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Pop MM, Bouros D, Klimko A, Florian IA, Florian IS. Intracranial epidermoid cysts: benign entities with malignant behavior: experience with 36 cases. Sci Rep 2023; 13:6474. [PMID: 37081102 PMCID: PMC10119307 DOI: 10.1038/s41598-023-33617-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 04/15/2023] [Indexed: 04/22/2023] Open
Abstract
Intracranial epidermoid cysts are benign slow-growing ectodermal inclusions that account for less than 1% of all intracranial tumors. We retrospectively reviewed 36 such cases to evaluate the demographic characteristics, clinical manifestations, anatomical distribution, surgical management, and treatment outcome of these tumors. Additionally, we sought to identify the relationship between median or paramedian cistern tumor localization and clinical parameters, such as recurrence risk, hospitalization duration, and postoperative complication rates. The most frequently observed neurological symptoms were transient headaches (77.8%), dizziness (36.1%), CN VII palsy (19.4%), CN VIII hearing difficulty (19.4%) and cerebellar signs (19.4%). The most common surgical approaches included retrosigmoid (36.1%), subfrontal (19.4%) and telovelar (19.4%) approaches; gross total resection was feasible in 83.3% of cases. The postoperative complication rate was 38.9%. Tumors were more frequently found in the paramedian cisterns (47.2%), followed by the median line cisterns (41.6%). Multivariate analysis revealed that postoperative hydrocephalus and age < 40 years were prognostic factors for tumor recurrence. Median-like tumor location was a risk factor for the presence of symptomatic hydrocephalus both preoperatively and postoperatively, increasing the likelihood of protracted hospitalization (> 10 days). Despite their benign histopathological nature, these tumors have an important clinical resonance, with a high rate of postoperative complications and a degree of recurrence amplified by younger age and hydrocephalus.
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Affiliation(s)
- Maria Mihaela Pop
- Department of Neurosurgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Clinic of Neurosurgery, Cluj County Emergency Clinical Hospital, Cluj Napoca, Romania
| | - Dragos Bouros
- Department of Neurosurgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
| | - Artsiom Klimko
- Laboratory of Molecular Neuro-Oncology, Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Ioan Alexandru Florian
- Department of Neurosurgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Clinic of Neurosurgery, Cluj County Emergency Clinical Hospital, Cluj Napoca, Romania
| | - Ioan Stefan Florian
- Department of Neurosurgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Clinic of Neurosurgery, Cluj County Emergency Clinical Hospital, Cluj Napoca, Romania
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Brindisino F, Lorusso M, De Carlo L, Mourad F, Marruganti S, Passudetti V, Salomon M. Intracranial Epidermoid Cyst Mimics Musculoskeletal Shoulder Disease: Findings from a Case Report in Physiotherapy Clinical Practice. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13590. [PMID: 36294171 PMCID: PMC9603296 DOI: 10.3390/ijerph192013590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/15/2022] [Accepted: 10/17/2022] [Indexed: 06/16/2023]
Abstract
Shoulder pain is often attributable to a musculoskeletal disorder, but in some instances, it may be linked to pathologies outside the physiotherapist's area of expertise. Specifically, some intracranial problems can cause pain and disability to the shoulder complex. This case report aims to describe the clinical presentation, history taking, physical examination, and clinical decision-making procedures in a patient with an intracranial epidermoid cyst mimicking a musculoskeletal disorder of the shoulder girdle. A 42-year-old man complained of pain and disability in his left shoulder. Sudden, sharp pain was reported during overhead movements, associated with intermittent tingling of the left upper trapezius and left scapular area. Moreover, the patient reported reduced hearing in his left ear and left facial dysesthesia. The physical examination led the physiotherapist to hypothesize a pathology outside the physiotherapist's scope of practice and to refer the patient to another health professional to further investigate the patient through imaging. It is essential for the physiotherapist to recognize when the patient's clinical condition requires a referral to another healthcare professional. Therefore, the physiotherapist must be able to, in a timely manner, identify signs and symptoms suggesting the presence of medical pathology beyond his expertise, through appropriate medical history collection and physical evaluation.
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Affiliation(s)
- Fabrizio Brindisino
- Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise C/da Tappino c/o Cardarelli Hospital, 86100 Campobasso, Italy
- Department of Clinical Sciences and Translational Medicine, University of Roma “Tor Vergata” c/o Medicine and Surgery School, 00133 Rome, Italy
| | - Mariangela Lorusso
- Department of Clinical Sciences and Translational Medicine, University of Roma “Tor Vergata” c/o Medicine and Surgery School, 00133 Rome, Italy
| | | | - Firas Mourad
- Department of Physiotherapy, LUNEX International University of Health, Exercise and Sports, 4671 Luxembourg, Luxembourg
- Luxembourg Health & Sport Sciences Research Institute A.s.b.l., 50, Avenue du Parc des Sports, 4671 Luxembourg, Luxembourg
| | - Sharon Marruganti
- Department of Clinical Sciences and Translational Medicine, University of Roma “Tor Vergata” c/o Medicine and Surgery School, 00133 Rome, Italy
| | - Valerio Passudetti
- Department of Clinical Sciences and Translational Medicine, University of Roma “Tor Vergata” c/o Medicine and Surgery School, 00133 Rome, Italy
| | - Mattia Salomon
- Department of Clinical Sciences and Translational Medicine, University of Roma “Tor Vergata” c/o Medicine and Surgery School, 00133 Rome, Italy
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3
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Garov EV, Kryukov AI, Zelenkova VN, Zelenkov AV. [Case of diagnosis and surgical treatment of intracranial cholesteatoma]. Vestn Otorinolaringol 2022; 87:89-94. [PMID: 36107187 DOI: 10.17116/otorino20228704189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The article provides a brief overview of the epidemiology of congenital and acquired intracranial cholesteatoma, the theory of its pathogenesis, classification, and clinical features. The most common localization of congenital and acquired intracranial cholesteatoma is described and various surgical approaches are presented that allow total removal of the formation. A clinical case of diagnosis and surgical treatment of acquired intracranial cholesteatoma caused by chronic suppurative otitis media is presented. A clinical example indicates the possibility of a long asymptomatic course of acquired intracranial cholesteatoma. The use of a combined (extradural subtemporal and transmastoid) surgical approach made it possible to completely remove the acquired cholesteatoma of the temporal lobe of the brain in a patient with chronic suppurative otitis media.
