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Bayatli E, Ozgural O, Eroglu U, Dogan I, Hasimoglu S, Bozkurt M, Kahilogullari G, Ugur HC, Unlu A. Posterior fossa epidermoid tumors: a single-center study and proposed classification system. Br J Neurosurg 2024; 38:1091-1099. [PMID: 35037530 DOI: 10.1080/02688697.2021.2022099] [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] [Received: 06/01/2021] [Revised: 12/15/2021] [Accepted: 12/20/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUND Epidermoid tumors of the cerebellopontine angle and posterior fossa account for approximately 1% of all intracranial tumors. Classifications that may guide surgical planning in the current neurosurgical practice are lacking. This study aimed to focus on the surgical outcome and suggest a classification system that may aid neurosurgeons in determining the goal of resection to minimize morbidity and mortality rates. METHODS The study population comprised patients who underwent surgery and follow-up for tissue-proven epidermoid tumors between 2015 and 2020. Patients' data, including demographic features, clinical symptomatology, the extent of surgical resection, and postoperative outcomes, were retrospectively evaluated. A new classification system was designed based on the anatomical-radiological findings and was evaluated in terms of clinical symptomatology, radiological features, surgical approach, and postoperative outcomes. RESULTS The patient population comprised 22 women (57.9%) and 16 men (42.1%), with a mean age of 34.9 years. A practical classification system based on the radiological-anatomical vertical (1, 2, and 3) and horizontal (a, b, and c) tumor extensions was designed. No significant differences were found in the patients in terms of sex/age. The most commonly observed symptom was gait disturbance (34.2%). The preoperative tumor diameter was significantly larger in the subtotal resection (STR) group than in the gross total resection (GTR) and near-total resection (NTR) groups. Significantly more cistern involvement was observed in the STR group than in the GTR group. The GTR, NTR, and STR rates were higher in grade 1, 3, and 2 cases, respectively. The subgroup 'a' was correlated with higher resection rates (GTR and NTR), whereas the subgroup 'b' was correlated with STR. CONCLUSIONS Our suggested classification system represents a simple and practical model that may guide neurosurgeons in predicting the goal of resection during surgical planning and in minimizing potential morbidity.
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Affiliation(s)
- Eyüp Bayatli
- Department of Neurosurgery, School of Medicine, Ankara University, Ankara, Turkey
| | - Onur Ozgural
- Department of Neurosurgery, School of Medicine, Ankara University, Ankara, Turkey
| | - Umit Eroglu
- Department of Neurosurgery, School of Medicine, Ankara University, Ankara, Turkey
| | - Ihsan Dogan
- Department of Neurosurgery, School of Medicine, Ankara University, Ankara, Turkey
| | - Siavash Hasimoglu
- Department of Neurosurgery, School of Medicine, Ankara University, Ankara, Turkey
| | - Melih Bozkurt
- Department of Neurosurgery, School of Medicine, Ankara University, Ankara, Turkey
| | - Gokmen Kahilogullari
- Department of Neurosurgery, School of Medicine, Ankara University, Ankara, Turkey
| | - Hasan Caglar Ugur
- Department of Neurosurgery, School of Medicine, Ankara University, Ankara, Turkey
| | - Agahan Unlu
- Department of Neurosurgery, School of Medicine, Ankara University, Ankara, Turkey
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Hovis GE, Chandla A, Kolker SE, Yang I, Nagasawa DT. Ossified spinal epidermoid cyst: A systematic review and case report. Heliyon 2024; 10:e37093. [PMID: 39315203 PMCID: PMC11417560 DOI: 10.1016/j.heliyon.2024.e37093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 08/15/2024] [Accepted: 08/27/2024] [Indexed: 09/25/2024] Open
Abstract
Background Epidermoid cysts (ECs) are rare, benign lesions which comprise less than 1 % of all spinal tumors. Calcification of spinal ECs is rare, and EC ossification within the lumbar spine has never been documented. We report the only known congenital lumbar epidermoid tumor with ossification and a literature review of intradural lumbar ECs. Methods Studies meeting the following criteria were included: 1) EC as the primary tumor type, 2) intradural location, 3) involvement of the lumbar spinal level, and 4) primary presentation. Studies lacking individual patient data or published in a non-English language were excluded. Results A total of 172 studies were reviewed and 43 were included in analysis. Of the 83 total patients, 37 (45.1 %) were male and 45 (54.9 %) female, at an average age of 26 years. The L3 and L4 spinal levels were most frequently involved. Acquired etiology was reported in 49 (59.0 %) patients, and 24 (28.9 %) cases were congenital. Multivariate analyses demonstrated trends between decreased age and improved outcome, decreased delay in diagnosis and improved outcome, and increased extent of resection with reduced recurrence. Nine calcified spinal ECs were identified, with no previous report of EC ossification in the lumbar spine. Conclusion We present a case report of the only known ossified epidermoid tumor of the lumbar spine and a comprehensive literature review of 83 patients with intradural lumbar ECs. This review demonstrated trends between reduced age and improved outcome, reduced delay in diagnosis and improved outcome, and increased extent of resection with reduced recurrence.
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Affiliation(s)
- Gabrielle E.A. Hovis
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, USA
| | - Anubhav Chandla
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, USA
| | - Steven E. Kolker
- Department of Pathology, Providence Saint John's Health Center, Santa Monica, CA, USA
| | - Isaac Yang
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Pathology, Providence Saint John's Health Center, Santa Monica, CA, USA
- Department of Radiation Oncology, University of California, Los Angeles, California, USA
- Department of Head and Neck Surgery, University of California, Los Angeles, California, USA
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, California, USA
- Los Angeles Biomedical Research Institute, University of California, Los Angeles, California, USA
- Harbor-UCLA Medical Center, University of California, Los Angeles, California, USA
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Gonçalves FG, Manteghinejad A, Rimba Z, Khrichenko D, Viaene AN, Vossough A. Diffusion Analysis of Intracranial Epidermoid, Head and Neck Epidermal Inclusion Cyst, and Temporal Bone Cholesteatoma. AJNR Am J Neuroradiol 2024:ajnr.A8376. [PMID: 38866433 DOI: 10.3174/ajnr.a8376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 06/04/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND AND PURPOSE Intracranial epidermoid tumors, temporal bone cholesteatomas, and head and neck epidermoid inclusion cysts are typically slow-growing, benign conditions arising from ectodermal tissue. They exhibit increased signal on DWI. While much of the imaging literature describes these lesions as showing diffusion restriction, we aimed to investigate these qualitative signal intensities and interpretations of restricted diffusion with respect to normal brain structures. This study aimed to quantitatively evaluate the ADC values and histogram features of these lesions. MATERIALS AND METHODS This retrospective study included children with histologically confirmed diagnoses of intracranial epidermoid tumors, temporal bone cholesteatomas, or head and neck epidermoid inclusion cysts. Lesions were segmented, and voxelwise calculation of ADC values was performed along with histogram analysis. ADC calculations were validated with a second analysis software to ensure accuracy. Normal brain ROIs-including the cerebellum, white matter, and thalamus-served as normal comparators. Correlational analysis and Bland-Altman plots assessed agreement among software tools for ADC calculations. Differences in the distribution of values between the lesions and normal brain tissues were assessed using the Wilcoxon rank sum and Kruskal-Wallis tests. RESULTS Forty-eight pathology-proved cases were included in this study. Among them, 13 (27.1%) patients had intracranial epidermoid tumors, 14 (29.2%) had head and neck epidermoid inclusion cysts, and 21 (43.7%) had temporal bone cholesteatomas. The mean age was 8.67 (SD, 5.30) years, and 27 (52.9%) were female. The intraclass correlation for absolute agreement for lesional ADC between the 2 software tools was 0.997 (95% CI, 0.995-0.998). The intracranial epidermoid tumor, head and neck epidermoid inclusion cyst, and temporal bone cholesteatoma median ADC values were not significantly different (973.7 versus 875.7 versus 933.2 ×10-6 mm2/s, P = .265). However, the ADCs of the 3 types of lesions were higher than those of 3 normal brain tissue types (933 versus 766, × 10-6 mm2/s, P < .0001). CONCLUSIONS The ADC values of intracranial epidermoid tumors, temporal bone cholesteatomas, and head and neck epidermoid inclusion cysts are higher than those of normal brain regions. It is not accurate to simply classify these lesions as exhibiting restricted diffusion or reduced diffusivity without considering the tissue used for comparison. The observed hyperintensity on DWI compared with the brain is likely attributable to a relatively higher contribution of the T2 shinethrough effect.
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Affiliation(s)
| | - Amirreza Manteghinejad
- Department of Radiology (A.M., Z.R., D.K., A.V.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Zekordavar Rimba
- Department of Radiology (A.M., Z.R., D.K., A.V.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Dmitry Khrichenko
- Department of Radiology (A.M., Z.R., D.K., A.V.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Angela N Viaene
- Division of Anatomic Pathology (A.N.V.), Children's Hospital of Philadelphia, Pennsylvania
| | - Arastoo Vossough
- Department of Radiology (A.M., Z.R., D.K., A.V.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine (A.V.), University of Pennsylvania, Philadelphia, Pennsylvania
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4
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Delgardo MW, Teasley DE, Tang AJ, Izima C, Peet BM, Pascual-Leone A, Reeves G, Youngerman BE, Connolly ES, McKhann GM, Bruce JN, Feldstein NA, Canoll P, Sisti MB. Optimizing Surgical Outcomes for Intracranial Epidermoid Tumors: A Retrospective Analysis of Clinical Predictors, Surgical Decisions, and Patient Clustering. World Neurosurg 2024:S1878-8750(24)01397-4. [PMID: 39147022 DOI: 10.1016/j.wneu.2024.08.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 08/03/2024] [Accepted: 08/05/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND/OBJECTIVE Intracranial epidermoid tumors (ETs) are rare, benign lesions that present significant challenges in neurosurgical management due to their propensity to encase vital neurovascular structures. We aimed to evaluate the impact of clinical, demographic, and tumor-specific factors on surgical decisions (gross total resection [GTR] vs. subtotal resection [STR]) and outcomes and identify patient clusters with distinct profiles and outcomes post-resection. METHODS We retrospectively analyzed 72 patients with ET treated from 1998 to 2022, employing multivariable logistic regression for GTR versus STR predictors and Kaplan-Meier curves for progression-free survival (PFS). K-prototype clustering classified patients based on clinical data. RESULTS The mean age of our cohort was 39.8 ± 20.1 years. About 13.9% of patients had a recurrence, with a median PFS of 108 months (interquartile range: 57 -206). Seizures significantly predicted GTR (P < 0.05), whereas adherence to critical structures reduced GTR likelihood (P < 0.05). Initial surgeries more often achieved GTR, correlating with longer PFS (P < 0.0001) and reduced recurrence (P < 0.01) versus re-operations. Cluster analysis identified three distinct groups, with the initial GTR cluster showing superior PFS and the lowest recurrence (P < 0.0001 and P < 0.01, respectively). Statistically significant predictors of PFS included age and preoperative seizure presence, with older age favoring longer PFS (P < 0.01) and seizures associated with reduced PFS (P < 0.01). In addition, patients with previous surgeries showed a trend toward shorter PFS (P < 0.05). CONCLUSIONS This study emphasizes the importance of tailored surgical strategies in managing intracranial ETs, advocating for GTR to optimize long-term outcomes where possible. Future prospective studies are essential to further refine treatment approaches, enhancing survival for ET patients.
