Summary
We reviewed 22 epidermoid and 10 dermoid tumours of the skull and brain from patients operated on consecutively at Henry Ford Hospital between 1975 and 1991.
There were 19 intradural (16 epidermoid, 3 dermoid) and 13 extradural (6 epidermoid, 7 dermoid) lesions. The average age at presentation was 35 years for patients with epidermoids and 15 years for those with dermoids. Common clinical presentations for patients with intradural lesions included headache, visual deficits, and seizures, whereas patients with extradural lesions harbored asymptomatic scalp masses. All patients with intradural lesions were investigated with computed tomography (CT) and cerebral angiography, and 8 patients underwent magnetic resonance imaging (MRI).
Total resection was possible in 12 (92%) of 13 extradural tumours, all with excellent outcomes. Eight (42%) of the intradural tumours were completely resected.
Overall, with the intradural tumours we had good to excellent results in 17 patients (90%), poor results in 1 (5%), and 1 death (5%). Re-operation was needed in 5 intradural recurrences (26%) with deterioration in only one patient's neurologic status postoperatively.
From a review of ours and others' data, we conclude that 1) these tumours have an insidious onset despite significant size and mass effect as demonstrated by imaging studies; 2) CT, angiography, and particularly MRI help to define the extent of subarachnoid tumour spread and involvement of neurovascular structures, thus permitting better surgical planning; 3) a significant number of intradural tumours are difficult to excise because of their adherence to neurovascular structures, and thus are related to higher morbidity and mortality; and 4) because of extremely slow growth, complete tumour resection should not be the goal at the risk of injury to neurovascular structures.
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References
Abramson RC, Morawetz RB, Schutt M (1989) Multiple complications from an intracranial epidermoid cyst: case report and literature review. Neurosurgery 24: 574–577
Altschuler EM, Jungreis CA, Sekhar LN, Jannetta PJ, Sheptak PE (1990) Operative treatment of intracranial epidermoid cysts and cholesterol granulomas: report of 21 cases. Neurosurgery 26: 606–614
Alvord EC (1977) Growth rate of epidermoid tumors. Ann Neurol 2: 367–370
Berger MS, Wilson CB (1985) Epidermoid cysts of the posterior fossa. J Neurosurg 61: 214–219
Cantu RC, Ojemann RG (1968) Glucosteroid treatment of keratin meningitis following removal of a fourth ventricular epidermoid tumor. J Neurol Neurosurg Psychiatry 31: 73–75
Crawford R (1990) Dermoid cyst of the scalp: intracranial extension. J Pediatr Surg 25: 294–295
Davidson H, Ouchi T, Steiner RE (1985) MRI imaging of congenital intracranial germinal layer neoplasms. Neuroradiology 27: 301–303
Eekhof JLA, Thomeer RTWM, Bots GThAM (1985) Epidermoid tumor in the lateral ventricle. Surg Neurol 23: 189–192
Fiume D, Gazzari G, Spallone A, Santucci N (1985) Epidermoid cysts of the fourth ventricle. Surg Neurol 29: 189–192
Grant FC, Austin GM (1950) Epidermoids: clinical evaluation and surgical results. J Neurosurg 7: 190–198
Guidetti B, Gagliardi FM (1977) Epidermoid and dermoid cysts: clinical evaluation and late surgical results. J Neurosurg 47: 12–18
Hamel E, Frowein RA, Karimi-Nejad A (1980) Intracranial intradural epidermoids and dermoids. Surgical results of 38 cases. Neurosurg Rev 3: 215–219