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Affiliation(s)
- E V Garov
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - A I Kryukov
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - V N Zelenkova
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - A V Zelenkov
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
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Chuang EG, Malicki D, Levy M, Crawford JR. Atypical presentation of large intracranial epidermoid tumour in a child. BMJ Case Rep 2021; 14:14/8/e244311. [PMID: 34344657 PMCID: PMC8336149 DOI: 10.1136/bcr-2021-244311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
| | - Denise Malicki
- Pathology, Rady Children's Hospital University of California San Diego, San Diego, California, USA
| | - Michael Levy
- Neurosurgery, University of California San Diego, San Diego, California, USA
| | - John Ross Crawford
- Neurosciences and Pediatrics, University of California San Diego, San Diego, California, USA
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5
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Kumar A, Maurya VP, Kanjilal S, Bhaisora KS, Sardhara J, Das KK, Mehrotra A, Srivastava AK, Jaiswal AK, Behari S. Clinicoradiological Features and Treatment Outcome of Supratentorial Intraparenchymal Epidermoid Cyst: A Report of Five Cases and Literature Review. J Neurosci Rural Pract 2021; 12:571-580. [PMID: 34295114 PMCID: PMC8289516 DOI: 10.1055/s-0041-1730125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objectives
Intraparenchymal epidermoid cysts (IECs) are rare lesions. They represent less than 1% of the intracranial epidermoid cysts. The supratentorial IEC is a clinically and prognostically distinct subset. Given the rarity, most of the articles are case reports. We present a series of five cases of supratentorial IEC to characterize their clinical presentation and outcome, with emphasis on the surgical features.
Materials and Methods
We searched our database for all cases of intracranial epidermoid cysts operated between January 2005 and January 2020. Five patients were identified having IEC from the hospital information system and the neurosurgical operation record book. Standard craniotomy and decompression of the lesion were performed in all these patients. Standard postoperative care includes computed tomography scan of head on the day of surgery and magnetic resonance imaging of brain after 6 weeks to look for the residual lesion, if any. Subsequent follow-up visits in outpatient department to look for resolution of the presurgical symptoms.
Results
The mean age of the patients in our series was 28.8 years (range: 28–40 years.). All the five patients were male. Four patients had IEC involving frontal lobe and one in parietal lobe with a small occipital lobe extension. Seizure was the most common presenting complaint followed by headache. Complete excision was achieved in all the cases. All the three patients with seizure attained seizure freedom postlesionectomy. Focal neurological deficits resolved gradually in postoperative period. There was no recurrence of lesion during follow-up.
Conclusion
Supratentorial IEC most commonly affects young males, involve frontal lobe and present clinically with seizure. Complete surgical excision offers best outcome in the form of remission of seizure disorder.
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Affiliation(s)
- Ashutosh Kumar
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ved Prakash Maurya
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Soumen Kanjilal
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kamlesh Singh Bhaisora
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Jayesh Sardhara
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kuntal Kanti Das
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anant Mehrotra
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Arun Kumar Srivastava
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Awadhesh Kumar Jaiswal
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjay Behari
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Intraparenchymal Epidermoid Cyst Close to Broca Area-Awake Craniotomy and Gross Total Resection. World Neurosurg 2020; 141:367-372. [PMID: 32593769 DOI: 10.1016/j.wneu.2020.06.135] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Epidermoid tumors, or epidermoid cysts (ECs), are benign, slow-growing, congenital, and rare lesions that represent approximately 0.2%-1.8% of all intracranial tumors. Intraparenchymal ECs are very rare lesions that may account for 1.5% of all intracranial epidermoid tumors; frontal lobe involvement is found in 39.2% of intraparenchymal ECs. We present a case using awake craniotomy to achieve maximal safe gross total resection of a rare intraparenchymal EC close to Broca area in a bilingual patient. CASE DESCRIPTION A 45-year-old man presented with a generalized seizure episode. He was initially treated with levetiracetam, which led to renal failure. Imaging findings demonstrated an intraparenchymal left frontal EC with peripheral coarse calcifications at Broca area. As the patient was bilingual and had a normal neurologic examination, we performed a left frontal awake craniotomy under local anesthesia so as to map both languages, using the motor task and a test for language monitoring, alternating a naming task in Portuguese and English and a semantic task in Portuguese. A gross total resection was achieved with no neurologic deficits. Histopathologic examination confirmed the diagnosis of an epidermoid cyst. After 1 year, the patient is still seizure-free. CONCLUSIONS Awake surgery proved to be a useful tool for complete resection of the capsule even in a very eloquent language area. In multilingual patients with benign intra-axial lesions, intraoperative mapping should be performed for all the languages in which the patient is fluent to avoid postoperative neurologic deficits.
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Manjila S, Asmar NE, Vidalis BM, Alonso F, Singh G, Vadamalai K, Cohen ML, Bambakidis NC, Arafah BM, Selman WR. Intratumoral Rathke's Cleft Cyst Remnants Within Craniopharyngioma, Pituitary Adenoma, Suprasellar Dermoid, and Epidermoid Cysts: A Ubiquitous Signature of Ectodermal Lineage or a Transitional Entity? Neurosurgery 2020; 85:180-188. [PMID: 30010935 DOI: 10.1093/neuros/nyy285] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 06/03/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The authors present cystic epithelial masses in the suprasellar region which on histopathology revealed 4 mixed tumors having simple cuboidal epithelium of Rathke's Cleft Cyst (RCC) elements trapped within pituitary adenoma, epidermoid cyst, dermoid cyst, and papillary craniopharyngioma respectively. OBJECTIVE To highlight the developmental theory of ectodermal continuum in the realm of suprasellar epithelial cystic lesions and examines the cardinal aspects that distinguish RCC from its confounder, ciliary craniopharyngioma. METHODS The authors performed a medical chart review on 4 patients who had coexisting RCC with craniopharyngioma, pituitary adenoma, suprasellar dermoid, and epidermoid cysts. RESULTS This series of unique suprasellar lesions elucidate the spectrum of cases from Rathke's cyst to other suprasellar epithelial cysts including a recently identified clinical entity called ciliary craniopharyngioma, which authors feel is a misnomer. The authors also report the first case of ruptured dermoid cyst admixed with elements of Rathke's cyst elements and xanthogranuloma in neurosurgical literature. CONCLUSION We propose that the new entity of ciliary craniopharyngioma could be just another variant of RCC elements nested within a typical papillary or adamantinomatous lesion. Further study is warranted to understand the implications of natural history with tumors containing RCC elements.
