Moreno-Jimenez S, Tena-Suck ML, Collado-Ortiz MA, Castillejos-López M, Alvarado-Moreno D, Kramis HM

Language: English
References: 26
Page: 182-189
PDF size: 127.04 Kb.

ABSTRACT

This study details our series of intracranial epidermoid cysts. A historical cohort of 110 epidermoid cysts that were excised from intracranial location over a 16 year period was reviewed. The incidence of epidermoid cysts, clinico- pathological examinations and cyst recurrence rate were noted. 110 cases were included in this study. 60 were males and 52 were females. The range aged was 15-74 years, mean 36,36 ± 13,45 for males and 34, 20 ± 12,17 for female. Their locations included; supratentorial region (n=20), cerebello pontine angle (n=46), Middle ear (n=34), intraventricular and intraparenchymal (n=3), and one in cistern magnum, pineal region, retoclival, medular and mesencephalic region. Surgical exeresis was performed in all cases, partial in 25(26%) cases and total in 71 cases. 74% of the patients had a good prognosis and just 10(10.4%) cases had bad one. There was correlation between tumor size papillomatosis (p = 0.002), inflammation, and granuloma formation p = 0.000 respectively), between older patients and dyskeratosis (p = 0.008) and with the presence of dystrophic calcifications and longer follow-up (p = 0.013). Aseptic meningitis occurred postoperatively in 4 cases, recurrence of tumor was in 22 (20%) cases, two patients died and the rest of the cases had a satisfactory outcome.
Conclusions: Recurrent leakage of the irritating cyst contents and subsequent chemical inflammatory response may be responsible for recurrence, high-density on CT scans and the cystic nature.

REFERENCES

1. Roy K, Bhattacharyya AK, Tripathy P, Bhattacharyya MK, Das B. Intracranial epidermoid a 10-year study. J Indian Med Assoc 2008;106:450-3.

2. Yaºargil MG, Abernathey CD, Sarioglu AC. Microneurosurgical treatment of intracranial dermoid and epidermoid tumors. Neurosurgery 1989;24:561-7.

3. Dutt SN, Mirza S, Chavda SV, Irving RM. Radiologic differentiation of intracranial epidermoids from arachnoid cysts. Otol Neurotol 2002;23:84–92.

4. Katzman GL. Epidermoid cyst. En: Diagnostic imaging: brain. Salt Lake City, Utah: Amirsys, 2004; I-7-16.

5. McLendon RE, Tien RD. Tumors and tumor-like lesions of maldevelopmental origin. In: Russell and Rubinstein’s pathology of tumor OsbornAG. Miscellaneous tumors, cysts, and metastases. En: Diagnostic neuroradiology. St Louis, Mo: Mosby, 1994; 631–649.

6. Osborn AG, Preece MT. Intracranial cysts: radiologicpathologic correlation and imaging approach. Radiology 2006;239:650-64.

7. Suzuki C, Maeda M, Matsumine A, Matsubara T, Taki W, Maier SE, Takeda K. Apparent diffusion coefficient of subcutaneous epidermal cysts in the head and neck comparison with intracranial epidermoid cysts. Acad Radiol 2007;14:1020-8.

8. Alves AL, Pereira CS, Ribeiro Fde A, Fregnani JH. Analysis of histopathological aspects in acquired middle ear cholesteatoma. Braz J Otorhinolaryngol 2008;74:835-41.

9. Praveen KS, Devi BI. Calcified epidermoid cyst of the anterior interhemispheric fissure. Br J Neurosurg 2009; 23:90-1.

10. Maffazzoni DR, Barbosa-Coutinho LM, Chemalle Ide M, Maciel E. Carcinoma originating in an intracranial epidermal cyst. Case report. Arq Neuropsiquiatr 1986;44:391-4.

11. Schiefer TK, Link MJ. Epidermoids of the cerebellopontine angle: a 20-year experience. Surg Neurol 2008;70:584-90.

12. Li F, Zhu S, Liu Y, Chen G, Chi L, Qu F. Hyperdense intracranial epidermoid cysts: a study of 15 cases. Acta Neurochir (Wien) 2007; 149:31-9.

13. Han IB, Huh R, Chung SS, Kim OJ. Cerebellopontine angle epidermoid tumors presenting with bilateral gaze nystagmus. Br J Neurosurg 2008;22:441-4.

14. Guttal KS, Naikmasur VG, Joshi SK, Bathi RJ. Trigeminal neuralgia secondary to epidermoid cyst at the cerebellopontine angle: case report and brief overview. Odontology 2009;97:54-6.

15. Rao VJ, James RA, Mitra D. Imaging characteristics of common suprasellar lesions with emphasis on MRI findings. Clin Radiol 2008; 63:939-47.

16. Tuna H, Torun F, Torun AN, Erdogan A. Intrasellar epidermoid cyst presenting as pituitary apoplexy. J Clin Neurosci 2008;15:1154-6.

17. Robertson G, Mills R. Findings at exploratory tympanotomy for conductive hearing loss. Laryngol Otol 2009;123:1087-9.

18. Lopes M, Capelle L, Duffau H, Kujas M, Sichez JP, Van Effenterre R, Faillot T, Bitar A, Fohanno D. Surgery of intracranial epidermoid cysts. Report of 44 patients and review of the literature. Neurochirurgie 2002;48:5-13.

19. Rutherford SA, Leach PA, King AT. Early recurrence of an intracranial epidermoid cyst due to low-grade infection: case report. Skull Base 2006;16:109-16.

20. Kaylie DM, Warren FM 3rd, Haynes DS, Jackson CG. Neurotologic management of intracranial epidermoid tumors. Laryngoscope 2005;115:1082-6.

21. Kaido T, Okazaki A, Kurokawa S, Tsukamoto M. Pathogenesis of intraparenchymal epidermoid cyst in the brain: a case report and review of the literature. Surg Neurol 2003;59:211-6.

22. Lee VS, Provenzale JM, Fuchs HE, Osumi A, McLendon RE. Post-traumatic epidermoid cyst: CT appearance. J Comput Assist Tomogr 1995;19:153-5.

23. Prat Acín R, Galeano I. Giant occipital intradiploic epidermoid cyst associated with iatrogenic puncture. Acta Neurochir (Wien) 2008;150:413-4.

24. Cho JH, Jung TY, Kim IY, Jung S, Kang SS, Kim SH. A giant intradiploic epidermoid cyst with perforation of the dura and brain parenchymal involvement. Clin Neurol Neurosurg 2007;109:368-73.

25. Mejdoubi M, Lagarde S, Ponsot A, Gigaud M. Intracranial epidermoid cyst secondary to mucocele surgery. J Radiol 2009;90:233-5.

26. Locatelli M, Alimehmeti R, Rampini P, Prada F. Intradiploic frontal epidermoid cyst in a patient with repeated head injuries: is there a causative relationship. Acta Neurochir (Wien) 2006;148:1107-10.