diagnosis of epidermoid cyst with intralesional hemorrhagic components. CONCLUSION Intradiploic epidermoid cysts may cause intracranial hypertension by occlusion of main cranial venous sinuses; intralesional hemorrhage may act as precipitating factor in occlusion of the torcular herophili, producing rapidly worsening intracranial hypertension, which requires prompt surgical treatment to reverse symptomatology. Radical surgical resection is necessary to avoid recurrence.
Collapse
Affiliation(s)
- Diamantoula Pagkou
- Department of Neurosurgery, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Mattia Del Maestro
- PhD School in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia
| | - Sabino Luzzi
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Patrizia Morbini
- Department of Molecular Medicine, Unit of Pathological Anatomy, University of Pavia, Pavia, Lombardia, Italy
| | - Nikolaos Foroglou
- Department of Neurosurgery, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Renato Juan Galzio
- Department of Neurosurgery, Maria Cecilia Hospital, Cotignola, Province of Ravenna, Italy
| |
Collapse
|
8
|
Spinato G, Gaudioso P, Falcioni M, Mosto MCD, Cocuzza S, Maniaci A, Fabbris C, Politi D, Volo T, Ferri E, Cristalli G, Mannelli L, Salvatore M, Rizzo PB, Frezza D. Giant Epidermoid Cyst of Posterior Fossa-Our Experience and Literature Review. Dose Response 2021; 19:15593258211002061. [PMID: 33815017 PMCID: PMC7995313 DOI: 10.1177/15593258211002061] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Intracranial epidermoid cysts are the most frequent congenital intracranial lesion. They rare and benign tumors that can present in different clinical situations depending on location and extension of the disease. Diagnosis is obtained with radiological imaging with RM and non-enhanced TC as elective investigating methods. Elective treatment is surgery, based on total/subtotal excision sparring healthy neurovascular structures, considering the benign nature of this lesion. CASE REPORT In this study we present the case of a 79-year-old woman affected by recidivist epidermal cyst of the posterior fossa. Clinical presentation was characterized by positional subjective vertigo, intense headache localized in the right part of the head increased by Valsalva maneuver and retroarticular subcutaneous swelling. Radiological investigation found a giant epidemoid cyst of the posterior fossa (8,4 x 4,8 x 5,8 cm), treated with surgery. In the postoperative, the patient was fine and no neurological deficit has been encounterd. REVIEW In this study, we present a review of the literature regarding giant epidermoid cysts of posterior fossa. Only 11 cases were reported before ours, which actually is one of the largest ever described.
Collapse
Affiliation(s)
- Giacomo Spinato
- Department of Neurosciences, Section of Otolaryngology and Regional Centre for Head and Neck Cancer, University of Padova, Treviso, Italy
- Department of Surgery, Oncology and Gastroenterology, Section of Oncology and Immunology, University of Padova, Padova, Italy
| | - Piergiorgio Gaudioso
- Department of Neurosciences, Section of Otolaryngology and Regional Centre for Head and Neck Cancer, University of Padova, Treviso, Italy
| | - Maurizio Falcioni
- Department of Head and Neck, University Hospital of Parma, Parma, Italy
| | - Maria Cristina Da Mosto
- Department of Neurosciences, Section of Otolaryngology and Regional Centre for Head and Neck Cancer, University of Padova, Treviso, Italy
| | - Salvatore Cocuzza
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section; University of Catania, Catania, Sicily, Italy
| | - Antonino Maniaci
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section; University of Catania, Catania, Sicily, Italy
| | - Cristoforo Fabbris
- Department of Neurosciences, Section of Otolaryngology and Regional Centre for Head and Neck Cancer, University of Padova, Treviso, Italy
| | - Doriano Politi
- Functional Department of Head and Neck, ENT Unit, ULSS3, Venice-Mestre Hospital, Venice, Italy
| | - Tiziana Volo
- Functional Department of Head and Neck, ENT Unit, ULSS3, Venice-Mestre Hospital, Venice, Italy
| | | | | | | | | | - Paolo Boscolo Rizzo
- Department of Neurosciences, Section of Otolaryngology and Regional Centre for Head and Neck Cancer, University of Padova, Treviso, Italy
| | - Daniele Frezza
- Otosurgery Unit, ULSS2, Treviso Hospital, Treviso, Italy
