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Alhammad O, Joueidi F, Aljohani HN, Basurrah AA, Ansary M. The Endoscopic Resection of Sellar and Suprasellar Epidermoid Cyst in a Pediatric Patient: A Case Report and Review of the Literature. Cureus 2023; 15:e50084. [PMID: 38186446 PMCID: PMC10770576 DOI: 10.7759/cureus.50084] [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: 12/06/2023] [Indexed: 01/09/2024] Open
Abstract
Epidermoid cysts are benign congenital tumors that originate from the ectodermal tissue. The sellar/suprasellar region is an infrequent location for epidermoid cysts and such cases are rarely reported in pediatric patients, as these become symptomatic only when they reach 30 years of age. Surgical intervention is considered the ideal treatment option in patients with suprasellar epidermoid cysts, either via open or endonasal approach. We discuss a case of a 12-year-old male who presented with left visual impairment and was treated with successful resection through an endoscopic endonasal approach (EEA). We also engage in a literature review of the use of EEA in the management of sellar/suprasellar epidermoid cysts in the pediatric age group.
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Affiliation(s)
- Othman Alhammad
- Neurosurgery, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | | | - Hanan N Aljohani
- Neurosurgery, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | | | - Muhammad Ansary
- Neuroscience Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
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He Y, Zhang S. An unexpected case report of epidermoid cyst at the oculomotor nerve: mimicking a common cyst on MRI. Front Endocrinol (Lausanne) 2023; 14:1153263. [PMID: 37388211 PMCID: PMC10301739 DOI: 10.3389/fendo.2023.1153263] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 04/13/2023] [Indexed: 07/01/2023] Open
Abstract
Intracranial epidermoid cysts are benign lesions and are rarely seen in clinical practice. Owing to similarities in imaging findings to those of common cystic lesions, the preoperative diagnosis is rendered challenging. Here, we present a case report of an epidermoid cyst at the right oculomotor nerve, which was initially misdiagnosed as a common cyst. A 14-year-old female child was admitted to our department due to a previous magnetic resonance imaging scan of a cystic lesion on the right side of the saddle that was suspected to be an oculomotor nerve cyst. In our department, this patient underwent a complete surgical resection of the tumor, and the pathology results revealed an epidermoid cyst. This is the first study that reported an epidermoid cyst at the right oculomotor nerve entering the orbit, mimicking a common cyst in imaging. We hope that this study would allow clinicians to consider this type of lesion as a differential diagnosis. Moreover, we suggest that specific diffusion-weighted imaging scan should be performed to aid in the diagnosis.
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Affiliation(s)
| | - Sunfu Zhang
- Department of Neurosurgery, Chengdu Third People’s Hospital, Chengdu, Sichuan, China
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Prolonged Postoperative Pyrexia and Transient Nonnephrogenic Vasopressin-Analogue-Resistant Polyuria following Endoscopic Transsphenoidal Resection of an Infundibular Epidermoid Cyst. Case Rep Neurol Med 2021; 2021:6690372. [PMID: 33936824 PMCID: PMC8060105 DOI: 10.1155/2021/6690372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/11/2021] [Accepted: 03/22/2021] [Indexed: 12/03/2022] Open
Abstract
Prolonged postoperative pyrexia (PPP) due to Mollaret's meningitis following endoscopic transsphenoidal surgery (eTSS) for an intracranial epidermoid cyst can be confused with postoperative meningeal infection after transsphenoidal resection, especially in the middle of the COVID-19 pandemic. Anosmia, as well as dysgeusia, cannot be evaluated in patients of eTSS for a while after surgery. We report a case of an infundibular epidermoid cyst with post-eTSS Mollaret's meningitis (MM). The post-eTSS MM caused vasopressin-analogue-resistant polyuria (VARP) in synchronization with PPP. A 59-year-old man experiencing recurrent headaches and irregular bitemporal hemianopsia over three months was diagnosed with a suprasellar tumor. The suprasellar tumor was an infundibular cyst from the infundibular recess to the posterior lobe of the pituitary, which was gross-totally resected including the neurohypophysis via an extended eTSS. Since awakening from general anesthesia after the gross total resection (GTR) of the tumor, the patient continuously had suffered from headache until the 13th postoperative day (POD13). The patient took analgesics once a day before the surgery and three times a day after the surgery until POD11. Pyrexia (37.5–39.5 degree Celsius) in synchronization with nonnephrogenic VARP remitted on POD18. Intravenous antibiotics had little effect on changes of pyrexia. Serum procalcitonin values (reference range <0.5 ng/mL) are 0.07 ng/mL on POD12 and 0.06 ng/mL on POD18. His polyuria came to react with sublingual desmopressin after alleviation of pyrexia. He left the hospital under hormone replacement therapy without newly added neurological sequelae other than hypopituitarism. After GTR of an infundibular epidermoid cyst, based on values of serum procalcitonin, post-eTSS MM can be distinguished from infection and can be treated with symptomatic treatments. The postoperative transient nonnephrogenic VARP that differs from usual central diabetes insipidus can react with sublingual desmopressin after alleviation of PPP in the clinical course of post-eTSS MM. An infundibular epidermoid cyst should be sufficiently resected in one sitting to minimize comorbidities, its recurrence, or postoperative MM to the utmost.