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Affiliation(s)
- Mychael W Delgardo
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York, USA
| | - Damian E Teasley
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York, USA
| | - Anthony J Tang
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York, USA
| | - Chiemela Izima
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York, USA
| | - Brianna M Peet
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York, USA
| | - Andrés Pascual-Leone
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York, USA
| | - Geoffrey Reeves
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York, USA
| | - Brett E Youngerman
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York, USA
| | - E Sander Connolly
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York, USA
| | - Guy M McKhann
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York, USA
| | - Jeffrey N Bruce
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York, USA
| | - Neil A Feldstein
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York, USA
| | - Peter Canoll
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York, USA
| | - Michael B Sisti
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York, USA.
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5
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Kiss-Bodolay D, Hautmann X, Lee KS, Rohde V, Schaller K. Intracranial Epidermoid Cyst: A Volumetric Study of a Surgically Challenging Benign Lesion. World Neurosurg 2024; 185:e1129-e1135. [PMID: 38493891 DOI: 10.1016/j.wneu.2024.03.035] [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] [Received: 01/13/2024] [Revised: 03/07/2024] [Accepted: 03/08/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Intracranial epidermoid cysts are rare, benign tumors. Nevertheless, the microsurgical removal of these cysts is challenging. This is due to their capacity to adhere to the neurovascular tissue, as well as the associated difficulties in microsurgically peeling off their capsular wall hidden in dead angles. To better understand the rate of recurrence after surgical intervention, we have performed preoperative and postoperative volumetric analysis of epidermoid cysts, allowing the estimation of their growth rate after resection. METHODS Imaging data from 22 patients diagnosed and surgically treated for an intracranial epidermoid cyst between 2000 and 2022 were retrospectively collected from 2 European neurosurgical centers with microsurgical expertise. Volumetric analysis was performed on magnetic resonance imaging data. RESULTS Average cyst volume at diagnosis, before any surgery, measured in 12 patients was 28,877.6 ± 10,250.4 mm3 (standard error of the mean [SEM]). Estimated growth rate of incompletely resected epidermoids after surgery was 1,630.05 mm3 ± 729.95 (SEM). Assuming linear growth dynamics and normalizing to postoperative residual volume, the average postoperative growth rate corresponded to 61.5% ± 34.3% (SEM) of the postoperative residual volume per year. We observed signs of recurrence during a radiologic follow-up period of 6.0 ± 2.8 years (standard deviation) in more than 50% of our patients. CONCLUSIONS Due to their slow-growing nature, epidermoid cysts can often reach a complex multicompartmental size before resection, even in young patients, thus requiring complex approaches with challenging capsular resection, which implies a high risk of nerve and vascular injury per se. Tumor recurrence may be predicted on the basis of postoperative volumetry.
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Affiliation(s)
- Daniel Kiss-Bodolay
- Department of Neurosurgery, Geneva University Hospital, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Xenia Hautmann
- Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany
| | - Kok Sin Lee
- Department of Basic Neurosciences and the Center for Neuroscience, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Veit Rohde
- Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany
| | - Karl Schaller
- Department of Neurosurgery, Geneva University Hospital, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Russo J, Thompson B, Ansari N, Mohtadi M, Ozgur SS, Michael P. Cranial Conundrum: An Unusual Case of an Epidermoid Cyst in the Prepontine Cistern. Cureus 2024; 16:e51549. [PMID: 38313893 PMCID: PMC10835021 DOI: 10.7759/cureus.51549] [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] [Accepted: 01/02/2024] [Indexed: 02/06/2024] Open
Abstract
We present a fascinating case of a patient who suffered from persistent headaches for three months due to an epidermoid cyst located in the prepontine cistern. Epidermoid cysts are a very uncommon type of intracranial tumor, known for their slow growth and gradual onset of neurological symptoms. In this particular case, our patient, a 35-year-old, experienced a headache that was accompanied by dizziness, photophobia, and pain when moving their eyes. Further imaging revealed a cystic lesion in the prepontine cistern, which had a mass effect on the pons. After confirming the lesion was likely an epidermoid cyst through an MRI, the patient underwent surgery to have it removed. We hope to highlight the rarity of this type of tumor and its unique features when viewed through imaging.
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Affiliation(s)
- Joseph Russo
- Internal Medicine, St. Joseph's University Medical Center, Paterson, USA
| | - Bradley Thompson
- Internal Medicine, St. Joseph's University Medical Center, Paterson, USA
| | - Nida Ansari
- Internal Medicine, St. Joseph's University Medical Center, Paterson, USA
| | - Malina Mohtadi
- Internal Medicine, St. Joseph's University Medical Center, Paterson, USA
| | - Sacide S Ozgur
- Internal Medicine, St. Joseph's University Medical Center, Paterson, USA
| | - Patrick Michael
- Internal Medicine, St. Joseph's University Medical Center, Paterson, USA
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Ott S, Lübke A, Mohme M, Westphal M. A 64-year progression of an intradiploic epidermoid of the frontal skull: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2023; 6:CASE23614. [PMID: 38109733 PMCID: PMC10732322 DOI: 10.3171/case23614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 11/16/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Epidermoid cyst tumors can arise as intradiploic tumors in the frontal skull bones around the fontanel in childhood but are mostly found at the frontal or frontotemporal base of the brain or in the cerebellopontine angle. Therefore, finding a symptomatic intradiploic lesion in the convexity in late adulthood is uncommon. Intradiploic epidermoids can cause complications as they grow, by eroding and perforating their surroundings, and in cases of destruction of the wall of a pneumatized sinus, they can cause pneumocephalus. OBSERVATIONS In the present case, a female patient presented with a skull lesion that had grown progressively over 64 years, resulting in spontaneous pneumocephalus. Surgery with subsequent cranioplasty was performed. The histological examination confirmed the presence of an intradiploic epidermoid. LESSONS This case highlights that complete resection of the lesion with subsequent cranioplasty is recommended before symptoms and reconstructive challenges due to the enormous size of the defect. This case serves as a reminder that intradiploic epidermoids, although uncommon, will expand throughout life and can cause significant complications such as pneumocephalus after decades. Timely surgical interventions after diagnosis are recommended to prevent further complications and to achieve a successful outcome in terms of complete resection and reconstruction.
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Affiliation(s)
- Stefanie Ott
- Department of Neurosurgery, UKE Hamburg Eppendorf, Hamburg, Germany; and
| | - Andreas Lübke
- Center for Diagnostics, Institute of Pathology with the Sections Molecular Pathology and Cytopathology, UKE Hamburg Eppendorf, Hamburg, Germany
| | - Malte Mohme
- Department of Neurosurgery, UKE Hamburg Eppendorf, Hamburg, Germany; and
| | - Manfred Westphal
- Department of Neurosurgery, UKE Hamburg Eppendorf, Hamburg, Germany; and
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Yufeng Z, Xiaoqing J, Lulu X, Pei H, Shengwu L, Zhongsheng L. Giant epidermoid cyst penetrating the skull: a case report and literature review. Br J Neurosurg 2023; 37:1693-1698. [PMID: 34320894 DOI: 10.1080/02688697.2021.1950635] [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] [Received: 06/08/2021] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
Abstract
Intracranial epidermoid cyst is a rare pseudotumor of the nervous system, accounting for 0.2%-1.8% of all intracranial tumors. It is usually located in the cerebellopontine Angle or parasellar area, with insipid onset, slow growth and usually less than 2 cm in diameter. Giant epidermoid cysts that invade the bone have rarely been reported in the literature. Herein, we report a case of giant ECs extradural to the parietal bone, penetrating the skull and continuing to expand outward. In addition, a systematic search of four authoritative databases was conducted to collect the relevant reports of giant epidermoid cyst with diameter > 5cm for the first time, and to discuss the clinical and radiographic features of patients with giant epidermoid cyst and the influence of treatment options.
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Affiliation(s)
- Zhu Yufeng
- Department of Graduate School, Qinghai University, Xining, China
| | - Jin Xiaoqing
- Department of neurosurgery, Qinghai Provincial People's Hospital, Xining, China
| | - Xu Lulu
- Department of Geriatric Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Han Pei
- Department of neurosurgery, Qinghai Provincial People's Hospital, Xining, China
| | - Lin Shengwu
- Department of Graduate School, Qinghai University, Xining, China
| | - Lu Zhongsheng
- Department of neurosurgery, Qinghai Provincial People's Hospital, Xining, China
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Yaltırık Bilgin E, Ünal Ö, Törenek Ş, Çiledağ N. Computerized Tomography Texture Analysis in the Differential Diagnosis of Intracranial Epidermoid and Arachnoid Cysts. Cureus 2023; 15:e41945. [PMID: 37588326 PMCID: PMC10425918 DOI: 10.7759/cureus.41945] [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] [Accepted: 07/15/2023] [Indexed: 08/18/2023] Open
Abstract
PURPOSE This study evaluated the differences between arachnoid and epidermoid cysts in computerized tomography (CT) texture analysis (TA). MATERIAL AND METHODS The study included 12 patients with intracranial epidermoid cysts and 26 patients with intracranial arachnoid cysts who were diagnosed with diffusion-weighted magnetic resonance imaging (DW-MRI) and who had undergone an unenhanced CT examination before treatment. The LIFEx application software was used to obtain texture features. Eighty-two texture features from 38 lesions were automatically calculated for each lesion. The Shapiro-Wilk test was used to test the normality of the scores, and the Mann-Whitney U Test was used to test the difference between the groups. Receiver operating characteristic (ROC) curves and multivariate logistic regression modeling examined the parameters' diagnostic performances. RESULTS The median age of the patients was 53 years (range: 19-88 years). Eighty-two texture parameters were evaluated in the first order: gray-level co-occurrence matrix (GLCM), gray-level run length matrix (GLRLM), neighbor gray-tone difference matrix (NGTDM), and gray-level size zone matrix (GLSZM) groups. There was a statistically significant difference between the arachnoid cyst and the epidermoid cyst in the variables of compacity, compactness 1, compactness 2, sphericity, asphericity, sum average, coarseness, and low gray-level zone (p<0.05). According to the multiple logistic regression model, it was determined that the sum average in the GLCM group (B=-0.11; p=0.015), coarseness (B= 869.5; p=0.044) in the NGTDM group, and morphological sphericity (B=24.18; p=0.047) were the radiomics variables that increased the probability of epidermoid diagnosis. According to the classification table of the model, the sensitivity rate was found to be 83%, and the specificity rate was found to be 96%. Therefore, the probability of accurate model classification was 92%. CONCLUSION CT TA is a method that can be applied with high diagnostic accuracy in the differential diagnosis of intracranial epidermoid and arachnoid cysts, especially in patients who cannot undergo an MRI examination.