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Affiliation(s)
- Sunil Manjila
- Department of Neurological Surgery, The Neurological Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Nadine El Asmar
- Department of En-docrinology, University Hospitals Cleve-land Medical Center, Cleveland, Ohio
| | - Benjamin M Vidalis
- Department of Neurological Surgery, University of New Mexico Hospitals, Albuquerque, New Mexico
| | - Fernando Alonso
- Department of Neurological Surgery, The Neurological Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Gagandeep Singh
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Karthik Vadamalai
- Department of Neurological Surgery, The Neurological Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Mark L Cohen
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Nicholas C Bambakidis
- Department of Neurological Surgery, The Neurological Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Baha M Arafah
- Department of En-docrinology, University Hospitals Cleve-land Medical Center, Cleveland, Ohio
| | - Warren R Selman
- Department of Neurological Surgery, The Neurological Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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Sutiono AB, Sidabutar R, Pareira ES, Toda M, Yoshida K. Characteristics intracranial epidermoid cyst between two hospital from developed vs developing institution and literature review. INTERDISCIPLINARY NEUROSURGERY-ADVANCED TECHNIQUES AND CASE MANAGEMENT 2019. [DOI: 10.1016/j.inat.2019.100500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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9
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Akahoshi M, Yanaka K, Watanabe D, Nakamura K, Zaboronok A, Ishikawa E, Matsumura A. Atypical chronological changes on neuroimaging in the epidermoid in the frontal lobe with intracystic hemorrhage and tumor growth: Case report. Radiol Case Rep 2018; 13:1133-1136. [PMID: 30233744 PMCID: PMC6138860 DOI: 10.1016/j.radcr.2018.07.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 07/09/2018] [Accepted: 07/16/2018] [Indexed: 11/15/2022] Open
Abstract
Intracranial epidermoids are rare lesions accounting for 0.2%-1.8% of all intracranial tumors. They commonly develop in the cerebellopontine angle and the parasellar region and can appear with atypical neuroimaging features due to intracystic hemorrhages which complicate diagnosis. The authors present a case of a 62-year-old woman with a frontal epidermoid cyst with a hemorrhage and tumor growth. A series of atypical radiological findings showed gradual changes in the lesion appearance that were confirmed with surgery and histopathology. To avoid surgical complications such as chemical meningitis, it is important to remember that epidermoid cysts occasionally bleed, leading to atypical MRI and/or CT findings and diagnostic difficulties. Development of epidermoid cysts in atypical locations in the brain may result in challenges to accurate diagnosis.
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Affiliation(s)
- Minami Akahoshi
- Department of Neurosurgery, Tsukuba Memorial Hospital, 1187-299 Kaname, Tsukuba, Ibaraki, 300-2622 Japan
| | - Kiyoyuki Yanaka
- Department of Neurosurgery, Tsukuba Memorial Hospital, 1187-299 Kaname, Tsukuba, Ibaraki, 300-2622 Japan
| | - Daisuke Watanabe
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tenodai, Tsukuba, Ibaraki, 305-8575 Japan
| | - Kazuhiro Nakamura
- Department of Neurosurgery, Tsukuba Memorial Hospital, 1187-299 Kaname, Tsukuba, Ibaraki, 300-2622 Japan
| | - Alexander Zaboronok
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tenodai, Tsukuba, Ibaraki, 305-8575 Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tenodai, Tsukuba, Ibaraki, 305-8575 Japan
- Corresponding author.
| | - Akira Matsumura
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tenodai, Tsukuba, Ibaraki, 305-8575 Japan
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Abstract
In this paper, we will present a case of a 63-year-old female with bifrontal epidermoid tumor who has gone under bilateral craniotomy. In a case report study, a 63-year-old female with a chief complaint of progressive headache that has been admitted to Department of Neurosurgery was studied. Magnetic resonance imaging was performed for better evaluation. After detection of bifrontal epidermoid cyst, the patient underwent surgery, and following the surgery, a cut of the tumor has been excised, sent for pathology sampling and reviewed for detection of cyst. Microscopic review of the resected part reported normal brain tissue along with sections containing parts of cyst wall covered by squamous epithelium and huge amount of irregularly stratified keratin within its lumen, which clearly emphasizes on diagnosis of a typical epidermoid tumor. Bifrontal epidermoid cyst is rare, and according to our study, the clinical symptoms and patients imaging were consistent with other studies.
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Affiliation(s)
- Bahram Aminmansour
- Department of Neurosurgery, Isfahan University of Medical Sciences, Alzahra Hospital, Isfahan, Iran
| | - Majid Rezvani
- Department of Neurosurgery, Isfahan University of Medical Sciences, Alzahra Hospital, Isfahan, Iran
| | - Parvin Mahzouni
- Department of Pathology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amir Mahabadi
- Department of Neurosurgery, Isfahan University of Medical Sciences, Alzahra Hospital, Isfahan, Iran
| | - Ehsan Mohammad Hosseini
- Department of Neurosurgery, Isfahan University of Medical Sciences, Alzahra Hospital, Isfahan, Iran
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Abstract
Intraparenchymal epidermoid cysts (IECs) are rare lesions, thus the preoperative diagnosis and proper surgical management are still a challenge. We searched the database at our institution and performed a search of English literature in PubMed and Google Scholar. Keywords used were as follows: "intraparenchymal"; "intracerebral"; "intraaxial"; "epidermoid cyst"; "brainstem"; "cholesteatoma"; "pearly tumor". Only cases that were true intraparenchymally located and contained adequate clinical information were included. Six cases of IECs were recorded at our institution. Total removal was achieved in all the six patients with good outcomes. 29 cases meeting the above criteria were found in the literature. Including ours, a total of 35 patients were analyzed. Females were more frequently affected (F/M ratio, 1.9:1). Most of them were located in the brainstem (42.9%) and temporal lobe (22.9%). While in children, all were located in the brainstem. 45.2% showed subtle peripheral enhancement on Magnetic Resonance Imaging (MRI), and all appeared hyperintense on Diffusion Weighted Imaging (DWI). In the subgroup of cerebral lobes and cerebellums, total resection was achieved in 89.5%, and they all showed good outcomes. While in the subgroup of brainstem, 46.7% (seven cases) underwent total resection and 50% (three cases) of them died postoperatively. MRI with DWI is helpful in the preoperative diagnosis. Total resection should be achieved for the IECs located in cerebral lobes and cerebellums, while subtotal resection is a wise and safe strategy for the IECs located in the brainstem.