| |
Collapse
|
9
|
Sahoo R, Tripathy P, Sunder Gajendra Mohapatra S, Mohapatra D, Mohapatra M. Occipital intradiploic epidermoid presenting as benign intracranial hypertension: A rare manifestation. INDIAN JOURNAL OF NEUROSURGERY 2017. [DOI: 10.4103/2277-9167.124246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
| | | | | | | | - Madan Mohapatra
- Ophthalmology, Institute of Medical Science and SUM Hospital
| |
Collapse
|
10
|
Cerebellopontine angle epidermoid cysts: clinical presentations and surgical outcome. Neurosurg Rev 2015; 39:259-66; discussion 266-7. [PMID: 26566990 DOI: 10.1007/s10143-015-0684-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 06/30/2015] [Accepted: 08/09/2015] [Indexed: 10/22/2022]
Abstract
Epidermoid cysts constitute less than 1% of intracranial tumors with the majority of them involving cerebellopontine angle (CPA). Although several mechanisms for cranial nerve dysfunction due to these tumors have been proposed, no direct evaluation for hyper- or hypoactive dysfunction has been done. In this case series, pathophysiology of cranial nerve dysfunction in CPA epidermoid cysts was evaluated with special attention to a new mechanism of capsule strangulation caused by stratified tumor capsule. Twenty-two cases with epidermoid cysts of CPA micro-neurosurgically treated in our departments since 2005 were reviewed. Clinical status of the patients before the surgery and post-operative functional outcome were recorded. Available data from the English literature were summarized for comparison. Mass reduction of cyst contents in most cases was usually associated with prompt and marked improvement of the symptoms suggesting neuroapraxia caused by compression of the tumor content and/or mild ischemia. Among them, two cases showed strangulation of the affected nerves by the tumor capsule whose preoperative dysfunction did not improve after surgery in spite of meticulous microsurgical removal of the lesion. Involved facial and abducent nerves in these two cases showed distortion of nerve axis and nerve atrophy distal to the strangulation site. We report the first direct evidence of etiology of cranial nerve dysfunction caused by cerebellopontine angle epidermoid tumors. Young age and rapidly progressive neurological deficit might be the characteristics for strangulation of the affected nerves by the cyst capsule. Even though the number of cases might be limited, immediate decompression and release of the strangulating band might be urged in such patients to prevent irreversible deficits.
Collapse
|
11
|
Moreira-Holguin JC, Medélez-Borbonio R, Quintero-Lopez E, García-González U, Gómez-Amador JL. Intradiploic epidermoid cyst with intracranial hypertension syndrome: Report of two cases and literature review. Int J Surg Case Rep 2015; 16:81-6. [PMID: 26433925 PMCID: PMC4643448 DOI: 10.1016/j.ijscr.2015.09.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 09/17/2015] [Accepted: 09/17/2015] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Intradiploic epidermoid intracranial cysts (IEIC) derive from ectodermal cells and are covered with stratified squamous epithelium. They are extremely rare, and most common locations are in the occipital, frontal and parietal bones. They have a very slow growth and can be asymptomatic until becoming evident by the deformation produced. The treatment is based on the removal of the lesion, and subsequent histopathological confirmation. PRESENTATION OF CASE Two cases are reported, with intracranial hypertension syndrome, which is very uncommon because of the slow growth of this type of pathology; however, decompensations occurring in the space-occupying lesions at intracranial level explain this type of clinical presentation. DISCUSSION The most common presentation of intracranial intradiploic epidermoid cysts (IEIC) is asymptomatically, which is made evident by the prominence at the level of the soft tissues and then presenting less frequently local pain and cephalea; rarely the size of the lesion can cause focal neurological signs. CONCLUSION These benign lesions, although they are of low incidence, are seen very rarely in intradiploic locations and above all, of significant size, may produce significant mass effect in patients, which was initially tolerated because of its slow growth, however, they may become decompensate and cause intracranial hypertension syndrome.