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Affiliation(s)
- Ezel Yaltırık Bilgin
- Radiology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, TUR
| | - Özkan Ünal
- Radiology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, TUR
| | - Şahap Törenek
- Radiology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, TUR
| | - Nazan Çiledağ
- Radiology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, TUR
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10
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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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11
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Khaba MC, Dube NA. Clinicopathological report on epidermoid cysts of the brain: A case series and literature review from an African perspective. Int J Surg Case Rep 2023; 105:107969. [PMID: 36913889 PMCID: PMC10011047 DOI: 10.1016/j.ijscr.2023.107969] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 03/11/2023] Open
Abstract
INTRODUCTION Epidermoid cysts are rare benign lesions of the central nervous system which accounts for approximately 1-2 % of all intracranial tumours. They are commonly located in the parasellar region, cerebellopontine angle; however, brain parenchyma origin is rare. We report clinicopathological features of these rare lesions. METHOD AND MATERIAL This is a retrospective study of epidermoid cyst of the brain diagnosed between 01 January 2014 and 31 December 2020. RESULTS The four patients had mean age of 30,8 years (range: 3-63), one male and 3 females. All four patients presented with headache and one associated with seizures. Radiological images showed two posterior fossa; each occipital and temporal locations. All tumours were successfully removed and histopathological assessment confirmed epidermoid cysts. All patients showed clinical improvement and were discharged home. CONCLUSION Epidermoid cysts of the brain are rare and still remain a preoperative clinico-radiological conundrum as they may be indistinguishable from other intracranial tumours. Therefore, collaboration with histopathologists is advised in the management of these cases.
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Affiliation(s)
- Moshawa Calvin Khaba
- Department of Anatomical Pathology, Dr George Mukhari Academic Laboratory, National Health Laboratory Service, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa.
| | - Nomthandazo Amanda Dube
- Department of Neurosurgery, Dr George Mukhari Academic Hospital, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
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Ergen A, Caklili M, Uzuner A, Kurnaz Ozbek S, Cabuk B, Anik I, Ceylan S. Endoscopically operated 15 ventral skull-base dermoid and epidermoid cysts: Outcomes of a case series and technical note. Neurochirurgie 2023; 69:101424. [PMID: 36868134 DOI: 10.1016/j.neuchi.2023.101424] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 12/09/2022] [Accepted: 12/22/2022] [Indexed: 03/05/2023]
Abstract
BACKGROUND Epidermoid and dermoid tumors in the sellar region are rare. These cystic lesions are a surgical challenge, as the thin capsule adheres firmly to nearby structures. A case series of 15 patients is presented. METHODS The patients were operated on in our clinic between April 2009 and November 2021. The endoscopic transnasal approach (ETA) was used. Lesions were located in the ventral skull base. In addition, the literature was reviewed to compare clinical features and outcomes of ventral skull-base epidermoid/dermoid tumors operated on via ETA. RESULTS In our series, removal of cystic contents and tumor capsule (gross total resection: GTR) was achieved in 3 patients (20%). GTR was not possible for the others, because of adhesions to vital structures. Near total resection (NTR) was achieved in 11 patients (73.4%), and subtotal resection (STR) in 1 (6.6%). At a mean follow-up of 55±26.27 months, there were no cases of recurrence requiring surgery. CONCLUSION Our series demonstrates that ETA is suitable for resection of epidermoid and dermoid cysts in the ventral skull base. GTR cannot always be the absolute clinical aim, because of inherent risks. In patients with expected long-term survival, the aggressiveness of surgery should be weighed on an individual risk/benefit basis.
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Affiliation(s)
- A Ergen
- Department of Neurosurgery and Pituitary Research Center, Kocaeli University, School of Medicine, Kocaeli, Turkey.
| | - M Caklili
- Department of Neurosurgery and Pituitary Research Center, Kocaeli University, School of Medicine, Kocaeli, Turkey.
| | - A Uzuner
- Department of Neurosurgery and Pituitary Research Center, Kocaeli University, School of Medicine, Kocaeli, Turkey.
| | - S Kurnaz Ozbek
- Department of Histology and Embryology, Kocaeli University, School of Medicine, Kocaeli, Turkey.
| | - B Cabuk
- Department of Neurosurgery and Pituitary Research Center, Kocaeli University, School of Medicine, Kocaeli, Turkey.
| | - I Anik
- Department of Neurosurgery and Pituitary Research Center, Kocaeli University, School of Medicine, Kocaeli, Turkey.
| | - S Ceylan
- Department of Neurosurgery and Pituitary Research Center, Kocaeli University, School of Medicine, Kocaeli, Turkey.
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Singh S, Das KK, Kumar K, Rangari K, Dikshit P, Bhaisora KS, Sardhara J, Mehrotra A, Srivastava AK, Jaiswal AK, Behari S. Cerebellopontine Angle Epidermoids: Comparative Results of Microscopic and Endoscopic Excision Using the Retromastoid Approach”. Skull Base Surg 2022; 83:e60-e68. [DOI: 10.1055/s-0040-1722713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 11/05/2020] [Indexed: 10/22/2022]
Abstract
Abstract
Background Densely packed neurovascular structures, often times inseparable capsular adhesions and sometimes a multicompartmental tumor extension, make surgical excision of cerebellopontine angle epidermoids (CPEs) a challenging task. A simultaneous or an exclusive endoscopic visualization has added a new dimension to the classical microscopic approaches to these tumors recently.
Methods Eighty-six patients (age: 31.6 ± 11.7 years, M:F = 1:1) were included. Nineteen patients (22.1%) had a multicompartmental tumor. Tumor extension was classified into five subtypes. Sixty-two patients underwent a pure microscopic approach (72%) out of which 10 patients (16%) underwent an endoscope-assisted surgery (11.6%) and 24 patients (28%) underwent an endoscope-controlled excision. Surgical outcomes were retrospectively analyzed.
Results Headache (53.4%), hearing loss (46.5%), and trigeminal neuralgia (41.8%) were the leading symptoms. Interestingly, 21% of the patients had at least one preexisting cranial nerve deficit. Endoscopic assistance helped in removing an unseen tumor lobule in 3 of 10 patients (30%). Pure endoscopic approach significantly reduced the hospital stay from 9.2 to 7.3 days (p = 0.012), and had a statistically insignificant yet a clearly noticeable lesser incidence of subtotal tumor excision (0 vs. 10%, p = 0.18) with comparable cranial nerve deficits but with a higher postoperative cerebrospinal fluid (CSF) leak rate (29% vs. 4.8%, p = 0.004).
Conclusion Endoscope assistance in CPE surgery is a useful addition to conventional microscopic retromastoid approach. Pure endoscopic excision in CPE is feasible, associated with a lesser duration of hospital stay, better extent of excision in selected cases, and it has a comparable cranial nerve morbidity profile albeit with a higher rate of CSF leak.
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Affiliation(s)
- Suyash Singh
- 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
| | - Krishna Kumar
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kamlesh Rangari
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Priyadarshi Dikshit
- 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
| | - 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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Freiburg Neuropathology Case Conference : A 58-year-old Patient with an Asymptomatic Cerebellopontine Angle Mass Lesion. Clin Neuroradiol 2022; 32:587-592. [PMID: 35545685 PMCID: PMC9187539 DOI: 10.1007/s00062-022-01175-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2022] [Indexed: 11/03/2022]
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15
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Ceccato GHW, de Oliveira JS, dos Santos Neto PH, Carvalho ND, Coelho VN, Hasegawa HA, Valli DAB, Ferreira A, Sufianov AA, Borba LAB. Microsurgical Resection of Giant Posterior Fossa Epidermoid Cyst Using Combined Presigmoid and Retrosigmoid Approaches: 3-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2022; 22:e274. [DOI: 10.1227/ons.0000000000000159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 12/15/2021] [Indexed: 11/19/2022] Open
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16
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Trivedi R, Trivedi P, Gupta R. Giant Epidermoid Cyst of the Posterior Fossa. Cureus 2022; 14:e20923. [PMID: 35154917 PMCID: PMC8815708 DOI: 10.7759/cureus.20923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2022] [Indexed: 11/05/2022] Open
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17
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Städt M, Holtmannspötter M, Nania A, Ritter L, Voit-Höhne H. Case report: Scattered intraventricular lesions on MRI following epidermoid cyst resection. Radiol Case Rep 2021; 17:190-193. [PMID: 34815825 PMCID: PMC8593265 DOI: 10.1016/j.radcr.2021.09.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/13/2021] [Accepted: 09/16/2021] [Indexed: 11/28/2022] Open
Abstract
Local recurrence after epidermoid cyst surgery is a frequently reported complication, but intraventricular spread after surgery has not yet been described in literature. We present the case of a 61-year-old male patient with steadily progressive headaches after surgical excision of an epidermoid cyst in the right cerebellopontine angle about two months ago. The MRI showed multiple intraventricular FLAIR-hyperintensities with diffusion restriction, suggestive of scattered remnants of the epidermoid cyst. We recommend early postoperative MRI-scans after cranial epidermoid surgery, which should be carefully inspected not only for local remnants but also rare complications like intraventricular spread.
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Affiliation(s)
- Michael Städt
- Institute of Neuroradiology, Paracelsus Medical University, 90471 Nuremberg, Germany
| | | | - Alberto Nania
- Department of clinical neurosciences, NHS Lothian, EH16 4SA Edinburgh, UK
| | - Leonard Ritter
- Department of Neurosurgery, Paracelsus Medical University, 90471 Nuremberg, Germany
| | - Heinz Voit-Höhne
- Institute of Neuroradiology, Paracelsus Medical University, 90471 Nuremberg, Germany
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18
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Vakharia KV, Naylor RM, Nassiri AM, Driscoll CLW, Link MJ. Microsurgical Resection of a Petroclival Epidermoid Cyst Using an Anterior Petrosectomy Approach: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 21:E565. [PMID: 34560780 DOI: 10.1093/ons/opab364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/10/2021] [Indexed: 11/14/2022] Open
Abstract
Epidermoid cysts are rare, benign lesions that result from inclusion of ectodermal elements during neural tube closure.1 Cysts are composed of desquamated epithelial cells and restrict diffusion on magnetic resonance imaging (MRI).2,3 Symptoms are attributable to anatomic location.4,5 In this video, we illustrate the surgical treatment of an epidermoid cyst located in the right cerebellopontine angle, petrous apex, and Meckel's cave. The patient, a 33-yr-old female with right-sided V1 trigeminal hypoesthesia, underwent surveillance imaging for 2 yr. However, she developed progressive V1 and V2 trigeminal hypoesthesia and imaging revealed enlargement of the lesion. Therefore, surgical resection was pursued. The patient consented to the procedure. The patient underwent a right middle fossa craniotomy and anterior petrosectomy. After identifying the greater superficial petrosal nerve and cutting the middle meningeal artery as it exited foramen spinosum, Kawase's triangle was drilled, and the dura over Meckel's cave and the subtemporal dura were opened. The lesion was resected, taking care to preserve the trigeminal nerve and the basilar artery. A retrosigmoid craniotomy was then fashioned. The cyst and its capsule were dissected off the brainstem and cranial nerves utilizing natural corridors between the trigeminal and vestibulocochlear nerves as well as between the facial and lower cranial nerves. Gross total resection was confirmed on postoperative MRI, and she was discharged home on postoperative day 5. Three months after surgery, she underwent formal pinprick testing, which revealed 95% loss of sensation in V1, 20% loss in V2, and normal sensation in V3. Three-month postoperative MRI showed no residual tumor.
