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Abstract
Epidermoid cyst of the brain is a rare benign embryonal tumor. It has an excellent prognosis because of its slow-growing nature. Clinically, symptoms are variable and depend on the location of the cyst. Sudden death may occur as a result of lethal complications because of the tumor growth, but it is still rare. In this article, we present a rare case of sudden unexpected death of a 58-year-old man, with no neurologic history, due to an epidermoid cyst of the brain diagnosed at autopsy.
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Case report: Pediatric giant suprasellar epidermoid cyst. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2019.100612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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3
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You E, Bokhari R, Sirhan D. Split-Pons Syndrome by Epidermoid Cyst: A Case Report and Review of the Literature. World Neurosurg 2019; 131:275-280.e1. [DOI: 10.1016/j.wneu.2019.07.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 07/04/2019] [Accepted: 07/05/2019] [Indexed: 10/26/2022]
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Shtaya A, Dabbous B, Fanou E, Bridges L, Hettige S. Unusual Intraparenchymal Pontomedullary Epidermoid Cyst in a 2-Year-Old Child: A Case Report and Review of the Literature. World Neurosurg 2017; 104:1046.e15-1046.e20. [PMID: 28529053 DOI: 10.1016/j.wneu.2017.04.164] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 04/25/2017] [Accepted: 04/26/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Intrinsic brainstem epidermoid cysts are rare, benign, slow-growing lesions. Their eloquence precludes complete excision; however, subtotal resection often will result in prolonged or sometimes permanent relief of presenting symptoms and signs. We describe an unusual case and review the literature of this pathology in the pediatric population. CASE DESCRIPTION We report an intra-axial pontine epidermoid cyst in a 2-year-old girl who presented with developmental delay, multiple cranial nerve palsies, and pneumonia. Magnetic resonance imaging demonstrated an intrinsic pontine lesion with partial restricted diffusion and an enhancing plaque, the latter not typically seen in congenital lesions like epidermoid. However, gross surgical inspection and histopathology confirmed an epidermoid. CONCLUSIONS Our case, supported by the literature, shows that brain stem epidermoid cysts may have atypical radiologic characteristics and that near-total resection remains safe and can improve outcome.
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Affiliation(s)
- Anan Shtaya
- Academic Neurosurgery Unit, St George's, University of London, London; Department of Neurosurgery, Atkinson Morley Wing, St George's University Hospital, London, United Kingdom.
| | - Bassam Dabbous
- Department of Neurosurgery, Atkinson Morley Wing, St George's University Hospital, London, United Kingdom
| | - Evgenia Fanou
- Department of Neuroradiology, St George's University Hospital, London, United Kingdom
| | - Leslie Bridges
- Department of Cellular Pathology, St George's University Hospital, London, United Kingdom
| | - Samantha Hettige
- Department of Neurosurgery, Atkinson Morley Wing, St George's University Hospital, London, United Kingdom
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Mankotia DS, Tandon V, Sardana H, Rajeshwari M, Suri V, Sharma BS. A rare case of white pearls in brainstem. J Pediatr Neurosci 2016; 11:230-233. [PMID: 27857794 PMCID: PMC5108128 DOI: 10.4103/1817-1745.193379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Intrinsic brainstem epidermoid is extremely rare, and only 14 cases have been reported. Authors report a classic case of brainstem epidermoid in a 14-year-old male child presenting with symptoms of brainstem involvement. The child underwent a successful surgical excision. The lesion was intrinsic and caused diagnostic dilemma based on conventional radiological images. Based on our experience in this case and a thorough review of literature, we are of the opinion that diffusion-weighted images are very important in establishing the diagnosis. Such lesions are challenging and attempt to remove adherent tumor capsule may produce additional neurological deficits.