Collapse
Affiliation(s)
- J C Moreira-Holguin
- Neurosurgery Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico City, Mexico.
| | - R Medélez-Borbonio
- Neurosurgery Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico City, Mexico
| | - E Quintero-Lopez
- Neurosurgery Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico City, Mexico
| | - U García-González
- Neurosurgery Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico City, Mexico
| | - J L Gómez-Amador
- Neurosurgery Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico City, Mexico
| |
Collapse
|
12
|
Abstract
A 50-year-old man presented with a rare giant crossing cranium-temporal combined epidermal cyst. Physical examination found left facial numbness and temple severely numbness with light pressure. Horizontalis craniocerebral computed tomography demonstrated a mass lesion of 3.0 × 2.0 cm in the middle cranial fossa area; sagittal craniocerebral magnetic resonance scanning demonstrated a mass consisting of 2 leaves (the upper one, 4.0 × 3.0 cm; the lower one, 2.0 × 1.5 cm). Computed tomography angiography showed that the blood supply of the lesion came from superficial temporal artery and middle cranial fossa artery. The clinical diagnosis was neurilemmoma. Surgery revealed a pearly cyst consisting of 2 leaves (connected by a narrowed bridge located at the articular fossa of temporal bone) was 6 × 3 × 3 cm. Histologic examination disclosed disintegrated keratinizing epithelium layer, keratinizing epithelium layer, and stratified squamous epithelium layer from inner to outer and found no hair follicles or sebaceous gland with the diagnosis of epidermoid cyst. Surgery was successfully performed, and the patient was discharged home with severer left facial numbness relatively and left jaw slight opening. The present case suggests that epidermoid cysts can be seen in any location, even giant crossing cranium-temporal combined lesion, and the blood supply should be considered as a factor judging its pathogenesis.
Collapse
|
13
|
Khan AN, Khalid S, Enam SA. Intradiploic epidermoid cyst overlying the torcula: a surgical challenge. BMJ Case Rep 2011; 2011:2011/feb12_1/bcr0820103245. [PMID: 22707368 DOI: 10.1136/bcr.08.2010.3245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Intradiploic tumours are rare, slow growing tumours that can present in many different ways, including a painless lump, tenderness, headache and rarely with focal neurological signs. The authors present the case of a gentleman in whom the tumour presented in an unusual location and presented a surgical challenge. The major take home message from this case report is that an epidermoid cyst overlying the torcula is to be approached with great caution and care and is without doubt a surgical challenge.
Collapse
|
14
|
Enchev Y, Kamenov B, William A, Karakostov V. Posttraumatic giant extradural intradiploic epidermoid cysts of posterior cranial fossa : case report and review of the literature. J Korean Neurosurg Soc 2011; 49:53-7. [PMID: 21494364 DOI: 10.3340/jkns.2011.49.1.53] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Revised: 12/01/2010] [Accepted: 12/31/2010] [Indexed: 11/27/2022] Open
Abstract
We reported a unique case of posttraumatic giant infratentorial extradural intradiploic epidermoid cyst. A 54-year-old male, with a previous history of an open scalp injury and underlying linear skull fracture in the left occipital region in childhood, presented with a painful subcutaneous swelling, which had been developed gradually in the same region and moderate headache, nausea, vomiting and cerebellar ataxia. The duration of symptoms on admission was 3 months. Imaging studies revealed occipital bone destruction and giant extradural intradiploic lesion. The preoperative diagnosis was giant infratentorial extradural intradiploic epidermoid cyst. Surgery achieved total removal of the lesion, which was histologically confirmed and the postoperative course was uneventful. To our knowledge, this is the first case of giant infratentorial extradural intradiploic epidermoid cyst with a traumatic etiology described in the literature.
Collapse
Affiliation(s)
- Yavor Enchev
- Department of Neurosurgery, Medical University-Sofia, Sofia, Bulgaria
| | | | | | | |
Collapse
|
15
|
Duan ZX, Chu SH, Ma YB, Zhang H, Zhu JL. Giant intradiploic epidermoid cyst of the occipital bone. J Clin Neurosci 2009; 16:1478-1480. [PMID: 19586771 DOI: 10.1016/j.jocn.2008.09.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2008] [Revised: 09/17/2008] [Accepted: 09/18/2008] [Indexed: 02/07/2023]
Abstract
Epidermoid cysts are uncommon, benign and slow-growing lesions. They often reach an enormous size without producing neurologic symptoms. We describe a 35-year-old female who had a giant intradiploic epidermoid cyst of the occipital bone. She underwent posterior cranial fossa tumor resection. Pathology confirmed epidermoid cyst. There was no recurrence at 13-month follow-up. Total removal of these cysts and repeated washing of the cavity with 0.9% saline may prevent recurrence and aseptic meningitis.
