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MORISHITA T, WATANABE T, OHTA T, FUKUSHIMA M, KATAYAMA Y. Atypical Epidermoid Cyst With Repetitive Hemorrhages in the Supracallosal Region -Case Report-. Neurol Med Chir (Tokyo) 2009; 49:492-4. [DOI: 10.2176/nmc.49.492] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Takashi MORISHITA
- Division of Neurosurgery, Department of Neurological Surgery, Nihon University School of Medicine
| | - Takao WATANABE
- Division of Neurosurgery, Department of Neurological Surgery, Nihon University School of Medicine
| | - Takashi OHTA
- Division of Neurosurgery, Department of Neurological Surgery, Nihon University School of Medicine
| | - Masamichi FUKUSHIMA
- Division of Neurosurgery, Department of Neurological Surgery, Nihon University School of Medicine
| | - Yoichi KATAYAMA
- Division of Neurosurgery, Department of Neurological Surgery, Nihon University School of Medicine
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Kato K, Higa T, Ujiie H, Chernov M, Kubo O, Hori T. Intracranial epidermoid tumor after subcutaneous lipoma excision. Neurol Med Chir (Tokyo) 2008; 48:262-5. [PMID: 18574333 DOI: 10.2176/nmc.48.262] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 66-year-old man presented with complaints of numbness for the past 5 years and progressive motor weakness of the right leg for the previous 2 months. Magnetic resonance imaging revealed large intra- and extracranial tumors in the frontoparietal region. Physical examination suggested the extracranial lesion was a subcutaneous lipoma, which had been partially resected 60 years before, connected to the intracranial lesion via a defect of the skull. Gross total removal of the tumors was performed. Histological examination showed the intracranial lesion was epidermoid tumor, and connected to the extracranial lipoma by a lipoma bridge. The symptoms improved remarkably following surgery. This case of intracranial epidermoid tumor associated with intra-extracranial lipoma indicates that implantation of skin tissue in childhood carries the risk of epidermoid tumor even after several decades. Neuroimaging screening is recommended to detect the development of any intracranial components.
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Affiliation(s)
- Koichi Kato
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan.
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Steinberg T, Matiasek K, Brühschwein A, Fischer A. IMAGING DIAGNOSIS - INTRACRANIAL EPIDERMOID CYST IN A DOBERMAN PINSCHER. Vet Radiol Ultrasound 2007; 48:250-3. [PMID: 17508513 DOI: 10.1111/j.1740-8261.2007.00238.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
A 4-year-old Doberman Pinscher was evaluated for chronic progressive central vestibular disease and aggressiveness. A cyst-like lesion was identified in the region of the left cerebellopontine angle. The lesion was hypointense on T1-weighted and hyperintense on T2-weighted images. Differentials included an epidermoid or dermoid cyst, cystic neoplasm, and brain abscess. Hyperintensity on subsequent fluid-attenuated inversion recovery images excluded an arachnoid cyst. The histopathologic diagnosis was epidermoid cyst within the fourth ventricle.
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Affiliation(s)
- T Steinberg
- Department of Small Animal Medicine, Section of Neurology, Ludwig-Maximilians University, Munich, Germany.
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Hila H, Bouhaouala MH, Darmoul M, Jelassi H, Yedeas M. [Vermian epidermoid cyst revealed by head injury]. Neurochirurgie 2006; 52:63-6. [PMID: 16609662 DOI: 10.1016/s0028-3770(06)71172-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Vermian epidermoid cyst developing in the fourth ventricle is very rare. We report a case observed in a 24-year-old man, who presented severe headache, dizziness and a blurred vision following head injury. Examination revealed a discrete gait disturbance. Cerebral CT-scan showed a large hypodense lesion of the posterior fossa without contrast enhancement. MRI demonstrated the vermian location of this lesion which displaced the roof of the fourth ventricle upward and the brainstem forward. A suboccipital approach allowed total removal of a well-encapsulated epidermoid cyst, non adherent to the floor of the fourth ventricle. The postoperative course was uneventful.