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Kar SK, Das KK, Jaiswal AK, Jaiswal S. Mood Disorder as an Early Presentation of Epidermoid of Quadrigeminal Cistern. J Neurosci Rural Pract 2017; 8:443-445. [PMID: 28694630 PMCID: PMC5488571 DOI: 10.4103/jnrp.jnrp_507_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Intracranial epidermoids are space-occupying lesions of rare variant. Although cerebropontine angle and parasellar region are common sites of occurrence, it has been reported in various other parts of the intracranial cavity. Headache and features of increased intracranial tension are the common clinical manifestation. Report of psychiatric symptoms as the initial presentation of epidermoid is not known in literature except a single case report, which describes mutism to be the manifestation of intracranial epidermoid. We present here the case of a young male, who presented with long depressive episode persisting for 3 years with subsequent switch to mania, which persisted for more than 3 years. An episode of unconsciousness warranted neuroimaging, which revealed a large epidermoid of the quadrigeminal cistern. Surgical resection of the epidermoid was done. Persisting mood symptoms had responded to mood stabilizer and antipsychotic treatment.
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Affiliation(s)
- Sujita Kumar Kar
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Kuntal Kanti Das
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Awadhesh Kumar Jaiswal
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sushila Jaiswal
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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13
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Nakassa ACI, Chabot JD, Snyderman CH, Wang EW, Gardner PA, Fernandez-Miranda JC. Complete endoscopic resection of a pituitary stalk epidermoid cyst using a combined infrasellar interpituitary and suprasellar endonasal approach: case report. J Neurosurg 2017; 128:437-443. [PMID: 28409722 DOI: 10.3171/2016.11.jns161605] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Intracranial epidermoid cysts are benign lesions of epithelial origin that most frequently present with symptoms of mass effect. Although they are often associated with a high rate of residual tumor and recurrence, maximal safe resection usually leads to good outcomes. The authors report a complete resection of an uncommon pituitary stalk epidermoid cyst with intrasellar extension using a combined suprasellar and infrasellar interpituitary, endoscopic endonasal transsphenoidal approach. The patient, a 54-year-old woman, presented with headache, visual disturbance, and diabetes insipidus. Postoperatively, she reported improvement in her visual symptoms and well-controlled diabetes insipidus using 0.1 mg of desmopressin at bedtime and normal anterior pituitary gland function. One year later, she continues to receive the same dosage of desmopressin and is also taking 50 mcg of levothyroxine daily after developing primary hypothyroidism unrelated to the surgical procedure. A combined infrasellar interpituitary and suprasellar approach to this rare location for an epidermoid cyst can lead to a safe and complete resection with good clinical outcomes.
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Affiliation(s)
- Ana C I Nakassa
- 1Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and
| | - Joseph D Chabot
- 2Department of Neurosciences, St. Cloud Hospital, St. Cloud, Minnesota
| | - Carl H Snyderman
- 1Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and
| | - Eric W Wang
- 1Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and
| | - Paul A Gardner
- 1Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and
| | - Juan C Fernandez-Miranda
- 1Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and
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Muçaj S, Ugurel MS, Dedushi K, Ramadani N, Jerliu N. Role of MRI in Diagnosis of Ruptured Intracranial Dermoid Cyst. Acta Inform Med 2017; 25:141-144. [PMID: 28883682 PMCID: PMC5544451 DOI: 10.5455/aim.2017.25.141-144] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Introduction: Intracranial dermoid cystic tumors account for <1% of all intracranial masses. Case report: A 52-year-old male, having headaches, nausea and is presented with a history of 2 episodes of new onset seizures. On presentation, the patient had a normal physical exam, including a complete neurological and cranial nerve exam. Methods: Precontrast MRI; TSE/T2Wsequence in axial/coronal planes; 3D – HI-resolution T1W sagittal; FLAIR/T2W axial; FLAIR/T2W, Flash/T2W oblique coronal plane, GRE/T2W axial. Post-contrast TSE/T1W sequence in axial, coronal and sagittal planes. Diffusion weighted and ADC mapping, postcontrast: TSE/T1W sequence in axial, coronal and sagittal planes. Results: Subsequent MRI of the brain revealed an oval and lobulated 47x34x30mm (TRxAPxCC) non-enhancing T1-hyperintense mass in right cavernous sinus, with compression of surrounding mesial temporal lobe and right anterolateral aspect of mesencephalon. Findings are consistent with ruptured dermoid cyst, given the evacuated sebum content at its lower half. Sebum particles in millimetric sizes are seen within right Sylvian fissure, anterior horns of lateral ventricles and to a lesser extent within left Sylvian fissure, right parietal sulci, cerebral aqueduct, and basal cisterns. No restricted diffusion is seen, eliminating the possibility of epidermoid. A shunt catheter is evident traversing between right lateral ventricle and right parietal bone; besides, slit-like right lateral ventricle is noted (likely secondary to over-draining shunt catheter). Conclusion: Intracranial dermoid cysts are benign rare slow-growing tumors that upon rupture, however, widespread presence of T1 hyperintense droplets and leptomeningeal enhancement can be noted–making MRI the best imaging modality for diagnosis of this rare entity.