Collapse
Affiliation(s)
- Zhi-xin Duan
- Department of Neurosurgery, No. 3 People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Baoshan District, Shanghai 201900, China
| | | | | | | | | |
Collapse
|
16
|
Fox BD, Smitherman SM, Amhaz H, Ruiz MI, Rouah E, Radaideh M, Ehni BL. A supratentorial, hemorrhagic, intraparenchymal epidermoid cyst. J Clin Neurosci 2009; 16:1101-5. [PMID: 19428259 DOI: 10.1016/j.jocn.2008.04.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Accepted: 04/22/2008] [Indexed: 10/20/2022]
Abstract
Epidermoid cysts are slow growing benign tumors that represent < 1-2% of all intracranial tumors and rarely present as supratentorial, intraparenchymal masses. We present the first report of a supratentorial, hemorrhagic, intraparenchymal epidermoid cyst with its presentation, our operative approach, post-operative course, radiographic features, and a literature review.
Collapse
Affiliation(s)
- Benjamin D Fox
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas 77030, USA
| | | | | | | | | | | | | |
Collapse
|
17
|
Berhouma M, Bahri K, Jemel H, Khaldi M. Intracerebral epidermoid tumor: pathogenesis of intraparenchymal location and magnetic resonance imaging findings. J Neuroradiol 2006; 33:269-70. [PMID: 17041534 DOI: 10.1016/s0150-9861(06)77275-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
18
|
Bikmaz K, Cosar M, Bek S, Gokduman CA, Arslan M, Iplikcioglu AC. Intradiploic epidermoid cysts of the skull: a report of four cases. Clin Neurol Neurosurg 2005; 107:262-7. [PMID: 15884157 DOI: 10.1016/j.clineuro.2004.06.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Epidermoid cysts are uncommon, benign and slow-growing lesions. They may often reach an enormous size without producing neurological symptoms. Intradiploic epidermoid cysts are nearly 25% of all epidermoids. They are derived from ectodermal remnants that stay within the cranial bones during embryonic development. Intradiploic epidermoid cysts can be located in any part of the skull. Two of our four cases were located in left occipital bone and the others were in the frontal bone. These tumours can occur at any age from the first to the seventh decade of life. Our cases had a mean age of 38.75 years (19-55 years). They may reach great sizes before the initial diagnosis and may produce major neurological signs. For good long-term prognosis, correct radiological assessment and complete removal of the tumour with its capsule are essential. We report four cases of intradiploic epidermoid cysts of the skull and analyse the clinical, radiological features and treatment of these lesions in the light of relevant literature.
Collapse
Affiliation(s)
- Kerem Bikmaz
- Department of Neurosurgery, Social Security Okmeydani Teaching Hospital, Istanbul, Turkey
| | | | | | | | | | | |
Collapse
|
19
|
Sani S, Smith A, Leppla DC, Ilangovan S, Glick R. Epidermoid cyst of the sphenoid sinus with extension into the sella turcica presenting as pituitary apoplexy: case report. ACTA ACUST UNITED AC 2005; 63:394-7; discussion 397. [PMID: 15808736 DOI: 10.1016/j.surneu.2004.02.039] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2004] [Accepted: 02/23/2004] [Indexed: 11/18/2022]
Abstract
BACKGROUND Epidermoids of the central nervous system are rare tumors. They are usually found in the fourth decade of life and most commonly off midline in the cerebellopontine angle. We report here a rare case of an epidermoid arising from the sphenoid sinus with extension into the sella and adjacent structures with acute onset of neurological deficit. The significance of the clinical presentation resembling pituitary apoplexy and magnetic resonance imaging (MRI) findings is noted. CASE DESCRIPTION A 25-year-old man presented with acute severe headache, diplopia, and decreased visual acuity. Examination revealed right-sided ptosis and paresis of the third cranial nerve on the right side. Computed tomography and MRI were suggestive of a slow-growing sphenoid sinus mass with extension into the sella. The sublabial transsphenoidal approach was used to remove the mass under direct visualization. The patient's neurological status improved to baseline both subjectively and objectively after the operation. CONCLUSION Epidermoids, although rare, should be considered as part of the differential diagnosis when evaluating lesions of sphenoid sinus or sellar origin.