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Affiliation(s)
- H Hila
- Service d'Imagerie Médicale, Hôpital des FSI, 2070 La Marsa, Tunisie
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Ziyal IM, Bilginer B, Bozkurt G, Cataltepe O, Tezel GG, Akalan N. Epidermoid cyst of the brain stem symptomatic in childhood. Childs Nerv Syst 2005; 21:1025-9. [PMID: 16041548 DOI: 10.1007/s00381-005-1172-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Epidermoid cysts may remain asymptomatic for a long period of time due to their slowly growing pattern corresponding with the normal human skin turnover time and due to soft and light cyst content. They do not cause compression of neural and vascular structures initially that is why almost all of the cases in the literature are diagnosed during adulthood. METHODS We report here an epidermoid cyst in childhood, which was located in the medulla oblongata, unusually and atypically with liquefied cyst content. The liquefaction may occur due to an intrauterine or early childhood infection. The reported case also suffered previously a severe respiratory infection. Although the cyst is located in and around a highly eloquent neural area, plasticity of the brain stem prevented neurological deterioration due to this very slow growing extraaxial mass lesion. The ordinary cyst content found in the center of the cyst cavity during the operation suggested that the same ordinary material, which was previously at the periphery, ran to get liquefied in time. CONCLUSION 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.
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Affiliation(s)
- Ibrahim M Ziyal
- Department of Neurosurgery, Hacettepe University, School of Medicine, Ankara, Turkey.
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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.
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Affiliation(s)
- Sepehr Sani
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL 60612, USA.
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Abstract
Epidermoid cysts of the brain are rare tumor-like lesions, most often of maldevelopmental origin. They are benign in nature, causing symptoms depending on their localization. Surgical resection leads to excellent results. A case is reported of a 68-year-old-man who died suddenly and unexpectedly. Postmortem examination revealed signs of central dysregulation and a bifrontal epidermoid cyst. To the authors' knowledge, death resulting from epidermoid cyst of the brain has not been reported so far.
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Affiliation(s)
- Jakob Matschke
- Department of Neuropathology, University of Hamburg, Germany.
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Link MJ, Cohen PL, Breneman JC, Tew JM. Malignant squamous degeneration of a cerebellopontine angle epidermoid tumor. Case report. J Neurosurg 2002; 97:1237-43. [PMID: 12450053 DOI: 10.3171/jns.2002.97.5.1237] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors present the case of a woman with a cerebellopontine angle (CPA) epidermoid cyst that degenerated into a squamous cell carcinoma. Malignant degeneration of an epidermoid cyst is an extremely rare occurrence. Malignant transformation must be considered in the differential diagnosis when new contrast enhancement on imaging studies and progressive neurological deficit are seen in a patient harboring an epidermoid cyst. The patient initially presented with a 10-year history of left trigeminal neuralgia, subacute left-sided hearing loss, and with facial weakness of 3 weeks' duration. Initial magnetic resonance (MR) imaging revealed a left CPA mass, consistent with an epidermoid. There was faint contrast enhancement where the tumor was in contact with the lateral brainstem. A subtotal resection was performed. Histopathological findings were consistent with an epidermoid tumor. One year after initial presentation, the patient's neurological deficit had increased, and follow-up MR imaging demonstrated a large contrast-enhancing tumor filling the left CPA and compressing the brainstem. At repeated surgery a squamous cell carcinoma arising from the previous epidermoid was found. The patient was subsequently treated with external-beam radiotherapy and stereotactic radiosurgery. Her tumor stabilized. Three years and 8 months after the patient's initial presentation, a new area of tumor developed at the torcular Herophili. The patient died shortly thereafter. Malignant squamous degeneration is a rare cause of enhancement on MR images, as is progressive neurological deficit in a patient with an epidermoid. The combination of subtotal resection, external-beam radiotherapy, and stereotactic radiosurgery may be useful for local tumor control but the long-term prognosis is guarded.
