DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20200060

Microneurosurgical aspects in the management of posterior cranial fossa epidermoids: experience of 24 cases

V. V. Ramesh Chandra, B. C. M. Prasad, V. Niranjan, Paradesi Rajesh

Abstract


Background: There is considerable debate in the surgical management of epidermoid cyst, whether gross total or subtotal resection yields better long term outcomes. We present our institutional experience in evaluating the clinical presentation, diagnosis, and surgical strategy and extent of resection in the management of posterior cranial fossa epidermoid cyst.

Methods: A retrospective review of 24 patients diagnosed with posterior cranial fossa epidermoid tumors surgically treated at the institution between January 2010 and July 2019.

Results: A total of 24 patients who underwent surgery for intracranial epidermoid lesions were identified. Of these 13 were in the Cerebellopontine angle region, eight were in the fourth ventricle, and three in lateral cerebellar convexity. The mean duration from onset of symptoms to surgery was 1.6 years. Cranial nerve dysfunction was noted in 73% of patients preoperatively, most of them being the CPA epidermoids. Total removal was achieved in 16 patients, near-total resection in 6 patients, and subtotal removal in 2 patients. Three patients developed recurrence radiologically of them only one patient became symptomatic. The mean duration of follow-up was 3.8 years. The content of the tumor was pearly white material in all cases. Complications noted in the present series were not related to the completeness of excision. Mortality was noted in one patient.

Conclusions: The present study highlights various precautions to be taken intraoperatively in the prevention of development of aseptic meningitis and concludes that total removal of epidermoids does not result in significantly increased morbidity and mortality and should be the goal of surgical treatment. However, near/subtotal resection of lesions that are densely adherent to neurovascular structures is justified, as there is no significant difference in the rate of recurrence. An endoscope can be used to assess the completeness of surgery.


Keywords


Cerebellopontine region epidermoids, Fourth ventricular epidermoids, Posterior fossa epidermoids

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References


Russell DS, Rubinstein LJ. Pathology of Tumors of the Nervous System. 4th ed. Baltimore: Williams andWilkins; 1977:29-32.

Moscote-Salazar LR, Satyarthee GD, Calderon-Miranda WG, Agrawal A, Alvis-Miranda HR, Alcala-Cerra G, et al. Intradiploic pterional epidermoid tumor: A case report and review of the literature. J Pediatr Neurosci. 2017;12:262-4.

Patibandla MR, Yerramneni VK, Mudumba VS, Manisha N, Addagada GC. Brainstem epidermoid cyst: an update. Asian J Neurosurg. 2016;11(03):194-200.

deSouza CE, deSouza R, da Costa S, Sperling N, Yoon TH, Abdelhamid MM, Goel A. Cerebellopontine angle epidermoid cysts: a report on 30 cases. Journal of neurology, neurosurgery, and psychiatry.1989;52(8):986-990.

Apfelbaum RI. Epidermoid cysts and cholesterol granulomas centered on the posterior fossa: Twenty years ofdiagnosis and management. Neurosurg. 1987;21:805.

Talacchi A, Sala F, Alessandrini F, Turazzi S, Bricolo A. Assessment and surgical management of posterior fossa epidermoid tumors: report of 28 cases. Neurosurgery.1998;42(2):242-51.

Kobata H, Kondo A, Iwasaki K. Cerebellopontine angle epidermoids presenting with cranial nerve hyperactive dysfunction: pathogenesis and long-term surgical results in 30 patients. Neurosurgery.2002;50(2):276-86.

Chen S, Ikawa F, Kurisu K, Arita K, Takaba J, Kanou Y. Quantitative MR evaluation of intracranial epidermoid tumors by fast fluid-attenuated inversion recovery imaging and echo-planar diffusion-weighted imaging. Am J Neuroradiol. Jun 2001;22(6)1089-96.

Berger MS, Wilson CB. Epidermoid cysts of the posterior fossa. J Neurosurg.1985;62(2): 214-9.

Yaşargil MG, Abernathey CD, Sarioglu A. Microneurosurgical Treatment of Intracranial Dermoid and Epidermoid Tumors. Neurosurg. April 1989;24(4):561-7.

Akar Z, Tanriover N, Tuzgen S, Kafadar AM, Kuday C. Surgical Treatment of Intracranial Epidermoid Tumors. Neurologia medico-chirurgica, 2003;43(6):275-81.

Samii M, Tatagiba M, Piquer J, Carvalho GA. (1996). Surgical treatment of epidermoid Cysts of the cerebellopontine angle. J Neurosurg.1996;84(1):14-9.

Safavi-Abbasi S, Di Rocco F, Bambakidis N, Talley MC, Gharabaghi A, Luedemann W, et al. Has Management of Epidermoid Tumors of the Cerebellopontine Angle Improved? A Surgical Synopsis of the Past and Present. Skull Base. 2008;18:85-98.

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

Chowdhury FH, Haque MR, Sarker MH. Intracranial epidermoid tumor; micro neurosurgical Management: An experience of 23 cases. Asian J Neurosurg. 2013;8(1):21-8.

Kato K, Ujiie H, Higa T, Hayashi M, Kubo O, Okada Y, et al. Clinical presentation of Intracranial epidermoids: A surgical series of 20 initial and four recurred cases. Asian J Neurosurg. 2010;5:32-40.

Ramdasi R, Mahore A, Chagla A, Kawale J. White epidermoid at the foramen magnum. Neurol India. 2014;62:577-9.

Price EB, Moss HE. Osborn’s Brain: Imaging, Pathology, and Anatomy, Neuro-Ophthalmology.2014;38(2):96-7.

Nagasawa D, Yew A, Safaee M, Fong B, Gopen Q, Parsa AT, et al. Clinical characteristics and diagnostic imaging of epidermoid tumors. Clin Neurosci. 2011;18(9):1158-62.