Collapse
Affiliation(s)
- Sepehr Sani
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL 60612, USA.
| | | | | | | | | |
Collapse
|
20
|
Sudhakar N, Stephenson GC. Swelling on the head—a forgotten lesson: a case report of an intradiploic epidermal cyst with an iatrogenic complication. Br J Oral Maxillofac Surg 2004; 42:155-7. [PMID: 15013549 DOI: 10.1016/s0266-4356(03)00264-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2003] [Indexed: 11/29/2022]
Abstract
Swellings on the head are common, but all require appropriate investigation and caution must be exercised during surgical intervention. We report a patient in whom an attempt at biopsy of a swelling in the scalp was made without any radiological imaging and led to an intracranial complication that caused a neurological deficit. The lesion was an intradiploic epidermal cyst. Though appropriate precautions are usually taken, lessons previously learnt are sometimes forgotten. We would therefore like to remind readers that swellings of the scalp that seem to be attached to the skull on clinical examination should be investigated by radiographs and preferably by computed tomography before surgical intervention because of the possibility of intracranial extension.
Collapse
Affiliation(s)
- N Sudhakar
- Department of Neurosurgery, University Hospital of Wales, Cardiff CF14 4XW, Wales, UK.
| | | |
Collapse
|
21
|
Kaido T, Okazaki A, Kurokawa SI, Tsukamoto M. Pathogenesis of intraparenchymal epidermoid cyst in the brain: a case report and review of the literature. SURGICAL NEUROLOGY 2003; 59:211-6. [PMID: 12681557 DOI: 10.1016/s0090-3019(02)01042-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Intracranial epidermoid cysts are relatively common; however, epidermoid cysts in the brain parenchyma are rare. In addition, the etiology of intraparenchymal epidermoid cysts is not clear. CASE DESCRIPTION A 61-year-old woman presented with convulsive seizures. CT and MRI revealed a mass lesion in the right parietal lobe. With low-grade glioma as a preoperative diagnosis, the tumor was totally excised, but the subsequent pathologic diagnosis was epidermoid cyst. CONCLUSION Exact preoperative diagnosis of this disease would be helpful in preventing chemical meningitis. The etiology is likely related to the time and locus of sequestration of ectodermal tissue during fetal development. Clarifying the pathogenesis will lead to effective preventive measures.
Collapse
Affiliation(s)
- Takanobu Kaido
- Department of Neurosurgery, Nishinara National Hospital, Shichijo 2-789, Nara-city, Nara 630-8053, Japan
| | | | | | | |
Collapse
|
22
|
Affiliation(s)
- G Y Lee
- Department of Neurosurgery, University of Adelaide, Royal Adelaide Hospital, Australia.
| | | | | |
Collapse
|
23
|
Lam CH, Solomon RK, Brent Clark H, Casey SO. Reversal of Increased Intracranial Pressure with Removal of a Torcular Epidermoid: Case Report. Neurosurgery 2001. [DOI: 10.1227/00006123-200104000-00049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
24
|
Lam CH, Solomon RK, Clark HB, Casey SO. Reversal of increased intracranial pressure with removal of a torcular epidermoid: case report. Neurosurgery 2001; 48:929-32. [PMID: 11322454 DOI: 10.1097/00006123-200104000-00049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE AND IMPORTANCE Venous obstruction has been postulated as a cause of increased intracranial pressure, but it has been documented rarely. We present a case of obstruction of the torcula by a slow-growing epidermoid. The tumor caused increased intracranial pressure, which was relieved when it was excised. In addition, the torcular epidermoid is associated with a bifid straight sinus. CLINICAL PRESENTATION A 35-year-old man presented with a headache and a lump on the back of the head. Physical examination revealed a firm, bony lesion approximately 4 x 4 cm in size. Lumbar puncture demonstrated an intraspinal pressure of 39 cm H2O. Neuroradiological studies revealed an epidermoid that compressed and almost completely occluded the torcula. INTERVENTION After the tumor was resected, the intraspinal pressure decreased to 19 cm H2O and remained stable 6 months later. CONCLUSION Pure venous obstruction causes increased intracranial pressure. Removal of the obstruction relieves the intracranial hypertension. In addition, computed tomographic venography is a safe and easy method of documenting torcular anatomy, and it was useful in the follow-up of this patient. Computed tomographic venography can demonstrate a double straight sinus, which is a congenital variant that may be associated with the epidermoid.