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Affiliation(s)
- Michael J Link
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA
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Gelabert-González M, García-Allut A, González-García J, Martínez-Rumbo R. [Epidermoid cyst of the third ventricle]. Neurocirugia (Astur) 2002; 13:389-92. [PMID: 12444411 DOI: 10.1016/s1130-1473(02)70594-0] [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: 10/24/2022]
Abstract
Intracranial epidermoid tumours are very rare lesions of ectodermal origin that account for 1% of all intracranial tumours. The favourite sites affected by these tumours are the cerebellopontine angle and the chiasmal region. They also appear in the cerebral hemisphere and the intraventricular cavities. We report a case of epidermoid tumour of the third ventricle. The patient was a 68 year-old woman admitted in our service with a 7-days history of headaches and intermittent nausea and vomiting. A CT scan of the brain revealed a large hypodense mass in the third ventricle associated with hydrocephalus. An MRI was performed and revealed, on T1-weighted image, an irregular nonhomogeneous lower signal in relation with CSF. This tumour showed a very bright signal intensity on T2-weighted images. A transcallosal approach of the tumour mass was performed via a right frontal craniotomy. Using an ultrasonic aspirator, the tumour was removed. In a review of the literature, we found only 8 reported cases.
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Affiliation(s)
- M Gelabert-González
- Servicio de Neurocirugía, Hospital Clínico Universitario, Departamento de Cirugía, Universidad de Santiago de Compostela, España
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Vinchon M, Noulé N, Soto-Ares G, Dhellemmes P. Subduroperitoneal drainage for subdural hematomas in infants: results in 244 cases. J Neurosurg 2001; 95:249-55. [PMID: 11780894 DOI: 10.3171/jns.2001.95.2.0249] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Subduroperitoneal drainage (SDPD) is commonly used in the treatment of infantile subdural hematomas (SDHs). Few studies have focused on this technique and most series have included SDHs of various origins in children of different ages. The surgical procedure is not standardized and results achieved using this technique have not been well documented. The authors reviewed their cases of traumatic SDH treated with SDPD in infants (< 2 years of age). Their standard technique includes bilateral SDPD whenever the SDH is bilateral, placement of a free shunt, and systematic removal of the drainage unit after a few months. METHODS The authors performed SDPD in 244 infants with traumatic SDH. The patients' SDHs were controlled by SDPD in 241 cases, and 78.9% of the patients recovered to live a normal life. Complications of SDPD occurred in 38 patients (15.6%): obstruction in 22 cases (9%), infection in eight cases (3.28%), and internal hydrocephalus in eight cases (3.28%). Early complications could be ascribed to surgical technique, delayed complications were associated with the severity of the initial clinical presentation, and late complications were time dependent and unrelated to initial clinical severity. Poor clinical outcome was correlated to the severity of the initial presentation, but not to complications of surgery. CONCLUSIONS Because of its efficacy and low complication rate, SDPD is the procedure of choice when subdural taps fail to control SDH. The authors prefer bilateral drainage because of the low rate of complications. Drains should be systematically removed after a few months to prevent long-term complications.
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Affiliation(s)
- M Vinchon
- Department of Pediatric Neurosurgery, Centre Hospitalier Regional Universitaire de Lille, France.
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Gupta VK, Khandelwal N, Gupta SK, Ramzan AU, Kak VK. Cranial cystic epidermoid: report of two cases and review of the literature. AUSTRALASIAN RADIOLOGY 1996; 40:434-6. [PMID: 8996907 DOI: 10.1111/j.1440-1673.1996.tb00442.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Intercranial epidermoid tumours are benign lesions of congenital origin that are potentially curable. Although computerized axial tomography (CT) and magnetic resonance imaging (MRI) are usually diagnostic, a few atypical features sometimes make pre-operative diagnosis difficult. Two cases of cystic epidermoids with peripheral ring enhancement are reported. Relevant literature has been reviewed.