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Affiliation(s)
| | - Vivek Tandon
- Department of Neurosurgery, All Institute of Medical Sciences, New Delhi, India
| | - Hardik Sardana
- Department of Neurosurgery, All Institute of Medical Sciences, New Delhi, India
| | - Madhu Rajeshwari
- Department of Neuropathology, All Institute of Medical Sciences, New Delhi, India
| | - Vaishali Suri
- Department of Neuropathology, All Institute of Medical Sciences, New Delhi, India
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Patibandla MR, Yerramneni VK, Mudumba VS, Manisha N, Addagada GC. Brainstem epidermoid cyst: An update. Asian J Neurosurg 2016; 11:194-200. [PMID: 27366244 PMCID: PMC4849286 DOI: 10.4103/1793-5482.145163] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The incidence of epidermoid tumors is between 1% and 2% of all intracranial tumors. The usual locations of epidermoid tumor are the parasellar region and cerebellopontine angle, and it is less commonly located in sylvian fissure, suprasellar region, cerebral and cerebellar hemispheres, and lateral and fourth ventricles. Epidermoid cysts located in the posterior fossa usually arise in the lateral subarachnoid cisterns, and those located in the brain stem are rare. These epidermoids contain cheesy and flaky white soft putty like contents. Epidermoid cysts are very slow growing tumors having a similar growth pattern of the epidermal cells of the skin and develop from remnants of epidermal elements during closure of the neural groove and disjunction of the surface ectoderm with neural ectoderm between the third and fifth weeks of embryonic life. We are presenting an interesting case of intrinsic brainstem epidermoid cyst containing milky white liquefied material with flakes in a 5-year-old girl. Diffusion-weighted imaging is definitive for the diagnosis. Ideal treatment of choice is removal of cystic components with complete resection of capsule. Although radical resection will prevent recurrence, in view of very thin firmly adherent capsule to brainstem, it is not always possible to do complete resection of capsule without any neurological deficits.
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Affiliation(s)
- M R Patibandla
- Department of Neurosurgery, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | | | - Vijaya S Mudumba
- Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
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Mortini P, Bailo M, Spina A, Acerno S, Boari N, Gagliardi F. Cyst-cisternal shunting for cystic multirecurrent brainstem epidermoid: case report and literature review. Acta Neurochir (Wien) 2016; 158:1197-201. [PMID: 27106846 DOI: 10.1007/s00701-016-2813-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 04/13/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Surgical treatment of recurrent, posterior cranial fossa epidermoids in multioperated patients carries significant morbidity, mainly due to tumor adhesion to cranial nerves and vessels, and brainstem involvement. Radical resection is often not feasible; therefore surgery should aim to restore cerebrospinal fluid circulation, release engulfed neurovascular structures, and relieve brainstem compression. Intra-axial epidermoids are extremely rare. We present an innovative surgical technique of a cyst-cisternal shunting to treat cystic recurrent, unresectable brainstem epidermoids. METHODS The surgical technique is stepwise described and a case illustration is reported. The pertinent literature has been reviewed. RESULTS Few cases of brain stem epidermoid tumors have been described to date. The surgical steps of this technique and related intraoperative images are provided. One case illustration regarding the resection of a large recurrent cystic intra-axial brainstem epidermoid is reported to demonstrate the application of the technique in a clinical setting. The patient was followed up for 14 years and did not experience any recurrence, showing a stable disease at the last follow-up control. A systematic review of the competent literature has been provided. CONCLUSIONS Cyst-cisternal shunting in case of recurrent, brainstem epidermoid is a safe and long-term effective technique to relieve mass effect into the brainstem.
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Affiliation(s)
- Pietro Mortini
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
| | - Michele Bailo
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
| | - Alfio Spina
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy.
| | - Stefania Acerno
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
| | - Nicola Boari
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
| | - Filippo Gagliardi
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
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Epidermoid cyst mimicking an intrinsic brainstem tumor. Neurocirugia (Astur) 2013; 24:135-8. [DOI: 10.1016/j.neucir.2012.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Revised: 07/24/2012] [Accepted: 09/03/2012] [Indexed: 11/24/2022]
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Wong JJ, Huda S, Wieshmann UC. An unusual presentation of an epidermoid brain tumour: a tale of two specialties. BMJ Case Rep 2012; 2012:bcr-2012-006546. [PMID: 22967680 DOI: 10.1136/bcr-2012-006546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
A 33-year-old right-handed lady was referred to the psychiatry and neurology services by her general practitioner. Previously, she was under psychiatric care for bipolar affective disorder. Recently, her mood had deteriorated prompting the re-referral to the psychiatrists. In addition she had strange attacks. These strange attacks seemed to her like 'sensory overload' or that the 'brain just stops'. Other sensations throughout the attacks included feeling like she is in a 'fish bowl' and surrounding sights and sounds were distorted. She could not speak. After the attack she was hot and flustered, suffered memory loss and was tearful. Both the psychiatrist and the neurologist considered the possibility of these attacks being psychiatric in aetiology. However, the alternative possibility of a coexistence to epilepsy and depression was investigated and MRI demonstrated an epidermoid tumour with the supratentorial portion displacing the left temporal lobe.