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Affiliation(s)
- Kunal V Vakharia
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan M Naylor
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Ashley M Nassiri
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Colin L W Driscoll
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J Link
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
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Hellinger RL, Wolf AL, Amendola B, Coy S. Gamma knife radiosurgery of epidermoid tumors: an analysis of treatment results of eight patients. Rep Pract Oncol Radiother 2021; 26:683-687. [PMID: 34760304 DOI: 10.5603/rpor.a2021.0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 05/06/2021] [Indexed: 11/25/2022] Open
Abstract
Background Epidermoid tumors (ETs) of the central nervous system (CNS) are rare tumors that typically occur in the 4th decade. They typically grow around vital neurovascular structures which makes surgical treatment difficult. The objective of this paper is to report on the effectiveness and safety in the management of epidermoid tumors with gamma knife surgery (GKS). Materials and methods This is a retrospective study of the medical records of 8 patients treated with GKS for epidermoid tumors between July 2010 to June 2019. The median prescription dose was 11 Gy, ranging from 10 to 12 Gy, 5 patients received the total dose target to the 50% line and 3 to the 55% isodose line. The mean tumor volume was 12.4 cc ranging from 4.4 to 24.8cc. The median follow-up time was 33.7 months and ranged from 0.9 to 58.8 months. At follow-up, patients were evaluated for neurological signs and symptoms and radiographic evidence of progression of disease. Two patients were treated after failure of linac stereotactic radiosurgery. One patient underwent stereotactic radiosurgery prior to GKS, and the other had failed surgical resection prior to GKS. Results The median age was 33 years old. There were two males and six females. The most common presenting manifestation was headaches followed by vision and hearing problems. Symptoms were resolved in all cases, except for one who had partial control of trigeminal neuralgia. All patients were locally controlled by imaging and neurological examination at first follow-up. Conclusion Gamma knife surgery is a safe and effective alternative treatment in patients with CNS epidermoid tumors and should be included in the initial recommendation.
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Affiliation(s)
- Ryan L Hellinger
- Innovative Cancer Institute, South Miami, Florida, United States, Miami Neuroscience Center, South Miami, Florida, United States
| | - Aizik L Wolf
- Innovative Cancer Institute, South Miami, Florida, United States, Miami Neuroscience Center, South Miami, Florida, United States
| | - Beatriz Amendola
- Innovative Cancer Institute, South Miami, Florida, United States, Miami Neuroscience Center, South Miami, Florida, United States
| | - Sammie Coy
- Innovative Cancer Institute, South Miami, Florida, United States, Miami Neuroscience Center, South Miami, Florida, United States
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20
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Kumar S, Sahana D, Rathore L, Sahu RK, Jain A, Borde P, Tawari M, Madhariya SN. Fourth Ventricular Epidermoid Cyst - Case Series, Systematic Review and Analysis. Asian J Neurosurg 2021; 16:470-482. [PMID: 34660356 PMCID: PMC8477812 DOI: 10.4103/ajns.ajns_539_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 03/26/2021] [Indexed: 01/23/2023] Open
Abstract
Background: Epidermoid cysts are extra-axial, pearly white avascular lesions mostly found in the cerebellopontine region. They are slow-growing and mostly become symptomatic when they attain significant size. They do occur at other anatomical locations, but fourth ventricle is a rare location. Three representative cases with their outcomes are described here. Methods: The systematic review was done with adherence to predefined criteria. The studied variables were age, gender, duration of symptoms (DOS), clinical features, hydrocephalus (HCP), extent of resection, postoperative complications, outcome, follow–up, and recurrence. Statistical analysis was done to identify predictive factors for outcome. Results: Final analysis included 58 studies containing 131 patients. The most common clinical feature was cerebellar dysfunction (93%). The most common cranial nerve involved was the abducens nerve (n = 37, 28.46%). Preoperative HCP was present in nearly a third (35%) of patients. The outcomes were not different with age (P = 0.23), gender (P = 0.74), DOS (P = 0.09), and HCP (P = 0.50). Improved outcomes were associated with total resections (P = 0.001), absence of preoperative cranial nerve dysfunctions (P = 0.004), and presentation with features of raised intracranial pressure (P = 0.005). Longer DOS (mean 76.74 months) was associated with significantly increased cranial nerve nuclei involvement (P = 0.03). Aseptic meningitis was reported in 14.5% of cases. Recurrences were infrequently reported (n = 9). Conclusions: Although the fourth ventricular epidermoid lesions are difficult to detect in an innocuous stage, when found, they should be extirpated early and totally, as a longer DOS leads to cranial nerve dysfunctions and suboptimal outcomes.
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Affiliation(s)
- Sanjeev Kumar
- Department of Neurosurgery, Pt. JNM Medical College and DKS Post Graduate Institute and Research Center, Raipur, Chhattisgarh, India
| | - Debabrata Sahana
- Department of Neurosurgery, Pt. JNM Medical College and DKS Post Graduate Institute and Research Center, Raipur, Chhattisgarh, India
| | - Lavlesh Rathore
- Department of Neurosurgery, Pt. JNM Medical College and DKS Post Graduate Institute and Research Center, Raipur, Chhattisgarh, India
| | - Rajiv Kumar Sahu
- Department of Neurosurgery, Pt. JNM Medical College and DKS Post Graduate Institute and Research Center, Raipur, Chhattisgarh, India
| | - Amit Jain
- Department of Neurosurgery, Pt. JNM Medical College and DKS Post Graduate Institute and Research Center, Raipur, Chhattisgarh, India
| | - Praveen Borde
- Department of Neurosurgery, Pt. JNM Medical College and DKS Post Graduate Institute and Research Center, Raipur, Chhattisgarh, India
| | - Manish Tawari
- Department of Neurosurgery, Pt. JNM Medical College and DKS Post Graduate Institute and Research Center, Raipur, Chhattisgarh, India
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Hasegawa H, Vakharia K, Carlstrom LP, Van Gompel JJ, Driscoll CLW, Carlson ML, Meyer FB, Link MJ. Long-term surgical outcomes of intracranial epidermoid tumors: impact of extent of resection on recurrence and functional outcomes in 63 patients. J Neurosurg 2021:1-9. [PMID: 34653989 DOI: 10.3171/2021.5.jns21650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/27/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors' objective was to reevaluate the role of microsurgery for epidermoid tumors by examining the associations between extent of resection (EOR), tumor control, and clinical outcomes. METHODS This was a retrospective study of patients with microsurgically treated intracranial epidermoid tumors. The recurrence-free and intervention-free rates were calculated using the Kaplan-Meier method. EOR was graded as gross-total resection (GTR) (total resection without residual on MRI), near-total resection (NTR) (a cyst lining was left in place), subtotal resection (STR) (> 90% resection), and partial resection (PR) (any other suboptimal resection) and used to stratify outcomes. RESULTS Sixty-three patients with mean clinical and radiological follow-up periods of 87.3 and 81.8 months, respectively, were included. Sixteen patients underwent second resections, and 5 underwent third resections. The rates of GTR/NTR, STR, and PR were 43%, 35%, and 22%, respectively, for the initial resections; 44%, 13%, and 44% for the second resections; and 40%, 0%, and 60% for the third resections (p < 0.001). The 5- and 10-year cumulative recurrence-free rates after initial resection were 64% and 32%, respectively. When stratified according to EOR, the 10-year recurrence-free rate after GTR/NTR was marginally better than that after STR (61% vs 35%, p = 0.130) and significantly better than that after PR (61% vs 0%, p < 0.001). The recurrence-free rates after initial microsurgery were marginally better than those after second surgery (p = 0.102) and third surgery (p = 0.065). The 5- and 10-year cumulative intervention-free rates after initial resection were 91% and 58%, respectively. When stratified according to EOR, the 10-year intervention-free rate after GTR/NTR was significantly better than that after STR (100% vs 51%, p = 0.022) and PR (100% vs 27%, p < 0.001). The 5-year intervention-free rate after initial surgery was marginally better than that after second surgery (52%, p = 0.088) and significantly better than that after third surgery (0%, p = 0.004). After initial, second, and third resections, permanent neurological complications were observed in 6 (10%), 1 (6%), and 1 (20%) patients, respectively. At the last follow-up visit, 82%, 23%, and 7% of patients were free from radiological recurrence after GTR/NTR, STR, and PR as the initial surgical procedure, respectively. CONCLUSIONS GTR/NTR seems to contribute to better disease control without significantly impairing functional status. Initial resection offers the best chance to achieve better EOR, leading to better disease control.
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Affiliation(s)
- Hirotaka Hasegawa
- Departments of1Neurologic Surgery and.,3Department of Neurosurgery, The University of Tokyo, Bunkyo, Tokyo, Japan
| | | | | | - Jamie J Van Gompel
- Departments of1Neurologic Surgery and.,2Otolaryngology (ENT)/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota; and
| | - Colin L W Driscoll
- Departments of1Neurologic Surgery and.,2Otolaryngology (ENT)/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota; and
| | - Matthew L Carlson
- Departments of1Neurologic Surgery and.,2Otolaryngology (ENT)/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota; and
| | | | - Michael J Link
- Departments of1Neurologic Surgery and.,2Otolaryngology (ENT)/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota; and
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The role of apparent diffusion coefficient as a predictive factor for tumor recurrence in patients with cerebellopontine angle epidermoid tumor. Neurosurg Rev 2021; 45:1383-1392. [PMID: 34581893 DOI: 10.1007/s10143-021-01654-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/04/2021] [Accepted: 09/24/2021] [Indexed: 01/03/2023]
Abstract
Intracranial epidermoid tumors are slowly growing benign tumors, but due to adjacent critical neurovascular structures, surgical resection is challenging, with the risk of recurrence. The apparent diffusion coefficient (ADC) has been used to evaluate the characteristics of brain tumors, but its utility for intracranial epidermoid tumors has not been specifically explored. This study analyzed the utility of preoperative ADC values in predicting tumor recurrence for patients with intracranial epidermoid tumors. Between 2008 and 2019, 21 patients underwent surgery for cerebellopontine angle (CPA) epidermoid tumor, and their preoperative ADC data were analyzed. The patients were divided into two groups: the recurrence group, defined by regrowth of the remnant tumor or newly developed mass after gross total resection on magnetic resonance imaging (MRI); and the stable group, defined by the absence of growth or evidence of tumor on MRI. Receiver operating characteristic (ROC) analysis was used to obtain the ADC cutoff values for predicting tumor recurrence. The prognostic value of the ADC was assessed using Kaplan-Meier curves. The minimum ADC values were significantly lower in the recurrence group than in the stable tumor group (P = 0.020). ROC analysis showed that a minimum ADC value lower than 804.5 × 10-6 mm2/s could be used to predict higher recurrence risk of CPA epidermoid tumors. Non-total resection and mean and minimum ADC values lower than the respective cutoffs were negative predictors of recurrence-free survival. Minimum ADC values could be useful in predicting the recurrence of CPA epidermoid tumors.