Collapse
Affiliation(s)
- C H Lam
- Department of Neurosurgery, University of Minnesota, Minneapolis 55455, USA
| | | | | | | |
Collapse
|
25
|
Arana E, Latorre FF, Revert A, Menor F, Riesgo P, Liaño F, Diaz C. Intradiploic epidermoid cysts. Neuroradiology 1996; 38:306-11. [PMID: 8738084 DOI: 10.1007/bf00596575] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We studied 37 intradiploic epidermoid cysts, reviewing typical and atypical radiological features and the differential diagnosis. The most common clinical feature was a long standing lump in the scalp, occurring in 25 patients (67.7%). Plain films were the most cost-effective radiological technique in diagnosis. The typical finding was a well-defined lytic lesion with sclerotic border, seen in 29 cases (78%). Atypical lesions were those larger than 5 cm and/or with an ill-defined edge, being observed in 8 cases (22%). CT and MRI were the best methods for assessing atypical ones. In all cases with typical radiological findings a preoperative diagnosis of intradiploic epidermoid cyst was suggested.
Collapse
Affiliation(s)
- E Arana
- Department of Radiology, University Hospital La Fe, Valencia, Spain
| | | | | | | | | | | | | |
Collapse
|
26
|
|
27
|
Prall JA, Lloyd GL, Breeze RE. Traumatic brain injury associated with an intradiploic epidermoid cyst: case report. Neurosurgery 1995; 37:523-5. [PMID: 7501121 DOI: 10.1227/00006123-199509000-00024] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
We present a case of an intradiploic epidermoid cyst with an unusual complication. After a minor fall, a patient with a large right parietal epidermoid suffered a traumatic brain injury caused by the transfer of the force of the fall through the cyst contents to the brain and by transdural herniation of the cyst contents into brain parenchyma. Elective resection of intradiploic epidermoids associated with large bony defects is recommended to avoid this apparently rare but potentially dangerous complication of an otherwise benign condition.
Collapse
Affiliation(s)
- J A Prall
- Division of Neurosurgery, University of Colorado Health Sciences Center, Denver, USA
| | | | | |
Collapse
|
28
|
Miller PJ, Hoffman R, Holliday R. Intradiploic epidermoid of the temporal bone: case history and literature review. Otolaryngol Head Neck Surg 1994; 111:827-31. [PMID: 7991266 DOI: 10.1177/019459989411100622] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- P J Miller
- Department of Otolaryngology, New York University School of Medicine 10016
| | | | | |
Collapse
|
29
|
López-Escobar M, Repetto J. Epidermoides diploicos con invasión craneal. Neurocirugia (Astur) 1992. [DOI: 10.1016/s1130-1473(92)70873-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
30
|
Sadato N, Numaguchi Y, Geisler FH, Kristt DA. Extradural epidermoid cyst occluding the transverse sinus: a case report. Comput Med Imaging Graph 1991; 15:129-32. [PMID: 2059949 DOI: 10.1016/0895-6111(91)90038-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A case of an epidermoid cyst obstructing the transverse sinus is presented. The preoperative radiologic evaluation comprised CT, MR Imaging, and cerebral angiogram. The discussion includes the relative value of each test as part of the preoperative evaluation and the differential diagnosis of lateral sinus occlusion.
Collapse
Affiliation(s)
- N Sadato
- Department of Radiology, University of Maryland Medical System/Hospital, Baltimore 21201
| | | | | | | |
Collapse
|
31
|
Intradiploic epidermoid cysts of the skull: report of 10 cases and review of the literature. Acta Neurochir (Wien) 1990; 102:33-7. [PMID: 2407051 DOI: 10.1007/bf01402183] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Intradiploic epidermoid cysts, fairly uncommon lesions in neurosurgical practice, are, as a rule, benign and slow-growing. Some attain great size, producing major neurological signs. Correct radiological assessment and complete removal of the tumour and its capsule are essential for adequate surgical treatment and good long-term prognosis. We report ten cases of intradiploic epidermoid cysts of the skull, three of which were giant lesions and one malignant, and analyze the clinicopathological and radiological features and treatment of these lesions in the light of the most important published data.