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Affiliation(s)
- Sefedin Muçaj
- Faculty of Medicine, Pristine University, Pristine, Kosovo.,National Institute of Public Health of Kosovo, Pristine, Kosovo
| | | | - Kreshnike Dedushi
- Faculty of Medicine, Pristine University, Pristine, Kosovo.,Department of Radiology, Diagnostic Centre, UCCK, Pristine, Kosovo
| | - Naser Ramadani
- Faculty of Medicine, Pristine University, Pristine, Kosovo.,National Institute of Public Health of Kosovo, Pristine, Kosovo
| | - Naim Jerliu
- Faculty of Medicine, Pristine University, Pristine, Kosovo.,National Institute of Public Health of Kosovo, Pristine, Kosovo
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15
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The sellar and suprasellar region: A “hideaway” of rare lesions. Clinical aspects, imaging findings, surgical outcome and comparative analysis. Clin Neurol Neurosurg 2016; 149:154-65. [DOI: 10.1016/j.clineuro.2016.08.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 08/09/2016] [Accepted: 08/11/2016] [Indexed: 11/22/2022]
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16
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Kankane VK, Jaiswal G, Gupta TK. Epidermoid cyst in Anterior, Middle & Extension of Posterior cranial fossa: rare Imaging with review of literature. ROMANIAN NEUROSURGERY 2016. [DOI: 10.1515/romneu-2016-0071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Epidermoid cysts are benign slow growing more often extra-axial tumors that insinuate between brain structures, we present the clinical, imaging, and pathological findings in 35 years old female patients with atypical epidermoid cysts which was situated anterior, middle & posterior cranial fossa. NCCT head revealed hypodense lesion over right temporal and perisylvian region with extension in prepontine cistern with mass effect & midline shift and MRI findings revealed a non-enhancing heterogeneous signal intensity cystic lesion in right frontal & temporal region extending into prepontine cistern with restricted diffusion. Patient was detoriated in night of same day of admission, emergency Fronto-temporal craniotomy with anterior peterousectomy and subtotal resection was done. The histological examination confirms the epidermoid cyst. The timing of ectodermal tissue sequestration during fetal development may account for the occurrence of atypical epidermoid cysts.
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17
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Moreira-Holguin JC, Medélez-Borbonio R, Quintero-Lopez E, García-González U, Gómez-Amador JL. Intradiploic epidermoid cyst with intracranial hypertension syndrome: Report of two cases and literature review. Int J Surg Case Rep 2015; 16:81-6. [PMID: 26433925 PMCID: PMC4643448 DOI: 10.1016/j.ijscr.2015.09.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 09/17/2015] [Accepted: 09/17/2015] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Intradiploic epidermoid intracranial cysts (IEIC) derive from ectodermal cells and are covered with stratified squamous epithelium. They are extremely rare, and most common locations are in the occipital, frontal and parietal bones. They have a very slow growth and can be asymptomatic until becoming evident by the deformation produced. The treatment is based on the removal of the lesion, and subsequent histopathological confirmation. PRESENTATION OF CASE Two cases are reported, with intracranial hypertension syndrome, which is very uncommon because of the slow growth of this type of pathology; however, decompensations occurring in the space-occupying lesions at intracranial level explain this type of clinical presentation. DISCUSSION The most common presentation of intracranial intradiploic epidermoid cysts (IEIC) is asymptomatically, which is made evident by the prominence at the level of the soft tissues and then presenting less frequently local pain and cephalea; rarely the size of the lesion can cause focal neurological signs. CONCLUSION These benign lesions, although they are of low incidence, are seen very rarely in intradiploic locations and above all, of significant size, may produce significant mass effect in patients, which was initially tolerated because of its slow growth, however, they may become decompensate and cause intracranial hypertension syndrome.
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Affiliation(s)
- J C Moreira-Holguin
- Neurosurgery Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico City, Mexico.
| | - R Medélez-Borbonio
- Neurosurgery Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico City, Mexico
| | - E Quintero-Lopez
- Neurosurgery Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico City, Mexico
| | - U García-González
- Neurosurgery Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico City, Mexico
| | - J L Gómez-Amador
- Neurosurgery Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico City, Mexico
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18
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Tong F, Jewells V, Trembath DG, Hadar E, Shin HW. Triple pathological findings in a surgically amenable patient with mesial temporal lobe epilepsy. EPILEPSY & BEHAVIOR CASE REPORTS 2015; 4:52-5. [PMID: 26288757 PMCID: PMC4536300 DOI: 10.1016/j.ebcr.2015.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 06/19/2015] [Accepted: 06/20/2015] [Indexed: 11/18/2022]
Abstract
Mesial temporal sclerosis (MTS) is a well-recognized cause of intractable epilepsy; however, coexistence with focal cortical dysplasia (FCD) is less common. Middle fossa epidermoid cysts are rare and may involve the temporal lobe. Most epidermoids are clinically silent, slow-growing, and seldom associated with overt symptomatology, including seizures. We describe a patient with multiple comorbidities including left MTS and a large epidermoid cyst involving the left quadrigeminal plate cistern compressing upon the cerebellar vermis and tail of the left hippocampus, resulting in refractory left temporal lobe epilepsy. The patient underwent left anterior temporal lobectomy. The surgical pathology demonstrated a third pathological finding of left temporal FCD type Ia. The patient has been seizure-free since the surgery. This case provides additional information with regard to the understanding of epileptogenicity and surgical planning in patients with MTS and epidermoid cysts.
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Affiliation(s)
- Fumin Tong
- Department of Neurology, University of North Carolina, Chapel Hill, NC 27599, USA
- Corresponding author at: Department of Neurology, University of North Carolina, Chapel Hill, NC 27599, USA. Tel.: + 1 919 966 8162.
| | - Valerie Jewells
- Department of Radiology, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Dimitri G. Trembath
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Eldad Hadar
- Department of Neurosurgery, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Hae Won Shin
- Department of Neurology, University of North Carolina, Chapel Hill, NC 27599, USA
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19
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20
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Velamati R, Hageman JR, Bartlett A. Meningitis secondary to ruptured epidermoid cyst: case-based review. Pediatr Ann 2013; 42:248-51. [PMID: 23718247 DOI: 10.3928/00904481-20130522-12] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Rukmini Velamati
- Department of Pediatrics, Comer Children’s Hospital, Pritzker School of Medicine, University of Chicago, 60637, USA. Rukmini.velamati@ uchospitals.edu
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21
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Chung JC, Kim SM, Sade B, Kim HK, Park MS, Chung SY, Park KS. Endoscope-assisted microsurgical removal of an epidermoid tumor within the cavernous sinus. Yonsei Med J 2012; 53:1216-9. [PMID: 23074125 PMCID: PMC3481371 DOI: 10.3349/ymj.2012.53.6.1216] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Epidermoid tumor of the cavernous sinus is rare. The aim of this case report is to discuss the role of neuroendoscopes in the removal of such lesions. A 21-year-old man presented with 6-year history of progressive headache, diplopia, and visual disturbance. Work-up revealed an epidermoid tumor located in the right cavernous sinus. An extradural transcavernous approach was utilized via a traditional frontotemporal craniotomy with endoscopic assistance. The postoperative course was uneventful with immediate improvement of the patient's headache. Postoperative magnetic resonance imaging demonstrated complete removal of the tumor. There were no signs of recurrence during a 2-year follow-up period. The endoscope is a useful tool for removing epidermoid tumors from the cavernous sinus and enhances visualization of areas that would otherwise be difficult to visualize with microscopes alone. Endoscopes also help minimize the retraction of neurovascular structures.
