Microsurgical excision of intracranial epidermoids: a short surgical series of 12 cases

Bhaskar Godugu, Mastan Reddy Ambarapu, Lakshman Rao Akyam, Sharath Kumar Maila


Background: Intracranial epidermoids are rare congenital cystic lesions where total excision is often difficult resulting in recurrence. In the current series we tried to analyze and report, the clinical findings, imaging criteria for diagnosis, surgical management strategy to achieve radical resection and outcomes were studied prospectively. Here we report our short experience with intracranial epidermoids as a whole.

Methods: 12 cases of intracranial epidermoids confirmed radiologically between Feb 2009 and Dec 2013 were operated by different surgical approaches according to the location of the lesion by micro neurosurgical techniques to achieve total resection. All these patients were followed up for various periods and results analyzed.

Results: Of the 12 epidermoids 5 were in CP angle, 4 were in supratentorial location. Of these 2 patients died and Transient facial palsy was observed in two cases and lower cranial nerve palsy in another case which improved later. 2 patients required VP shunt and there were no recurrences in the series. Total resection of the lesion was achieved in majority of the patients (83.3%) by microsurgical techniques.

Conclusions: With the availability of good imaging techniques and modern micro neurosurgical techniques it is possible to achieve total or near total excision where ever possible to avoid recurrence of the lesions, resulting in total cure of the patient.



Epidermoid, Microsurgical management, Recurrence

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Alvord EC Jr. Growth rates of epidermoid tumours. Ann Neurol. 1997;2:367-70.

Bartal A, Razon N, Avram J, Rockkind S, Doron A. Infratentorial epidermoids. Acta Neurochir (Wien). 1988;42:142-6.

Russel DS, Rubinstein LJ. Dermoid and epidermoid cyst. In: Russel DS, Rubinstein LJ, eds. Pathology of Tumours of the Central Nervous System. 2nd ed. London: Edward and Arnold; 1989: 690-702.

Hakyemez B, Aksoy U, Yildiz H, Ergin N. Intracranial epidermoid cysts: diffusion-weighted, FLAIR and conventional MR findings. Eur J Radiol. 2005;54:214-20.

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

de Souza CE, de Souza R, Da Costa S, Sperling N, Yoon TH, Abdel Hamid MM, et al. Cerebello-Pontine angle epidermoid cysts: a report on 30 cases. J Neurol Neurosurg Psychiatry. 1989;52:986-90.

Apfelbaum RI. Epidermoid cysts and cholesterol granulomas centered on the posterior fossa: twenty years of diagnosis and management. Neurosurgery. 1987;21:805.

Taneredi A, Fiume D, Gazzeri G. Epidermoid cysts of the fourth ventricle: very long follow up in 9 cases and review of the literature. Acta Neurochir. 2003;145:905-11.

Sirin S, Gonul E, Kahraman S, Timurkaynak E. Imaging of posterior fossa epidermoid tumours. Clin Neurol Neurosurg. 2005;107:461-7.

Yasargil MG, Abernathey CD, Sarioglu AC. Microsurgical treatment of intracranial dermoid and epidermoid tumours. Neurosurgery. 1989;24:561-7.

Altschuler EM, Jungries CA, Sekhar LN, Jannetta PJ, Shertak PE. Operative treatment of intracranial epidermoid cysts and cholesterol granulomas: report of 21 cases. Neurosurgery. 1990;26:606-14.

Long DM. Intracranial epidermoid tumours. In: Apuzzo ML, eds. Brain Surgery: Complication Avoidance and Management. 1st ed. New York: Churchill Livingstone; 1993: 669-88.

Lunardi P, Missori P, Innocenzi G, Gagliadi FM, Fortuna FM. Long-term results of surgical treatment of Cerebello-Pontine angle epidermoids. Acta Neurochir (Wein). 1990;103:105-8.

Samii M, Tatagiba M, Piquer J, Carvalho GA. Surgical treatment of epidermoid cysts of Cerebello-Pontine angle. J Neurosurg. 1996;84:14-9.