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23
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Bajwa MH, Hussain N, Bari ME. Prepontine intracerebral cyst with spontaneous resolution. Surg Neurol Int 2021; 12:402. [PMID: 34513168 PMCID: PMC8422461 DOI: 10.25259/sni_473_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/09/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Intracranial cysts in the prepontine region are rare and can lead to various complications if not managed appropriately. Symptomatic prepontine cysts may require surgical intervention. However, spontaneous resolution of such cysts is rarely reported in literature. Case Description: We describe the case of a middle-aged lady who presented with headaches and imbalance, with no focal neurological deficits on examination. Magnetic resonance imaging (MRI) of the brain showed a prepontine cyst compressing the brainstem with craniocaudal extension through the foramen magnum. The patient was given symptomatic treatment and followed closely with repeat MRI scans. These scans showed regression and eventual disappearance of the lesion, with complete resolution of symptoms. Conclusion: In light of the few reported cases of spontaneous resolution of prepontine cysts, we highlight the possibility of these lesions to self-resolve.
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Affiliation(s)
| | - Nasr Hussain
- Department of Neurosurgery, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Muhammad Ehsan Bari
- Department of Neurosurgery, The Aga Khan University, Karachi, Sindh, Pakistan
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24
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Jha VC, Shrivastava A, Jha N, Rewatkar S, Singh SK. Analysis of Giant Intraventricular and Extraventricular Epidermoids, Defining Risk Factors for Recurrence, an Institutional Experience. Asian J Neurosurg 2021; 16:326-334. [PMID: 34268160 PMCID: PMC8244699 DOI: 10.4103/ajns.ajns_488_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 01/11/2021] [Indexed: 12/14/2022] Open
Abstract
Background: Multicompartmental intraventricular epidermoids behave differently from multicompartmental extraventricular lesions and localized lesions during its management. Few studies are available which have analyzed risk factors separately in these groups of cases for recurrence of these lesions and time to recur. Materials and Methods: In this retrospective observational study, 72 cases of intracranial epidermoid were treated over a span of 7 years. Cases were categorized into three groups. Group 1 comprised 15% (11/72) of cases with intraventricular multicompartmental, Group 2 with 22% (16/72) extraventricular giant tumors with multicompartmental involvement and size >4.5 cm, and Group 3 comprised 63% (45/72) of patients with lesions <4.5 cm and localized. Data pertaining to demography, clinical and radiological features, surgery performed, postoperative complication, histology, and follow-up were obtained from medical records available in the institute. Results: The average duration to treat was 1.86 ± 0.52 (standard deviation [SD]) years, with headache as a major complaint in all the groups. Combined endoscope-assisted microsurgery was performed in 38.8% (28/72), microsurgery in 54.1% (39/72), and endoscopic excision in 6.9% (5/72) of cases. Tumor calcification was found in 23.6% (17/72) and preoperative capsular enhancement was seen in 19.4% (14/72) which persisted in 79% (11/14) of cases postoperatively on subsequent follow-up suggesting recurrence. On stepwise logistic regression analysis, preoperative capsular enhancement was a strong predictor of recurrence of tumor (P = 0.001). The average follow-up was 46 ± 14.92 (SD) months in Group 1, 52.34 ± 11.45 (SD) months in Group 2, and 63.36 ± 18.42 (SD) months in Group 3. Conclusion: Although the intracranial epidermoid is known to recur after long interval, tumor with specific characteristics can recur in short span of 5–6 years. Tumor characteristics such as preoperative capsular enhancement, multicompartmental distribution in vertebrobasilar territory, large size, and presence of calcification are strong predictors for recurrence. Performing endoscope-assisted microsurgery can decrease the postoperative morbidities but does not reduce the recurrence risk.
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Affiliation(s)
- Vikas Chandra Jha
- Department of Neurosurgery, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Adesh Shrivastava
- Department of Neurosurgery, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Neeraj Jha
- Department of Neurosurgery, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Sudhanshu Rewatkar
- Department of Neurosurgery, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Saraj Kumar Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, Patna, Bihar, India
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Pagkou D, Del Maestro M, Luzzi S, Morbini P, Foroglou N, Galzio RJ. Acute-onset diplopia from intracranial hypertension due to torcular herophili obstruction by an hemorrhagic intradiploic epidermoid cyst. Surg Neurol Int 2021; 12:100. [PMID: 33880205 PMCID: PMC8053460 DOI: 10.25259/sni_578_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 02/19/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Epidermoid cysts are benign slow-growing congenital lesions, constituting approximately 1% of all cranial tumors. Most of these lesions are located intradurally, while about 10-25% of them are located within the diploic spaces. Intradiploic epidermoid cysts are usually discovered incidentally and may remain asymptomatic for many years, but in rare instances, they may grow intracranially and produce brain compression. Sometimes, intradiploic epidermoid cysts may occlude the main cranial venous sinuses causing intracranial hypertension. CASE DESCRIPTION We present the case of a 24-year-old male harboring a paramedian right occipital intradiploic cyst with erosion of both outer and inner bony tables, which occluded the torcular herophili producing a worsening symptomatology with acute-onset diplopia from right sixth cranial nerve palsy; the patient also presented bilateral papilledema, but only reported mild headache and dizziness. Neuroradiological studies evidentiated a lesion compatible with intradiploic epidermoid cyst with intralesional hemorrhagic component, overlying and almost completely occluding the torcular herophili. Considering the fast worsening of symptomatology and the evidence of intracranial hypertension, the patient was operated on immediately after completion of clinical and radiological assessment. The lesion was radically removed with almost immediate reversal of signs and symptoms. Histopathology confirmed the diagnosis of epidermoid cyst with intralesional hemorrhagic components. CONCLUSION Intradiploic epidermoid cysts may cause intracranial hypertension by occlusion of main cranial venous sinuses; intralesional hemorrhage may act as precipitating factor in occlusion of the torcular herophili, producing rapidly worsening intracranial hypertension, which requires prompt surgical treatment to reverse symptomatology. Radical surgical resection is necessary to avoid recurrence.
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Affiliation(s)
- Diamantoula Pagkou
- Department of Neurosurgery, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Mattia Del Maestro
- PhD School in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia
| | - Sabino Luzzi
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Patrizia Morbini
- Department of Molecular Medicine, Unit of Pathological Anatomy, University of Pavia, Pavia, Lombardia, Italy
| | - Nikolaos Foroglou
- Department of Neurosurgery, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Renato Juan Galzio
- Department of Neurosurgery, Maria Cecilia Hospital, Cotignola, Province of Ravenna, Italy
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Gopakumar S, Srinivasan VM, Sharma H, Cherian J, Patel AJ. Fully Endoscopic Resection of an Epidermoid Cyst of the Cerebellopontine Angle: Bilateral Resection via a Unilateral Approach. Oper Neurosurg (Hagerstown) 2021; 20:E152-E155. [PMID: 32970119 DOI: 10.1093/ons/opaa291] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/05/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Epidermoid cysts are rare, benign intracranial neoplasms that typically arise at the cerebellopontine angle (CPA) and can be extensive lesions that intricately involve many critical neurovascular structures. We describe the case of a patient who presents with the classic picture of CPA epidermoid cyst and describe the value of the 4K endoscope for resection, which is illustrated in our accompanying surgical video. CLINICAL PRESENTATION The patient presents with headache, nausea, and vomiting accompanied by dizziness and balance issues. Radiographic imaging demonstrated a large lesion highly consistent with epidermoid cyst which involved the left CPA, encircled the basilar artery, and extended to the opposite side. Surgery was planned with a small left-sided retrosigmoid craniotomy with use of a 2-dimensional 4K endoscope to aid in resection, particularly of the contralateral side. This approach was successful with gross total resection apparent at 14-mo follow-up. CONCLUSION We describe the use of a fully endoscopic technique from a unilateral approach for resection of a lesion that extended in the CPA bilaterally. Additionally, we highlight the relevant neuroanatomical and neurovascular structures in this highly critical intracranial region which is well-visualized through endoscopy in the associated surgical video.
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Affiliation(s)
| | | | - Himanshu Sharma
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Jacob Cherian
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Akash J Patel
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.,Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, Texas
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Esmat HA. Suprasellar epidermoid cyst in an adult female, presenting as amnesia and somnolence: A rare case report. Int J Surg Case Rep 2021; 77:565-569. [PMID: 33395846 PMCID: PMC7701884 DOI: 10.1016/j.ijscr.2020.11.093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/12/2020] [Accepted: 11/16/2020] [Indexed: 11/24/2022] Open
Abstract
Suprasellar epidermoid cysts are rare benign congenital lesions. They are usually asymptomatic but, they may present with non-specific headache and visual disturbances. Our case presented with amnesia and somnolence which are unique for suprasellar epidermoid cysts. Endoscopic trans-nasal and trans-sphenoidal approaches can be the safe way for resection of these lesions. Attention needs to the possible postoperative complications and longtime imaging follow up.
Introduction Intracranial epidermoid cysts (ECs) are rare benign congenital lesions and account for approximately 0.3 to 1.8% of all intracranial brain tumors. They frequently occur at the cerebellopontine angles and parasellar regions, insinuating between brain structures. The author reports here a case of pathologically proven suprasellar epidermoid cyst in an adult female, presented with amnesia and somnolence to increase awareness about this unusual presentation. Case report A 58-year-old female was presented to our hospital complaining of amnesia for one year, followed by weakness and somnolence for 2 months. Radiological imaging showed the features of the suprasellar epidermoid cyst which resected through the transsphenoidal endoscopic approach. Discussion Epidermoid cysts are slow-growing, benign lesions however, they may rarely undergo malignant transformation into a squamous cell carcinoma. The mean age at presentation of these lesions is 40 years. Suprasellar/sellar lesions usually present with non-specific headaches and visual disturbances. However, our case presented with amnesia and somnolence. Conclusion Surasellare epidermoid cysts (ECs) are rare benign congenital lesions. They often manifest with headache and visual field defects but, they may present with atypical symptoms as amnesia and somnolence. Endoscopic transnasal and trans-sphenoidal approaches can help to remove the lesion in most cases. Attention needs to the possible postoperative complications and longtime imaging follow-up because this lesion may recur after a few years.
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Affiliation(s)
- Habib Ahmad Esmat
- Department of Radiology, Kabul University of Medical Sciences, Kabul, Afghanistan; Fellow of Radiology at EGE University Hospital, Izmir, Turkey.
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Lee P, Krisht KM, Mukunyadzi P, Krisht AF. Resection of an Isolated Pituitary Stalk Epidermoid Cyst Through a Pretemporal Approach: Case Report and Review of the Literature. World Neurosurg 2020; 146:26-30. [PMID: 32920157 DOI: 10.1016/j.wneu.2020.09.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/06/2020] [Accepted: 09/07/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Intracranial epidermoid cysts are congenital epidermal inclusion cysts derived from ectodermal origin with desquamated skin. The majority of these cysts occur in the cerebellopontine angle cistern. Epidermoid cyst of the pituitary stalk, however, is a rare location. To date, only 4 previous cases have been reported. CASE DESCRIPTION A 63-year-old male presented to our clinic with migraine headaches, dizziness, increased thirst, increased urinary frequency, and impotence. Magnetic resonance imaging of the brain demonstrated a rim-enhancing cystic mass with diffusion restriction on diffusion-weighted imaging located within the pituitary stalk. The patient underwent a pretemporal approach with gross total resection of the cyst. The patient's postoperative course was uneventful with no new deficits and/or endocrinopathies. CONCLUSION Epidermoid cyst of the pituitary stalk is an unusual and rare presentation. Four other cases treated via endoscopic approaches have been previously reported in the neurosurgical literature. To our knowledge this is the first case description of an infundibular epidermoid cyst pressing with isolated diabetes insipidus surgically treated via a transcranial pretemporal approach with gross total resection. The patient had a smooth and uneventful postoperative course with persistent diabetes insipidus.