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Affiliation(s)
- Jong Chul Chung
- Department of Neurosurgery, Eulji University Hospital, Daejeon, Korea
| | - Seong Min Kim
- Department of Neurosurgery, Eulji University Hospital, Daejeon, Korea
| | - Burak Sade
- Brain Tumor and Neuro-oncology Center, Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, USA
| | - Han Kyu Kim
- Department of Neurosurgery, Eulji University Hospital, Daejeon, Korea
| | - Moon Sun Park
- Department of Neurosurgery, Eulji University Hospital, Daejeon, Korea
| | - Seung Young Chung
- Department of Neurosurgery, Eulji University Hospital, Daejeon, Korea
| | - Ki Suk Park
- Department of Neurosurgery, Eulji University Hospital, Daejeon, Korea
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22
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Hanft SJ, Komotar RJ, Raper DMS, Sisti MB, McKhann GM. Epidermoid tumors of the temporal lobe as epileptogenic foci. J Clin Neurosci 2011; 18:1396-9. [PMID: 21802304 DOI: 10.1016/j.jocn.2011.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Accepted: 03/14/2011] [Indexed: 10/17/2022]
Abstract
Intracerebral epidermoid tumors of the temporal lobe are exceedingly rare. The vast majority of these slow-growing tumors remain clinically silent while only a select few are associated with overt symptomatology. We report two patients with epidermoid tumors whose unique location in the temporal lobe resulted in secondarily generalized seizures. Our first patient, a 19-year-old female, presented with a secondarily generalized tonic-clonic seizure and MRI revealed a superior temporal lobe lesion that was subsequently treated with an awake craniotomy and gross total resection. Our second patient was a 71-year-old male with a recent seizure history and known left temporal lobe lesion. The patient underwent craniotomy for gross total resection of the mass. In these two patients, we found that MRI proved diagnostic and surgical resection was curative. Our clinical experience and review of the literature indicate that gross total resection of these lesions confers control of localization-related epilepsy.
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Affiliation(s)
- Simon J Hanft
- Department of Neurological Surgery, Columbia University, New York, NY, USA
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23
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Sharifi G, Alavi E, Samadian M, Faramarzi F, Haddadian K. Mesial temporal lobe epidermoid tumour compressing the hippocampal formation caused refractory temporal lobe epilepsy. Br J Neurosurg 2011; 24:692-4. [PMID: 21070153 DOI: 10.3109/02688697.2010.499152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The authors report an unusual case of intradural epidermoid tumour in a 19-year-old girl presenting with refractory complex partial seizures including auditory hallucinations, and memory dysfunction. A complete resection was carried out sparing the hippocampus resulting in seizure freedom.
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Affiliation(s)
- Guive Sharifi
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
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24
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Abstract
Epidermoid cyst of the quadrigeminal cistern is uncommon, and its presentation as mutism as the main clinical finding with no other neurological finding is very rare. We report a case where the epidermoid cyst presented with progressive symptoms of absolute mutism, which improved significantly following surgery. The possible causes and pathophysiological mechanism of mutism in the lesions of this region are discussed in this paper.
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Affiliation(s)
- Priyanka Kawal
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow - 226 014, India
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25
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Kucera JN, Roy P, Murtagh R. Ruptured intracranial dermoid cyst manifesting as new onset seizure: a case report. J Radiol Case Rep 2011; 5:10-8. [PMID: 22470786 PMCID: PMC3303440 DOI: 10.3941/jrcr.v5i4.592] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Intracranial dermoid cysts are rare tumors derived from ectopic epithelial cells. They are slow-growing benign entities, but can cause significant morbidity through compression of neurovascular structures and, rarely, rupture into the subarachnoid space. We present a rare case of a spontaneously ruptured intracranial dermoid cyst presenting as new onset seizures due to chemical meningitis caused by dissemination of fat droplets.
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Affiliation(s)
| | - Pinakpani Roy
- University of South Florida College of Medicine, Tampa, FL, USA
| | - Ryan Murtagh
- Department of Radiology, Moffitt Cancer Center, Tampa, FL, USA
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26
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Zada G, Lin N, Ojerholm E, Ramkissoon S, Laws ER. Craniopharyngioma and other cystic epithelial lesions of the sellar region: a review of clinical, imaging, and histopathological relationships. Neurosurg Focus 2010; 28:E4. [PMID: 20367361 DOI: 10.3171/2010.2.focus09318] [Citation(s) in RCA: 154] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Cystic epithelial masses of the sellar and parasellar region may be difficult to differentiate on a clinical, imaging, or even histopathological basis. The authors review the developmental relationships and differentiating features of various epithelial lesions of the sellar region.
Methods
The authors performed a review of the literature to identify previous studies describing the etiological relationships and differentiating features of various cystic sellar lesions, including craniopharyngioma (CP), Rathke cleft cyst, xanthogranuloma, and dermoid and epidermoid cysts.
Results
There is significant evidence in the literature to support a common ectodermal origin of selected sellar and suprasellar cystic lesions, which may account for the overlap of features and transitional states observed in some cases. Research obtained from animal studies and reports of transitional cystic epithelial masses or lesions crossing over from typical to more aggressive pathological subtypes have collectively provided a solid foundation for this theory. Histological features that signify transitional entities beyond simple benign Rathke cleft cysts include squamous metaplasia, stratified squamous epithelium, and ciliated or mucinous goblet cells in squamous-papillary CPs. Several studies have identified key clinical, imaging, and histopathological features that can be used in the differentiation of these lesions.