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Affiliation(s)
- Jen-jou Wong
- Department of Psychiatry, Mersey Care NHS Trust, Liverpool, UK.
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Gopalakrishnan CV, Dhakoji A, Nair S. Epidermoid cyst of the brainstem in children: case-based update. J Child Neurol 2012; 27:105-12. [PMID: 21862831 DOI: 10.1177/0883073811414709] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Epidermoid cysts are rare, slow growing, space-occupying lesions of early adulthood. Among the various locations, involvement of the brainstem is quite exceptional. In children, these tumors are extremely uncommon; only 4 purely intrinsic brainstem epidermoids are reported in the literature. The pathogenesis of true intraaxial brainstem epidermoid is unclear and is usually not considered in the preoperative differential diagnosis of brainstem tumors. We report 2 additional cases of brainstem epidermoid cysts occurring in children, underlining their clinical characteristics, the difficulties faced in the diagnostic work-up, and the surgical treatment adopted. These tumors pose a surgical challenge and attempts at aggressive removal of the cyst wall are fraught with increased risks of morbidity and mortality. On the other hand, cases treated more conservatively show good or excellent results with minimal complications. Neurosurgical judgment at the time of surgery is warranted to ensure maximum resection while minimizing postoperative neurologic deficits.
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Affiliation(s)
- C V Gopalakrishnan
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, India.
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Takahashi M, Paz Paredes A, Scavarda D, Lena G. Brainstem epidermoid cyst in a child. Case report. Neurol Med Chir (Tokyo) 2007; 47:140-4. [PMID: 17384499 DOI: 10.2176/nmc.47.140] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 10-year-old girl presented with a brainstem epidermoid cyst manifesting as dysphagia and post-prandial vomiting. Magnetic resonance imaging disclosed a cystic mass in the brainstem with associated hydrocephalus. She was treated under a presumptive diagnosis of abscess until the definitive histological diagnosis was established at the fourth admission. In spite of four interventions, she remained in good condition with minimal cranial nerve pareses. Subtotal removal of the epidermoid cyst in the brainstem results in recurrence within a relatively short period, especially in children. Total resection of the tumor is the optimum treatment. The differential diagnosis includes abscess, cystic glioma, and neurenteric cyst.
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Affiliation(s)
- Mayu Takahashi
- Department of Pediatric Neurosurgery, Hôpital des Enfants, Marseille, France
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Recinos PF, Roonprapunt C, Jallo GI. Intrinsic brainstem epidermoid cyst. Case report and review of the literature. J Neurosurg 2006; 104:285-9. [PMID: 16619643 DOI: 10.3171/ped.2006.104.4.285] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Brainstem epidermoid cysts are rare lesions, with only 18 reported cases in the literature and only five purely intrinsic epidermoid cysts within this group. The authors present the case of a 3-year-old girl with a history of chronic headaches, progressive diplopia, and relapsing and remitting mild right hemiparesis who was found to harbor an intrinsic brainstem epidermoid cyst at the pontomedullary junction. Initial working diagnoses included intrinsic brainstem astrocytoma and cavernoma. After tumor enlargement and progressive symptoms, a diffusion-weighted (DW) magnetic resonance (MR) imaging sequence was performed and a definitive diagnosis of an intrinsic brainstem epidermoid cyst was made in the patient. The patient underwent a suboccipital craniotomy and complete resection of the cyst with the aid of intraoperative neurophysiological monitoring. Three years after the operation, the patient is neurologically intact and no evidence of tumor recurrence has been found. The rarity of brainstem epidermoid cysts can make their diagnosis difficult; thus a DW MR imaging sequence of the brain is a useful diagnostic modality. Intrinsic brainstem epidermoid cysts can be removed safely, in a manner similar to that used for the surgical treatment of focal tumors.
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Affiliation(s)
- Pablo F Recinos
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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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: 18] [Impact Index Per Article: 0.9] [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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14
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Abstract
Epidermoid tumors originating from the brainstem are extremely rare. The authors report a patient with an intraaxial epidermoid tumor of the pons. The tumor involved most of the pons and had a small exophytic component.
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Affiliation(s)
- R N Sener
- Department of Radiology, Ege University Hospital, Bornova, 35100 Izmir, Turkey. ,
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