Intracranial epidermoid cysts represent ∼ 0.2 to 1.8% of all intracranial tumors. These tumors are most frequently encountered in the cerebellar pontine angle or in the parasellar region. Rarely, they arise from the cranial diploe, being able to affect every flat bone of the cranium.We report a case of a 63-year-old male who presented with progressively worsening headache and vertigo with 6 months of evolution. Neuroimaging identified a probable occipital intradiploic epidermoid cyst with mass effect on the cerebellar hemispheres. This lesion was approached using a suboccipital craniotomy, followed by total resection of the tumor and cranioplasty with titanium plate placement. The histological evaluation confirmed the diagnosis of intraosseous epidermoid cyst. The patient had a successful recovery, without complications or neurologic dysfunction.Being benign lesions, commonly remaining asymptomatic and rarely presenting as a bony lump in the skull bone, it could be straightforward to assume a conservative management with planned follow-up. On the other side, a more aggressive strategy with surgical excision has been advocated, especially in lesions that tend to enlarge and erode the cranial bone with possible consequent epidural extension and mass effect symptoms. A preoperative diagnosis is extremely helpful in proper surgical planning. Diffusion weighted imaging facilitates a straightforward diagnosis.As was observed in our case, the largest reviews on intradiploic epidermoids available in the literature mostly demonstrated a benign clinical course. However, malignant transformation can occur. Some patients develop permanent neurologic deficits from mass effect or tumor infiltration. However, surgical approach of the tumor is curative in most cases. Nonetheless, from our experience, it is important to maintain clinical and imaging follow-up with regular monitoring to prevent possible tumor recurrences.
Esophageal cancer is one of the most fatal malignancies. It is often diagnosed during its advanced stages. Brain metastases, and especially cerebellar ones have been infrequently reported in the Literature. In patients with large cerebellar metastases, surgical removal is still the most effective therapy for improving survival and Karnofsky Performance Score (KFS).Stereotactic Radiosurgery is another treatment option for multiple brain metastases but the improvement in survival was only demonstrated in single metastasis.We report a case of multiple cerebellar metastases from esophageal squamous cell cancer in a 64 years old male, who underwent macroscopic total resection of all lesions. Up to date no treatment guidelines exist for esophageal cancer brain metastases. Multimodal therapy including surgery, radiation, and chemotherapy is now generally recommended for treatment of these lesions. Total resection of cerebellar ones should be the aim of surgical therapy, especially if a good KPS is expected.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.