Conclusions
The pattern of embryological formation of the hypothalamic-pituitary axis plays a major role in its propensity for developing cystic epithelial lesions. Subsequent inflammatory, metaplastic, and neoplastic processes may promote further progression along the pathological continuum, ranging from benign epithelial cysts to aggressive neoplastic cystic CPs. Selected clinical, imaging, and histopathological features can be used collectively to help differentiate these lesions and assign a formal diagnosis, thus accurately guiding further treatment.
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Affiliation(s)
| | - Ning Lin
- 1Departments of Neurosurgery and
| | | | - Shakti Ramkissoon
- 2Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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27
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Ahmed I, Auguste KI, Vachhrajani S, Dirks PB, Drake JM, Rutka JT. Neurosurgical management of intracranial epidermoid tumors in children. Clinical article. J Neurosurg Pediatr 2009; 4:91-6. [PMID: 19645539 DOI: 10.3171/2009.4.peds08489] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Epidermoid tumors are benign lesions representing 1% of all intracranial tumors. There have been few pediatric series of intracranial epidermoid tumors reported previously. The authors present their experience in the management of these lesions. METHODS The neurosurgical database at the Hospital for Sick Children was searched for children with surgically managed intracranial epidermoid tumors. The patients' charts were reviewed for demographic data, details of clinical presentation, surgical therapy, and follow-up. Ethics board approval was obtained for this study. RESULTS Seven children, all girls, were identified who met the inclusion criteria between 1980 and 2007. The average age at surgery was 11.2 years (range 8-15 years), and the mean maximal tumor diameter was 2.1 cm. Headache was the most common presenting symptom, and 1 tumor was found incidentally. Most patients had normal neurological examinations, but meningism was found in 2 cases. There were 3 cerebellopontine angle lesions, 1 pontomedullary lesion, and 3 supratentorial tumors. Hydrocephalus developed in 1 patient after aseptic meningitis, and she underwent shunt placement. There were no operative deaths. Complete resection could be performed in 2 patients. One patient experienced a small recurrence that did not require a repeated operation, while 1 subtotally resected lesion recurred and the patient underwent a second operation. CONCLUSIONS Intracranial epidermoid tumors are rare in the pediatric population. Total resection is desirable to minimize the risk of postoperative aseptic meningitis, hydrocephalus, and tumor recurrence. Aggressive neurosurgical resection may be associated with cranial nerve or ischemic deficits, however. In these cases, neurosurgical judgment at the time of surgery is warranted to ensure maximum resection while minimizing postoperative neurological deficits.
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Affiliation(s)
- Ibrahim Ahmed
- Division of Neurosurgery, The Hospital for Sick Children, The University of Toronto, Ontario, Canada
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28
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Fox BD, Smitherman SM, Amhaz H, Ruiz MI, Rouah E, Radaideh M, Ehni BL. A supratentorial, hemorrhagic, intraparenchymal epidermoid cyst. J Clin Neurosci 2009; 16:1101-5. [PMID: 19428259 DOI: 10.1016/j.jocn.2008.04.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Accepted: 04/22/2008] [Indexed: 10/20/2022]
Abstract
Epidermoid cysts are slow growing benign tumors that represent < 1-2% of all intracranial tumors and rarely present as supratentorial, intraparenchymal masses. We present the first report of a supratentorial, hemorrhagic, intraparenchymal epidermoid cyst with its presentation, our operative approach, post-operative course, radiographic features, and a literature review.
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Affiliation(s)
- Benjamin D Fox
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas 77030, USA
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29
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Mejdoubi M, Lagarde S, Ponsot A, Gigaud M. [Intracranial epidermoid cyst secondary to mucocele surgery]. JOURNAL DE RADIOLOGIE 2009; 90:233-5. [PMID: 19308010 DOI: 10.1016/s0221-0363(09)72476-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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30
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Tanriover N, Kacira T, Ulu MO, Gazioglu N, Oz B, Uzan M. Epidermoid tumour within the collateral sulcus: A rare location and atypical presentation. J Clin Neurosci 2008; 15:950-4. [DOI: 10.1016/j.jocn.2006.06.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2006] [Revised: 06/10/2006] [Accepted: 06/14/2006] [Indexed: 11/26/2022]
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31
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Aribandi M, Wilson NJ. CT and MR imaging features of intracerebral epidermoid--a rare lesion. Br J Radiol 2008; 81:e97-9. [PMID: 18270293 DOI: 10.1259/bjr/42146967] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
We present a rare case of intracerebral epidermoid cyst with partial calcification on CT and a characteristic hyperintense signal on diffusion-weighted MR imaging (DWI). MR imaging with DWI may help to accurately distinguish the lesion from other cystic tumours of the brain.
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Affiliation(s)
- M Aribandi
- Department of Radiology, Geisinger Medical Center, Danville, PA 17822, USA.
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32
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Bertal A, Hilmani S, Chrifi Alaoui S, Sami A, Achouri A, Ouboukhlik A, El Kamar A, El Azhari A. [Orbital epidermoid cyst. Case report]. Neurochirurgie 2007; 53:364-6. [PMID: 17916370 DOI: 10.1016/j.neuchi.2007.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2007] [Accepted: 05/31/2007] [Indexed: 10/28/2022]
Abstract
Epidermoid tumors represent 1% of all primary intracranial tumors. Most of them occur intradurally in cerebellopontine angle and parasellar citerns. The intra-orbital location accounts for 4 to 5% of all primary intra-orbital tumors. We report the case of a 23-year-old girl with progressive right proptosis who had developed 6 months earlier. The tumor was removed via an external orbitotomy approach. Histology confirmed the diagnosis.
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Affiliation(s)
- A Bertal
- Service de Neurochirurgie, CHU Ibn-Rochd, Casablanca, Maroc.