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Affiliation(s)
- Paul Lee
- Department of Neurological Surgery, CHI St. Vincent Arkansas Neuroscience Institute, Sherwood, Arkansas, USA
| | - Khaled M Krisht
- Department of Neurological Surgery, CHI St. Vincent Arkansas Neuroscience Institute, Sherwood, Arkansas, USA.
| | - Perkins Mukunyadzi
- Department of Neurological Surgery, CHI St. Vincent Arkansas Neuroscience Institute, Sherwood, Arkansas, USA
| | - Ali F Krisht
- Department of Neurological Surgery, CHI St. Vincent Arkansas Neuroscience Institute, Sherwood, Arkansas, USA
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Shear BM, Jin L, Zhang Y, David WB, Fomchenko EI, Erson-Omay EZ, Huttner A, Fulbright RK, Moliterno J. Extent of resection of epidermoid tumors and risk of recurrence: case report and meta-analysis. J Neurosurg 2020; 133:291-301. [PMID: 31277071 DOI: 10.3171/2019.4.jns19598] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 04/17/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Intracranial epidermoid tumors are slow-growing, histologically benign tumors of epithelial cellular origin that can be symptomatic because of their size and mass effect. Neurosurgical resection, while the treatment of choice, can be quite challenging due to locations where these lesions commonly occur and their association with critical neurovascular structures. As such, subtotal resection (STR) rather than gross-total resection (GTR) can often be performed, rendering residual and recurrent tumor potentially problematic. The authors present a case of a 28-year-old man who underwent STR followed by aggressive repeat resection for regrowth, and they report the results of the largest meta-analysis to date of epidermoid tumors to compare recurrence rates for STR and GTR. METHODS The authors conducted a systemic review of PubMed, Web of Science, and the Cochrane Collaboration following the PRISMA guidelines. They then conducted a proportional meta-analysis to compare the pooled recurrence rates between STR and GTR in the included studies. The authors developed fixed- and mixed-effect models to estimate the pooled proportions of recurrence among patients undergoing STR or GTR. They also investigated the relationship between recurrence rate and follow-up time in the previous studies using linear regression and natural cubic spline models. RESULTS Overall, 27 studies with 691 patients met the inclusion criteria; of these, 293 (42%) underwent STR and 398 (58%) received GTR. The average recurrence rate for all procedures was 11%. The proportional meta-analysis showed that the pooled recurrence rate after STR (21%) was 7 times greater than the rate after GTR (3%). The average recurrence rate for studies with longer follow-up durations (≥ 4.4 years) (17.4%) was significantly higher than the average recurrence rate for studies with shorter follow-up durations (< 4.4 years) (5.7%). The cutoff point of 4.4 years was selected based on the significant relationship between the recurrence rate of both STR and GTR and follow-up durations in the included studies (p = 0.008). CONCLUSIONS STR is associated with a significantly higher rate of epidermoid tumor recurrence compared to GTR. Attempts at GTR should be made during the initial surgery with efforts to optimize success. Surgical expertise, as well as the use of adjuncts, such as intraoperative MRI and neuromonitoring, may increase the likelihood of completing a safe GTR and decreasing the long-term risk of recurrence. The most common surgical complications were transient cranial nerve palsies, occurring equally in STR and GTR cases when reported. In all postoperative epidermoid tumor cases, but particularly following STR, close follow-up with serial MRI, even years after surgery, is recommended.
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Affiliation(s)
| | - Lan Jin
- 2Surgery, Yale School of Medicine
- 3Department of Environmental Health Sciences, Yale School of Public Health; and
| | - Yawei Zhang
- 2Surgery, Yale School of Medicine
- 3Department of Environmental Health Sciences, Yale School of Public Health; and
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Mohan A, Unni C, Kannoth P, Parambil RM. A Rare Case of Giant Intradiploeic Epidermal Cyst of the Frontal Bone with Intracranial Extension. Asian J Neurosurg 2020; 15:670-673. [PMID: 33145225 PMCID: PMC7591193 DOI: 10.4103/ajns.ajns_78_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 03/29/2020] [Accepted: 05/06/2020] [Indexed: 11/04/2022] Open
Abstract
Calvarial intradiploeic epidermal cyst are very rare neoplasms which can have intracranial extension. These cysts can attain a large size and can cause lytic destruction of the calvarium resembling malignancy. Since these lesions are benign complete excision is curative. We report the case of a 77-year-old male patient who presented with a large swelling on the forehead. Computed tomography and magnetic resonance imaging showed an expansile lytic lesion with intracranial extension. Complete excision of the lesion with cranioplasty was done. Histopathology was consistent with the epidermal cyst. These cysts attaining gigantic proportions are very few in literature.
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Affiliation(s)
- Akhil Mohan
- Department of Neurosurgery, Government Medical College. Kozhikode, Kerala, India
| | - Chandramohan Unni
- Department of Neurosurgery, Government Medical College. Kozhikode, Kerala, India
| | - Prakasan Kannoth
- Department of Neurosurgery, Government Medical College. Kozhikode, Kerala, India
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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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Kashyap S, Cheema B, Chhabra V. Endoscopic resection of the third ventricular epidermoid cysts: A case review and review of literature. Surg Neurol Int 2019; 10:98. [PMID: 31528436 PMCID: PMC6744775 DOI: 10.25259/sni-233-2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 04/13/2019] [Indexed: 11/04/2022] Open
Abstract
Background Epidermoid cysts are benign, congenital lesions that originate from ectodermal cells, they are most commonly found in the cerebellopontine angle, but rarely in the ventricular system. There is limited literature regarding the different microsurgical techniques utilized to approach these lesions. Methods A 63-year-old female with a recurrent third ventricular epidermoid cyst underwent gross total resection utilizing an endoscopic technique. We also reviewed the various endoscopic/microsurgical approaches and outcomes reported in literature. Results We identified 15 cases, including our own. Nine of these were managed using microsurgical techniques, while six cases (including ours) were treated endoscopically; gross total resection was achieved in 10/15 cases (67%). Most commonly, surgeons utilized the interhemispheric transcallosal approach (five cases). Tumor recurrence was seen in two cases. Complications attributed to these resections included: disorders of the hypothalamic-pituitary axis (3) - diabetes insipidus, galactorrhea, and hypopituitarism; tumor recurrence (2); aseptic meningitis (1); and a transient Korsakoff syndrome (1). Conclusion Epidermoid cysts of the third ventricle are exceedingly rare, and surgical resection is generally well tolerated. Microsurgical transcortical, transcallosal, and endoscopic approaches each have advantages and disadvantages, and are associated with unique procedure-specific complications. Continuing technological improvement would favor endoscopic approaches for resection of tumors of the third ventricle in the future.
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Affiliation(s)
- Samir Kashyap
- Departments of Neurosurgery, Kaiser Permanente Fontana Medical Center, Fontana, United States.,Departments of Neurosurgery, Riverside University Health System, Riverside, California, United States
| | - Bhagat Cheema
- Departments of Neurosurgery, Kaiser Permanente Fontana Medical Center, Fontana, United States
| | - Vaninder Chhabra
- Departments of Neurosurgery, Kaiser Permanente Fontana Medical Center, Fontana, United States
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Pseudo-Chemical Meningitis and the Malignant Transformation of an Epidermoid Cyst. Can J Neurol Sci 2019; 46:642-644. [PMID: 31232240 DOI: 10.1017/cjn.2019.235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Forbes JA, Banu M, Lehner K, Ottenhausen M, La Corte E, Alalade AF, Ordóñez-Rubiano EG, Greenfield JP, Anand VK, Schwartz TH. Endoscopic endonasal resection of epidermoid cysts involving the ventral cranial base. J Neurosurg 2019; 130:1599-1608. [PMID: 29882703 DOI: 10.3171/2017.12.jns172575] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 12/19/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Epidermoid cysts (ECs) commonly extend to involve the ventral cisterns of the cranial base. When present, symptoms arise due to progressive mass effect on the brainstem and adjacent cranial nerves. Historically, a variety of open microsurgical approaches have been used for resection of ECs in this intricate region. In recent years, the endoscopic endonasal approach (EEA) has been proposed as an alternative corridor that avoids crossing the plane of the cranial nerves. To date, there is a paucity of data in the literature regarding the safety and efficacy of the EEA in the treatment of ECs of the ventral cranial base. METHODS The authors reviewed a prospectively acquired database of EEAs for resection of ECs over 8 years at Weill Cornell, NewYork-Presbyterian Hospital. All procedures were performed by the senior authors. Standardized clinical and radiological parameters were assessed before and after surgery. Statistical tests were used to determine the impact of previous surgery and tumor volume on extent of resection and recurrence as well as the method of closure on rate of CSF leak. RESULTS Between January 2009 and February 2017, 7 patients (4 males and 3 females; age range 16-70 years) underwent a total of 8 surgeries for EC resection utilizing the EEA. Transplanum and transclival extensions were performed in 3 and 5 patients, respectively. Methods of closure incorporated a gasket seal in 6 of 8 procedures and a nasoseptal flap in 7 of 8 procedures. Gross-total resection (GTR) was achieved in 43% of patients, and near-total resection (> 95%) was obtained in another 43%. Complications included diabetes insipidus (n = 2), postoperative CSF leak (n = 2), transient third cranial nerve palsy (n = 1), and epistaxis (n = 1). With a mean follow-up of 43.5 months, recurrence has been observed in 2 of 7 patients. In 1 case, reoperation for recurrence was required 71 months following the initial surgery. Use of the gasket-seal technique with nasoseptal flap coverage significantly correlated with the absence of postoperative CSF leakage (p = 0.018). GTR was achieved in 25% of the patients who had prior surgeries and in 50% of patients without previous resections. The mean volume of cysts in which GTR was achieved (4.3 ± 1.8 cm3) was smaller than that in which subtotal or near-total resection was achieved (12.2 ± 11 cm3, p = 0.134). CONCLUSIONS The EEA for resection of ECs of the ventral cranial base is a safe and effective operative strategy that avoids crossing the plane of the cranial nerves. In the authors' experience, gasket-seal closure with nasoseptal flap coverage has been associated with a decreased risk of postoperative CSF leakage.