Hori T, Numata H, Hokama Y, Muraoka K, Takami M, Saito Y (1983) Trigeminal pain caused by a parapontine epidermal cyst. Surg Neurol 19: 517–519
Keville FJ, Wise BL (1959) Intracranial intradural epidermoid and dermoid tumors. J Neurosurg 16: 564–569
Leal O, Miles J (1978) Epidermoid cyst in the brain stem. J Neurosurg 48: 811–813
Love JG, Kernohan JW (1936) Dermoid and epidermoid tumors (cholesteatomas) of central nervous system. JAMA 107: 1876–1883
McDonnell DE (1977) Pineal epidermoid cyst: its surgical therapy. Surg Neurol 7: 387–391
Miller N, Epstein MH (1975) Giant intracranial dermoid cyst: case report and review of the literature on intracranial dermoids and epidermoids. Can J Neurol Sci (May): 127–134
Nagashima C, Takahama M, Sakaguchi A (1982) Dense cerebellopontine epidermoid cyst. Surg Neurol 29: 172–177
Netsky MG (1988) Epidermoid tumors. Review of the literature. Surg Neurol 29: 477–483
Nosaka Y, Nagao S, Tabuchi K, Nishimoto A (1979) Primary intracranial epidermoid carcinoma. J Neurosurg 54: 830–833
Olivecrona H (1932) On suprasellar cholesteatomas. Brain 55: 122–134
Olson JJ, Beck DW, Crawford SC, Menezes AH (1987) Comparative evaluation of intracranial epidermoid tumors with computed tomography and magnetic resonance imaging. Neurosurgery 21: 357–360
Picard L, Bernard C, Aimeras M, Bradard S, Roland J (1983) Computed tomography of intracranial epidermoid cysts. J Radiol 64: 529–535
Rosario M, Becker DH, Conley FK (1981) Epidermoid tumors involving the fourth ventricle. Neurosurgery 9: 9–13
Rubin G, Scienza R, Pasqualin A, Rosta L, Da Pian R (1989) Craniocerebral epidermoids and dermoids. Acta Neurochir (Wien) 97: 1–16
Sabin HI, Bordi LT, Symon L (1987) Epidermoid cysts and cholesterol granulomas centered in the posterior fossa: twenty years of diagnosis and management. Neurosurgery 21: 798–805
Salazar J, Vaquero J, Saucedo G, Bravo G (1987) Posterior fossa epidermoid cysts. Acta Neurochir (Wien) 85: 34–39
Sambasivan M, Nayar A (1974) Epidermoid cyst of the pineal region. J Neurol Neurosurg Psychiatry 37: 1333–1335
Scott M (1974) Epidermoid tumour (tumour perlee, cholestestoma) of the fourth ventricle: case report and review of the literature. J Neurol Neurosurg Psychiatry 37: 1329–1332
Smith AS, Benson JE, Blaser SI, Mizushima A, Tarr RW, Bellon EM (1991) Diagnosis of ruptured intracranial dermoid cyst: value of MR over CT. AJNR 12: 175–180
Steffey DJ, De Filipp GJ, Spera T, Gabrielsen TO (1988) MR imaging of primary epidermoid tumors. J Comput Assist Tomogr 12: 438–440
Vion-Dury J, Vincentelli F, Jiddane M, Van Bunnen Y, Rumeau C, Grisoli F, Salamon G (1987) MR imaging of epidermoid cysts. Neuroradiology 29: 333–338
Wang J, Chang M, Luo S (1989) Spontaneously ruptured pineal epidermoid cyst associated with a thalamic germinoma. Neurosurgery 24: 933–936
Weaver EN, Coulon RA (1979) Excision of brain stem epidermoid cyst. J Neurosurg 51: 254–257
Yamakawa K, Shitara N, Genka S, Manaka S, Takakura K (1989) Clinical course and surgical prognosis of 33 cases of intracranial epidermoid tumors. Neurosurgery 24: 568–573
Yaşargil MG, Abernathey CD, Sarioglu AC (1989) Microneurosurgical treatment of intracranial dermoid and epidermoid tumors. Neurosurgery 24: 561–567
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Gormley, W.B., Tomecek, F.J., Qureshi, N. et al. Craniocerebral epidermoid and dermoid tumours: a review of 32 cases. Acta neurochir 128, 115–121 (1994). https://doi.org/10.1007/BF01400660
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DOI: https://doi.org/10.1007/BF01400660