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Spinato G, Gaudioso P, Falcioni M, Mosto MCD, Cocuzza S, Maniaci A, Fabbris C, Politi D, Volo T, Ferri E, Cristalli G, Mannelli L, Salvatore M, Rizzo PB, Frezza D. Giant Epidermoid Cyst of Posterior Fossa-Our Experience and Literature Review. Dose Response 2021; 19:15593258211002061. [PMID: 33815017 PMCID: PMC7995313 DOI: 10.1177/15593258211002061] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction. Intracranial epidermoid cysts are the most frequent congenital intracranial lesion. They rare and benign tumors that can present in different clinical situations depending on location and extension of the disease. Diagnosis is obtained with radiological imaging with RM and non-enhanced TC as elective investigating methods. Elective treatment is surgery, based on total/subtotal excision sparring healthy neurovascular structures, considering the benign nature of this lesion. Case Report. In this study we present the case of a 79-year-old woman affected by recidivist epidermal cyst of the posterior fossa. Clinical presentation was characterized by positional subjective vertigo, intense headache localized in the right part of the head increased by Valsalva maneuver and retroarticular subcutaneous swelling. Radiological investigation found a giant epidemoid cyst of the posterior fossa (8,4 x 4,8 x 5,8 cm), treated with surgery. In the postoperative, the patient was fine and no neurological deficit has been encounterd. REVIEW. In this study, we present a review of the literature regarding giant epidermoid cysts of posterior fossa. Only 11 cases were reported before ours, which actually is one of the largest ever described.
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Affiliation(s)
- Giacomo Spinato
- Department of Neurosciences, Section of Otolaryngology and Regional Centre for Head and Neck Cancer, University of Padova, Treviso, Italy.,Department of Surgery, Oncology and Gastroenterology, Section of Oncology and Immunology, University of Padova, Padova, Italy
| | - Piergiorgio Gaudioso
- Department of Neurosciences, Section of Otolaryngology and Regional Centre for Head and Neck Cancer, University of Padova, Treviso, Italy
| | - Maurizio Falcioni
- Department of Head and Neck, University Hospital of Parma, Parma, Italy
| | - Maria Cristina Da Mosto
- Department of Neurosciences, Section of Otolaryngology and Regional Centre for Head and Neck Cancer, University of Padova, Treviso, Italy
| | - Salvatore Cocuzza
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", ENT Section; University of Catania, Catania, Sicily, Italy
| | - Antonino Maniaci
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", ENT Section; University of Catania, Catania, Sicily, Italy
| | - Cristoforo Fabbris
- Department of Neurosciences, Section of Otolaryngology and Regional Centre for Head and Neck Cancer, University of Padova, Treviso, Italy
| | - Doriano Politi
- Functional Department of Head and Neck, ENT Unit, ULSS3, Venice-Mestre Hospital, Venice, Italy
| | - Tiziana Volo
- Functional Department of Head and Neck, ENT Unit, ULSS3, Venice-Mestre Hospital, Venice, Italy
| | | | | | | | | | - Paolo Boscolo Rizzo
- Department of Neurosciences, Section of Otolaryngology and Regional Centre for Head and Neck Cancer, University of Padova, Treviso, Italy
| | - Daniele Frezza
- Otosurgery Unit, ULSS2, Treviso Hospital, Treviso, Italy
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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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