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Affiliation(s)
- Jonathan A Forbes
- 1Department of Neurological Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - Matei Banu
- 2Department of Neurological Surgery, Columbia Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - Kurt Lehner
- 3Hofstra-Northwell Health School of Medicine, New York, New York
| | - Malte Ottenhausen
- 1Department of Neurological Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - Emanuele La Corte
- 4University of Milan and Department of Neurosurgery, Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy
| | - Andrew F Alalade
- 5Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Edgar G Ordóñez-Rubiano
- 1Department of Neurological Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
- 6Department of Neurological Surgery, Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital de San José, Bogotá, Colombia
| | - Jeffrey P Greenfield
- 1Department of Neurological Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - Vijay K Anand
- 7Department of Otolaryngology, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York; and
| | - Theodore H Schwartz
- 1Department of Neurological Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
- 7Department of Otolaryngology, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York; and
- 8Department of Neuroscience, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
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Jain N, Tadghare J, Patel A. Epidermoid Cyst of the Cerebellopontine Angle Presenting with Contralateral Trigeminal Neuralgia: Extremely Rare Case and Review of Literature. World Neurosurg 2019; 122:220-223. [DOI: 10.1016/j.wneu.2018.10.204] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 10/09/2018] [Accepted: 10/11/2018] [Indexed: 11/26/2022]
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Balasundaram P, Garg A, Prabhakar A, Joseph Devarajan LS, Gaikwad SB, Khanna G. Evolution of epidermoid cyst into dermoid cyst: Embryological explanation and radiological-pathological correlation. Neuroradiol J 2019; 32:92-97. [PMID: 30604653 DOI: 10.1177/1971400918821086] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Intracranial dermoid and epidermoid cysts are usually considered to be two different entities in the radiological and surgical literature. Epidermoid cysts are classically off midline in location, isointense to cerebrospinal fluid on T1 and T2-weighted images and have restricted diffusion, whereas dermoid cysts are classically midline in location, have T1-hyperintense regions due to the presence of fat and show facilitated diffusion. We report a case of radiological epidermoid cyst in baseline imaging, which evolved into a radiological dermoid cyst over time, and explain this unique occurrence with a review of the embryology and histopathogenesis of these cysts.
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Affiliation(s)
- Parthiban Balasundaram
- 1 Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, India
| | - Ajay Garg
- 1 Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, India
| | - Anuj Prabhakar
- 1 Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, India
| | - Leve S Joseph Devarajan
- 1 Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, India
| | - Shailesh B Gaikwad
- 1 Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, India
| | - Gaurav Khanna
- 2 Department of Pathology, All India Institute of Medical Sciences, India
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Busch CM, Prickett JT, Stein R, Cuoco JA, Marvin EA, Witcher MR. Meckel Cave Epidermoid Cyst Presenting as Multiple Cranial Nerve Deficits Due to Indirect Tumoral Compression of the Cavernous Sinus: A Case Report and Literature Review. World Neurosurg 2019; 121:88-94. [DOI: 10.1016/j.wneu.2018.09.206] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/23/2018] [Accepted: 09/25/2018] [Indexed: 11/15/2022]
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Mangraviti A, Mazzucchi E, Izzo A, Sturdà C, Albanese A, Marchese E, Olivi A, Puca A, Sturiale CL. Surgical Management of Intracranial Giant Epidermoid Cysts in Adult: A Case-Based Update. Asian J Neurosurg 2018; 13:1288-1291. [PMID: 30459920 PMCID: PMC6208223 DOI: 10.4103/ajns.ajns_91_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Epidermoid cysts (ECs) are benign and slow-growing lesions that account for about 0.2%-2% of all intracranial tumors. Symptoms appear slowly and tumors may have already grown to giant proportions when patients receive their first diagnosis. The optimal treatment for ECs is surgical removal, which includes the total resection of the entire capsule of the lesion in order to minimize the risk of malignant transformation associated with partial removal. However, considering the giant size that the ECs can reach at the time of the diagnosis, and their adherence to the surrounding structures, the risks and benefits of total versus subtotal resections in the short- and long-term patients' outcome are still under debate. Here, we report a case of an extensive giant EC and offer a discussion of its characteristics, surgical management, and postoperative outcome, taking a cue to argue about the recent literature based in the latest case studies.
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Affiliation(s)
- Antonella Mangraviti
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli – IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Edoardo Mazzucchi
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli – IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Izzo
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli – IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cosimo Sturdà
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli – IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessio Albanese
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli – IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Enrico Marchese
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli – IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Olivi
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli – IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alfredo Puca
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli – IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carmelo Lucio Sturiale
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli – IRCCS, Rome, Italy
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Grahnke K, Burkett D, Li D, Szujewski C, Leonetti JP, Anderson DE. Cranial Nerve Preservation Following Surgical Treatment for Epidermoid Cysts of the Posterior and Middle Fossae. J Neurol Surg B Skull Base 2018; 79:445-450. [PMID: 30210971 DOI: 10.1055/s-0037-1617431] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 11/19/2017] [Indexed: 10/18/2022] Open
Abstract
Epidermoid cysts are rare lesions, accounting for 0.2 to 1.8% of all intracranial tumors. They most commonly occur in the cerebellopontine angle where they may cause a breadth of neurologic complications due to mass effect on the nearby cranial nerves (CN), vascular structures, and the brain stem. Treatment of epidermoid cysts is surgical, with the goal of complete resection using microsurgical technique and even more importantly preservation of the involved CNs, vasculature, and brain parenchyma. Successful surgery can result in total resolution of symptoms, but, in certain situations, may not be advisable due to adherence, scarring, or inflammation making dissection of CN fascicles difficult and possibly hazardous. We conducted a retrospective review from 1998 to 2016 and compiled a series of 28 skull base epidermoid cysts operated on at our institution. Cases were evaluated for presenting symptoms, history of prior resection, and postoperative results including CN function, extent of resection, residual tumor, and need for reoperations. The average tumor size (largest diameter) was 3.9 cm with a range of 1 to 7cm. Eighteen of twenty-eight (64%) patients underwent a gross total resection and ten underwent subtotal resection. No patients, whether presenting with CN deficits or not, experienced permanent worsening of CN function following surgery. Complete resection of epidermoid cysts should remain a high priority of therapy, but, in our opinion, preservation of CN function should be a primary goal, determining the extent of resection to provide patients with the highest quality of life possible following surgery.
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Affiliation(s)
- Kurt Grahnke
- Departments of Neurological Surgery and Otolaryngology, Head and Neck Surgery, and Stritch School of Medicine, Loyola University Chicago, Health Sciences Campus, Maywood, Illinois, United States
| | - Daniel Burkett
- Department of Neurological Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, United States
| | - Daphne Li
- Departments of Neurological Surgery and Otolaryngology, Head and Neck Surgery, and Stritch School of Medicine, Loyola University Chicago, Health Sciences Campus, Maywood, Illinois, United States
| | - Caroline Szujewski
- Departments of Neurological Surgery and Otolaryngology, Head and Neck Surgery, and Stritch School of Medicine, Loyola University Chicago, Health Sciences Campus, Maywood, Illinois, United States
| | - John P Leonetti
- Departments of Neurological Surgery and Otolaryngology, Head and Neck Surgery, and Stritch School of Medicine, Loyola University Chicago, Health Sciences Campus, Maywood, Illinois, United States
| | - Douglas E Anderson
- Departments of Neurological Surgery and Otolaryngology, Head and Neck Surgery, and Stritch School of Medicine, Loyola University Chicago, Health Sciences Campus, Maywood, Illinois, United States
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40
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McCormack EP, Cappuzzo JM, Litvack Z, Almira-Suarez MI, Sherman JS. Suprasellar Epidermoid Cyst Originating from the Infundibulum: Case Report and Literature Review. Cureus 2018; 10:e3226. [PMID: 30510861 PMCID: PMC6263494 DOI: 10.7759/cureus.3226] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Epidermoid cysts account for a small fraction of intracranial brain tumors, most commonly found in the cerebellopontine angle and parasellar cisterns. Here we present a rare case of an epidermoid cyst located in the suprasellar region, specifically originating from the infundibulum. Only one additional case with an epidermoid cyst originating within the pituitary stalk has been previously reported in the literature. The patient in this case presented with headaches, diplopia and blurred vision without any endocrinopathy. The patient's pre-operative evaluation was significant for pseudotumor cerebri, hyponatremia, obesity, and a history of smoking; post-operative course was significant for neurogenic diabetes insipidus.
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Affiliation(s)
| | - Justin M Cappuzzo
- Neurosurgery, University at Buffalo/State University of New York, Buffalo, USA
| | - Zachary Litvack
- Neurological Surgery, Swedish Brain and Spine Specialists, Seattle, USA
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Singh I, Rohilla S, Kumar P, Krishana G. Combined microsurgical and endoscopic technique for removal of extensive intracranial epidermoids. Surg Neurol Int 2018. [PMID: 29527394 PMCID: PMC5838849 DOI: 10.4103/sni.sni_392_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Intracranial epidermoid tumors are challenging lesions because they grow along the subarachnoid spaces around delicate neurovascular structures and often extend from one compartment to another. The purpose of this study was to determine the usefulness of endoscopic assistance in the microsurgical resection of these lesions, in which total resection is therapy of choice. Methods A total of 48 cases of intracranial epidermoids were treated by combined microscopic and endoscopic techniques. Initially, the tumor was removed under the microscope and after ensuring maximum excision, the endoscope was used to find out and excise any residual tumor. Results Out of these 48 cases complete excision was achieved in 44 cases and subtotal excision in four patients. Postoperative complications were seen in 17 patients, but none of the complications was attributed to the use of endoscope. Overall use of endoscope benefited 79% of cases. Conclusion We recommend combined microsurgical and endoscopic approach to achieve complete/maximum resection of extensive intracranial epidermoid tumors.
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Affiliation(s)
- Ishwar Singh
- Department of Neurosurgery, Pt. B. D. Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Seema Rohilla
- Department of Radiodiagnosis, Pt. B. D. Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Prashant Kumar
- Department of Anaesthesiology and Critical Care, Pt. B. D. Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Gopal Krishana
- Department of Neurosurgery, Pt. B. D. Sharma University of Health Sciences, Rohtak, Haryana, India
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Balogun JA, Adeleke NA, Salami AO, Odebode TO. Cerebellar Vermian Epidermoid Tumor: A Report of 2 Cases. World Neurosurg 2018; 112:153-157. [PMID: 29410035 DOI: 10.1016/j.wneu.2018.01.128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 01/15/2018] [Accepted: 01/16/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Epidermoid tumors are rare, benign slow-growing congenital tumors, most frequently located in the cerebellopontine angle of the intracranial cavity. They usually grow to a large size before patients become symptomatic. Although these tumors are amenable to surgery, their adherence to neurovascular structures poses a surgical challenge that results in subtotal resection, thus increasing the risk of recurrence. CASE DESCRIPTION We report 2 adult patients whose imaging studies revealed epidermoid tumors located in the cerebellar vermis, an uncommon site for such tumors. The patients presented with variable symptomatology. We highlight the imaging features and challenges of surgery. Both patients had good outcomes, with resolution of symptoms and neurologic deficits. CONCLUSIONS A safe complete excision of epidermoid tumor and its capsule is possible with a good understanding of their clinical and radiologic features and a high index of suspicion. To the best of our knowledge, this is the first report of cerebellar vermian epidermoid tumors from sub-Saharan Africa.