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Affiliation(s)
- V K Gupta
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Harrison MJ, Morgello S, Post KD. Epithelial cystic lesions of the sellar and parasellar region: a continuum of ectodermal derivatives? J Neurosurg 1994; 80:1018-25. [PMID: 8189257 DOI: 10.3171/jns.1994.80.6.1018] [Citation(s) in RCA: 122] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Cystic epithelial lesions of the sellar and parasellar region are classified on the basis of histology and location into Rathke's cleft cysts, epithelial cysts, epidermoid cysts, dermoid cysts, and craniopharyngiomas. A retrospective review of the clinical presentation, radiological findings, and histology was performed on 19 such lesions, and a survey of the literature pertinent to the classification, clinical presentation, and embryology of these lesions was conducted. Presentation was nonspecific and not predictive of histology. Imaging studies were generally useful in distinguishing these tumors, with the exception of Rathke's cleft cysts, suprasellar epidermoid cysts, and craniopharyngiomas, which frequently could not be differentiated. On microscopic examination, most lesions fit into distinct categories; however, overlap was common among all and some could not be definitively categorized by histological criteria. Evidence supportive of an ectodermal ancestry for sellar and parasellar epithelial-lined cystic lesions is presented. Based on the current findings and a review of the literature, it is suggested that these lesions represent a continuum of ectodermally derived cystic epithelial lesions.
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Affiliation(s)
- M J Harrison
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York
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Bini W, Sepehrnia A, Dündar M, Samii M. Epidermoid tumors of the IV ventricle: Report of 3 cases. Neurocirugia (Astur) 1993. [DOI: 10.1016/s1130-1473(93)70848-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Hung KL, Wu CM, Huang JS, How SW. Familial medulloblastoma in siblings: report in one family and review of the literature. SURGICAL NEUROLOGY 1990; 33:341-6. [PMID: 2184531 DOI: 10.1016/0090-3019(90)90203-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Two siblings in a family--a 5-year-old boy and an 8-year-old girl--suffered from progressive headache and gait disturbance in an interval of 1 year, consecutively. Neurologic manifestations were papilledema and truncal ataxia. Both of their computed tomography scans showed a large, well-enhanced tumor located in the cerebellar vermis with secondary hydrocephalus. Both had surgical resection followed by craniospinal irradiation and then chemotherapy. The pathologic findings confirmed the diagnosis of medulloblastomas. The family pedigree disclosed some other cancer in close relatives. These findings suggested a possible role of heredity in the oncogenesis of this tumor. To our knowledge, our cases are the seventh report of familial medulloblastoma occurring in nontwin siblings in the world.
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Affiliation(s)
- K L Hung
- Department of Pediatrics and Neurosurgery, Cathay General Hospital, Taiwan, Republic of China
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Zhou LF. Intracranial epidermoid tumours: thirty-seven years of diagnosis and treatment. Br J Neurosurg 1990; 4:211-6. [PMID: 2397047 DOI: 10.3109/02688699008992726] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The clinical, operative and pathological characteristics of 102 consecutive cases of intracranial epidermoid tumours are reported. These cases constituted 1.1% of all intracranial tumours and 13.5% of congenital neoplasma admitted to our service in the period 1951-88. Of 91 (89.2%) intradural tumours, 74 (72.5%) were in the subarachnoid cisterns, especially in the cerebellopontine angle cistern (31 cases). The tumours were solid in 69 cases (67.6%) and cystic in 26 (25.5%); the remaining 7 cases were not recorded. There were no specific clinical features with which to identify the nature and extent of the tumour. Diagnosis and treatment are described, with an evaluation of CT and MRI. Before 1981, total removal rate of tumour was 29.3%; after that date it was 72.7% with the aid of microsurgery. The overall surgical mortality rate was 4.9% (5 cases), but there were no deaths in the microsurgical group. Follow-up for a period of 0.5-37 years (mean 13 years) was carried out in 68 patients (70.1%). Among 24 patients with incomplete removal, recurrence of tumour was verified in 4 cases; 3 underwent reoperation with excellent or good results. One patient refused operation and died. All the remaining 20 cases, save 3 who died of other diseases, returned to their normal activities without recurrent manifestations. The results suggest that the primary treatment of epidermoid tumours should be surgical removal including the contents and capsule of a tumour. With the aid of microsurgical technique, complete removal is possible. Patients with incomplete removal can also obtain a long-term favourable result.
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Affiliation(s)
- L F Zhou
- Department of Neurosurgery, Shanghai Medical University, People's Republic of China
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