Collapse
|
32
|
Rubin G, Scienza R, Pasqualin A, Rosta L, Da Pian R. Craniocerebral epidermoids and dermoids. A review of 44 cases. Acta Neurochir (Wien) 1989; 97:1-16. [PMID: 2718791 DOI: 10.1007/bf01577734] [Citation(s) in RCA: 126] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We review 40 epidermoids and 4 dermoids of the skull and brain treated surgically in our Department between 1976 and 1987. Fourteen were extradural and 30 intradural. The mean duration of symptoms was 3 years for extradural and 10 years for intradural tumours. Symptoms varied with tumour site, in some sites being helpful in differential diagnosis. Skull X-rays and CT were the key diagnostic investigations in extradural and CT in intradural lesions, the latter, with few exceptions, presenting a characteristic CT scan. In 7 cases MRI supplied important details on the tumour boundaries. All the diploic and orbital lesions were removed totally, with a good outcome. Twelve of the intradural lesions were removed totally, 9 subtotally and 9 partially, with a good outcome in 21 patients and a poor outcome in 4; 5 patients died. Outcome was unrelated to degree of removal.
Collapse
Affiliation(s)
- G Rubin
- Department Neurosurgery, Verona City Hospital, Italy
| | | | | | | | | |
Collapse
|
33
|
Abstract
The authors describe two cases of giant intradiploic epidermoid cysts of the cranial vault and a case of a large epidermoid arising from the frontal sinus and extending intracranially. The aetiology of epithelial cysts is reviewed. The characteristic radiological and CT scan appearances of diploic epidermoid cysts are described, their clinical presentation and surgical management briefly discussed.
Collapse
Affiliation(s)
- P S Dias
- Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | | | | |
Collapse
|
34
|
Abstract
Reports of epidermoid tumors from 1965 through 1986 were reviewed with emphasis on new and unusual findings. Clinical data considered were rapid onset, rare symptoms, size and rate of growth, and complications. Uncommon locations included multiple sites in one patient and the anterior fontanelle. The radiologic data from computed tomography were the main contributors to diagnosis. An immunohistochemical test disclosed that cells of craniopharyngiomas are keratin-positive. Histologically benign epidermoids can behave as highly malignant tumors, and can become carcinomatous. Postoperative results for benign tumors were often excellent. Evidence was presented of the close relation among epidermoid and dermoid tumor, craniopharyngioma, ameloblastoma (adamantinoma), Rathke's cleft cyst, and aural cholesteatoma.
Collapse
Affiliation(s)
- M G Netsky
- Department of Pathology, Vanderbilt University School of Medicine, Nashville, Tennessee
| |
Collapse
|
35
|
Constans JP, Meder JF, De Divitiis E, Donzelli R, Maiuri F. Giant intradiploic epidermoid cysts of the skull. Report of two cases. J Neurosurg 1985; 62:445-8. [PMID: 3973714 DOI: 10.3171/jns.1985.62.3.0445] [Citation(s) in RCA: 34] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The authors describe two cases of giant intradiploic epidermoid cysts of the cranial vault in which there was massive intracranial extension causing signs of neurological involvement. The very slow growth and the benign histological nature of these tumors explain their long preoperative evolution and the mild neurological signs in some cases. Roentgenographic and computerized tomography findings permit a correct diagnosis. Complete removal of these cysts and their capsules can be easily accomplished, despite their large size. Total removal of these cysts is associated with a very good long-term prognosis.
Collapse
|
36
|
Abstract
A diffuse, bubblelike, high-density epidermoid cyst of the cerebellopontine angle is described as seen on CT scanning. The high density was attributed to high protein concentration of the cystic fluid due to a proliferative and exudative defense reaction to a "minor leak" of the lipidic material through the capsule, verified by Sudan black B stain. A description of the appearance of the tumor on computerized tomography, based on 42 cases of intracranial epidermoids reported in the literature, is discussed. To our knowledge this is the first morphological documentation of spontaneous leakage of cyst contents, and the second report in the English literature of a dense intracranial epidermoid.
Collapse
|
37
|
Abou-Samra M, Marlin AE, Story JL, Brown WE. Cranial epidermoid tumor associated with subacute extradural hematoma. Case report. J Neurosurg 1980; 53:574-5. [PMID: 7420185 DOI: 10.3171/jns.1980.53.4.0574] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The authors present a case of cranial epidermoid tumor that caused a subacute epidural hematoma after minor trauma. The radiological, operative, and pathological findings are described, and indications for elective excision of cranial epidermoid tumor are discussed.
Collapse
|