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Affiliation(s)
- James A Balogun
- Division of Neurosurgery, Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria; Department of Neurosurgery, University College Hospital, Ibadan, Nigeria; Division of Neurosurgery, Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria.
| | - Nurudeen A Adeleke
- Division of Neurosurgery, Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Ayodeji O Salami
- Department of Pathology, University College Hospital, Ibadan, Nigeria
| | - Timothy O Odebode
- Division of Neurosurgery, Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria
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43
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Huo CW, Caputo C, Wang YY. Suprasellar keratinous cyst: A case report and review on its radiological features and treatment outcome. Surg Neurol Int 2018; 9:15. [PMID: 29497568 PMCID: PMC5806421 DOI: 10.4103/sni.sni_269_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 11/21/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Keratinous or epidermoid cysts (ECs) are encapsulated lesions lined by squamous cell epithelium. They comprise approximately 1% of intracranial lesions. Contrary to dermoid cysts, they lack dermal elements such as sebaceous or apocrine glands and hair follicles. The sellar region is the second most common intracranial site following the cerebellopontine angle. Here, we report a case of EC in a patient who complained of endocrine disturbances. We also performed a systematic review on previously published cases to analyze clinical and radiological characteristics and report the treatment outcomes of suprasellar ECs. CASE DESCRIPTION A 42-year-old woman presented with a one-year history of amenorrhea, weight gain, severe headache, and visual disturbances for 6 months. Work-up identified an elevated prolactin level and a temporal field defect of the right eye. Magnetic resonance imaging (MRI) showed a cystic suprasellar lesion pushing on the optic chiasm. She underwent endoscopic trans-sphenoidal surgery, which confirmed a keratinous cyst on histology. Postoperatively, complete resection was confirmed on imaging. She did well although her hospital stay was prolonged due to diabetes insipidus and hypocortisolism. CONCLUSION Chronic endocrine disturbances can be the presenting complaints of a suprasellar EC, whose T1-weighted MRI appearance can be non-specific, mimicking other differential diagnoses, such as a Rathke's cleft cyst. However, the T2-weighted MRI appearances of ECs are generally hyper-intense and lesions show diffusion restriction. Treatment is surgical and yields good outcomes in most cases reported.
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Affiliation(s)
- C. W. Huo
- Department of Neurosurgery, St Vincent's Hospital Melbourne, Victoria, Australia
- Department of Surgery, St Vincent's Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - C. Caputo
- Department of Endocrinology, St Vincent's Hospital Melbourne, Victoria, Australia
| | - Y. Y. Wang
- Department of Neurosurgery, St Vincent's Hospital Melbourne, Victoria, Australia
- Department of Surgery, St Vincent's Hospital, The University of Melbourne, Parkville, Victoria, Australia
- Keyhole Neurosurgery, Suite B, Level 2 Healy Wing, 41 Victoria parade, Fitzroy, VIC, Australia
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Waqas M, Khan I, Khawaja R, Quddusi A, Enam SA. Self-resolving prepontine cyst. Surg Neurol Int 2017; 8:215. [PMID: 28966821 PMCID: PMC5609446 DOI: 10.4103/sni.sni_160_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 07/06/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Intracranial prepontine cysts are rare and include epidermoid cysts, arachnoid cysts, and neurenteric cysts. Symptomatic prepontine cysts may require surgical intervention. Reports of spontaneous resolution of cysts are rare. CASE DESCRIPTION We describe the case of a young gentleman who presented with headache and fever. Magnetic resonance imaging of the brain identified a prepontine lesion with features consistent with epidermoid cyst. During admission, the patient received symptomatic management in addition to empirical antibiotic therapy and dexamethasone. The patient improved symptomatically in the next 48 hours and was discharged. Follow-up imaging at 6 months and 1 year showed significant reduction in size of the lesion. CONCLUSION For asymptomatic prepontine cysts, a close radiological and clinical follow-up may prove useful.
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Affiliation(s)
- Muhammad Waqas
- Department of Surgery, Section of Neurosurgery, The Aga Khan University Hospital, Karachi, Pakistan
| | - Inamullah Khan
- Department of Surgery, Section of Neurosurgery, The Aga Khan University Hospital, Karachi, Pakistan
| | - Reehana Khawaja
- Department of Surgery, Section of Neurosurgery, The Aga Khan University Hospital, Karachi, Pakistan
| | - Ayesha Quddusi
- Department of Surgery, Section of Neurosurgery, The Aga Khan University Hospital, Karachi, Pakistan
| | - Syed Ather Enam
- Department of Surgery, Section of Neurosurgery, The Aga Khan University Hospital, Karachi, Pakistan
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Mastoid Epidermoid Tumor and Associated Dural Arteriovenous Fistula with Venous Sinus Occlusion. World Neurosurg 2017; 108:988.e15-988.e20. [PMID: 28830738 DOI: 10.1016/j.wneu.2017.08.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/04/2017] [Accepted: 08/08/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Dural arteriovenous fistula (DAVF) is an abnormal vascular connection between arterial and venous channels within dura mater. Although DAVFs have been linked to other types of intracranial tumors, this is the first case reporting the association between DAVF and an epidermoid tumor. CASE DESCRIPTION A middle-aged patient with chronic headache presented with Borden type II DAVF draining into the right transverse sigmoid junction and was also found to have an epidermoid tumor over the right mastoid. The patient underwent staged embolization of the fistula through both transvenous and transarterial routes. Continuous intraoperative venous pressure monitoring confirmed marked reduction in intracranial venous pressure, and the patient's symptoms completely resolved. However, the fistula still remained. The residual DAVF was then surgically disconnected, and the epidermoid tumor was resected in the same procedure. CONCLUSIONS This case demonstrates a DAVF can be associated with an epidermoid tumor. Tumor can compromise the venous outflow, which can then lead to intracranial venous hypertension and development of the DAVF. Venous pressure monitoring offers an objective method to verify resolution of venous hypertension, which might correlate with resolution of clinical symptoms.
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46
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Suprasellar Epidermoid Cyst with Atypical Imaging Findings. World Neurosurg 2017; 98:870.e1-870.e3. [DOI: 10.1016/j.wneu.2016.12.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 12/06/2016] [Accepted: 12/08/2016] [Indexed: 02/06/2023]
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Schembri M, Grech R. Interhemispheric epidermoid cyst. BMJ Case Rep 2015; 2015:bcr-2015-213393. [PMID: 26604238 DOI: 10.1136/bcr-2015-213393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
| | - Reuben Grech
- Department of Neuroradiology, Beaumont Hospital, Dublin, Ireland
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Aboud E, Abolfotoh M, Pravdenkova S, Gokoglu A, Gokden M, Al-Mefty O. Giant intracranial epidermoids: is total removal feasible? J Neurosurg 2015; 122:743-56. [DOI: 10.3171/2014.11.jns1481] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
Epidermoid tumors arise from misplaced squamous epithelium and enlarge through the accumulation of desquamated cell debris. Optimal treatment consists of total removal of the capsule; therefore, giant and multicompartmental tumors are particularly challenging. A conservative attitude in handling the tumor capsule is common given concerns about capsule adherence to neurovascular structures, and thus the possibility of recurrence is accepted with the intent of minimizing complications. This study focuses on the outcome of surgery in patients with giant epidermoid tumors for which total capsule removal was the aim.
METHODS
The authors conducted a retrospective analysis of all patients with giant epidermoid tumors treated by the senior author (O.A.), who pursued total removal of the capsule through skull base approaches. Patients were divided into 2 groups: one including patients with de novo tumors and the other consisting of patients who presented with recurrent tumors.
RESULTS
Thirty-four patients had undergone 46 operations, and the senior author performed 38 of these operations in the study period. The average tumor dimensions were 55 × 36 mm, and 25 tumors had multicompartmental extensions. Total removal of the tumor and capsule was achieved with the aid of the microscope in 73% of the 26 de novo cases but in only 17% of the 12 recurrent tumor cases. The average follow-up among all patients was 111 months (range 10–480 months), and the average postsurgical follow-up was 56.8 months (range 6–137 months). There were 4 recurrences in the de novo group, and every case had had a small piece of tumor capsule left behind. One patient died after delayed rupture of a pseudoaneurysm. In the de novo group, the average preoperative Karnofsky Performance Scale (KPS) score was 71.42%, which improved to 87.14% on long-term follow-up. In the group with recurrences, the KPS score also improved on long-term follow-up, from 64.54% to 84.54%. In the de novo group, 3 cases (11.5%) had permanent cranial nerve deficits, and 4 cases (15.4%) had a CSF leak. In the recurrence group, 3 cases (25%) had new, permanent cranial nerve deficits, and 1 (8.3%) had a CSF leak. Two patients in this group developed hydrocephalus and required a shunt.
CONCLUSIONS
Total removal of the capsule of giant epidermoid tumors was achieved in 73% of patients with de novo tumors and was associated with improved function, low morbidity and mortality, and a lower risk of recurrence. Surgery in patients with recurrent tumors was associated with higher morbidity and persistence of the disease.
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Affiliation(s)
| | - Mohammad Abolfotoh
- 2Department of Neurosurgery, Brigham and Women's Hospital, Harvard University, School of Medicine, Boston, Massachusetts; and
- 4Department of Neurosurgery, Ain Shams University, Cairo, Egypt
| | | | - Abdulkerim Gokoglu
- 2Department of Neurosurgery, Brigham and Women's Hospital, Harvard University, School of Medicine, Boston, Massachusetts; and
| | - Murat Gokden
- 3Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Ossama Al-Mefty
- 2Department of Neurosurgery, Brigham and Women's Hospital, Harvard University, School of Medicine, Boston, Massachusetts; and
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Lynch JC, Aversa A, Pereira C, Nogueira J, Gonçalves M, Lopes H. Surgical strategy for intracranial dermoid and epidermoid tumors: An experience with 33 Patients. Surg Neurol Int 2014; 5:163. [PMID: 25558422 PMCID: PMC4278097 DOI: 10.4103/2152-7806.145764] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 06/27/2014] [Indexed: 11/08/2022] Open
Abstract
Background: The aim of this paper is to report on our surgical strategy and technique and to identify the best management for intracranial dermoids and epidermoids tumors (IDETs). Methods: We retrospectively reviewed 33 consecutive patients (14 males and 19 females; mean age at surgery, 37.9 years) with pathologically confirmed IDETs who underwent surgical resection, with mean follow-up of 7.2 years. Results: Gross total tumor removal was achieved in 24 cases (72.7%) with zero surgical mortality and a recurrence rate of 9%. Conclusions: The surgical strategies used in this group of patients enabled total removal of most tumors without surgical mortality and with low morbidity and recurrence rates, proving to be safe and effective.
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Affiliation(s)
- Jose Carlos Lynch
- Department of Neurosurgery, Hospital Federal dos Servidores do Estado and National Cancer Institute, Rio de Janeiro, Brazil
| | - Antônio Aversa
- Department of Neurosurgery, Hospital Federal dos Servidores do Estado and National Cancer Institute, Rio de Janeiro, Brazil
| | - Celestino Pereira
- Department of Neurosurgery, Hospital Federal dos Servidores do Estado and National Cancer Institute, Rio de Janeiro, Brazil
| | - Jânio Nogueira
- Department of Neurosurgery, Hospital Federal dos Servidores do Estado and National Cancer Institute, Rio de Janeiro, Brazil
| | - Mariangela Gonçalves
- Department of Neurosurgery, Hospital Federal dos Servidores do Estado and National Cancer Institute, Rio de Janeiro, Brazil
| | - Hélio Lopes
- Department of Neurosurgery, Hospital Federal dos Servidores do Estado and National Cancer Institute, Rio de Janeiro, Brazil
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