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33
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Seidl Z, Vaneckova M, Vitak T. Intracranial lipomas: a retrospective study. Neuroradiol J 2007; 20:30-6. [PMID: 24299585 DOI: 10.1177/197140090702000104] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2007] [Accepted: 01/14/2007] [Indexed: 01/14/2023] Open
Abstract
Between 1996 and 2006, 17 patients with intracranial lipomas underwent MR imaging examination. Of these, two patients also had CT examination. Lipoma is not a typical tumor and could instead be called intracranial lipoma hamartoma or cerebral malformation. The predominant localization of the lipomas was close to midline structures, such as the area around the corpus callosum, quadrigeminal cisterns, etc. Interpreting the MRI it is necessary to differentiate epidermoid, dermoid and hemorrhage in the metahemoglobin stage from lipoma. Clinically, 47% of patients complained of headache, two presented with epileptic seizures and the remainder had different symptoms. The lipoma was just an incidental finding not related to the clinical symptomatology.
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Affiliation(s)
- Z Seidl
- Department of Radiology, First Medical School, General Teaching Hospital, Charles University; Prague, Czech Republic - VŠZ Academy, Duškova; Prague, Czech Republic - -
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34
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Kim DR, Kang HI, Kim JH, Kim JS. Epidermoid Cyst Arising from the Corpus Callosum. J Korean Neurosurg Soc 2007. [DOI: 10.3340/jkns.2007.41.3.177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Dok Ryong Kim
- Department of Neurosurgery, Eulji University School of Medicine, Seoul, Korea
| | - Hee In Kang
- Department of Neurosurgery, Eulji University School of Medicine, Seoul, Korea
| | - Jae Hoon Kim
- Department of Neurosurgery, Eulji University School of Medicine, Seoul, Korea
| | - Joo Seung Kim
- Department of Neurosurgery, Eulji University School of Medicine, Seoul, Korea
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35
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Hayek G, Mercier P, Fournier D, Menei P, Guy G. Tumori congeniti non neuroepiteliali. Neurologia 2007. [DOI: 10.1016/s1634-7072(07)70559-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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36
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Berhouma M, Bahri K, Jemel H, Khaldi M. Intracerebral epidermoid tumor: pathogenesis of intraparenchymal location and magnetic resonance imaging findings. J Neuroradiol 2006; 33:269-70. [PMID: 17041534 DOI: 10.1016/s0150-9861(06)77275-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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37
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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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38
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Sener RN. Intraparenchymal epidermoid tumor of the brain. Eur Radiol 2004; 15:838-9. [PMID: 15503046 DOI: 10.1007/s00330-004-2396-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2004] [Accepted: 05/27/2004] [Indexed: 11/27/2022]
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39
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Schroeder HWS, Oertel J, Gaab MR. Endoscope-assisted microsurgical resection of epidermoid tumors of the cerebellopontine angle. J Neurosurg 2004; 101:227-32. [PMID: 15309912 DOI: 10.3171/jns.2004.101.2.0227] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object. Epidermoid tumors located in the cerebellopontine angle (CPA) are challenging lesions because they grow along the subarachnoid spaces around delicate neurovascular structures and often extend into the middle cranial fossa. The purpose of this study was to determine the value of endoscopic assistance in the microsurgical resection of these lesions, in which total removal is the therapy of choice.
Methods. Eight patients harboring an epidermoid tumor of the CPA were treated using an endoscope-assisted microsurgical technique. A retrosigmoid suboccipital approach was used in five patients and a pterional transsylvian approach was chosen in the other three. In four patients the lesion was resected microsurgically and the endoscope was used repeatedly to verify complete tumor removal, whereas most of the tumor mass was removed with the aid of an operating microscope in the other four. Tumor parts extending into other cranial compartments that were not visible through the microscope were removed under endoscopic view by using rigid rod-lens scopes with 30 and 70° angles of view.
All epidermoids were completely evacuated and the membranes were widely resected. Large tumors occupying both the middle and posterior cranial fossa were removed through a single small opening without enlarging the craniotomy. Permanent hearing loss and permanent hypacusis were observed in one patient each. One patient with facial and one with abducent nerve palsy recovered within 6 and 4 months, respectively. A transient weakness of the chewing muscles was encountered in one patient. Postoperative magnetic resonance imaging revealed no residual tumor in any patient. To date no recurrences have been observed (follow up range 12–98 months).
Conclusions. The endoscope-assisted microsurgical technique enables safe removal even when tumor parts are not visible in a straight line. Tumor extensions into adjacent cranial compartments can be removed with the same approach without retracting neurovascular structures or enlarging the craniotomy.
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Affiliation(s)
- Henry W S Schroeder
- Department of Neurosurgery, Ernst Moritz Arndt University, Greifswald, Germany.
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40
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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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41
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Gokce G, Kaya K, Kilicarslan H, Tas F, Ayan S, Yildiz E, Gültekin EY. Epidermoid cyst in the renal pelvis. Int Urol Nephrol 2003; 35:9-10. [PMID: 14620274 DOI: 10.1023/a:1025904213509] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Epidermoid cysts are benign cysts localizing rarely in solid organs with an unclear pathogenesis. A 55 years old woman having an epidermoid cyst in the renal pelvis was evaluated according to the literature.
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Affiliation(s)
- Gokhan Gokce
- Cumhuriyet University, School of Medicine, Department of Urology, Sivas, Turkey.
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42
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Sener RN, Dzelzite S, Migals A. Huge craniopharyngioma: diffusion MRI and contrast-enhanced FLAIR imaging. Comput Med Imaging Graph 2002; 26:199-203. [PMID: 11918984 DOI: 10.1016/s0895-6111(01)00043-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Craniopharyngiomas are most commonly located extraaxially in the suprasellar area. They are benign but aggressive neoplasms. An adult patient is reported to have a huge craniopharyngioma with gross extensions to the surroundings. In diffusion MRI, it had high signal for b=1000 mm(2)/s (true diffusion) images, and at the same time, high ADC values (=2.12 and 2.27 x 10(-3)mm(2)/s, compared to that of normal cerebellar parenchyma 0.85 x 10(-3)mm(2)/s). In FLAIR images, obtained after administration of intravenous contrast medium, an intense, diffuse enhancement pattern was seen involving the viable tumor portions as well as the intratumoral fluid.
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Affiliation(s)
- R N Sener
- Department of Radiology, Ege University Hospital, Bornova, 35100-TR Izmir, Turkey.
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43
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Tumor epidermoide intracraneal con afectación transdural. RADIOLOGIA 2002. [DOI: 10.1016/s0033-8338(02)77804-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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