Assessment and Surgical Management of Posterior Fossa Epidermoid Tumors: Report of 28 Cases

Talacchi, Andrea; Sala, Francesco; Alessandrini, Franco; Turazzi, S.; Bricolo, Albino

doi:10.1097/00006123-199802000-00020

Cited by 108 publications

(106 citation statements)

References 58 publications

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“…Aseptic meningitis is more common in patients undergoing conservative approaches, probably because of the residual lesion's continuous direct contact with brain tissue and CSF after partial or subtotal removal. 14,24,40,44,51 This complication was almost absent in our series and has been less frequent in other contemporary reports with high rates of total removal and, perhaps, the routine prolonged use of high doses of corticosteroids.…”

Section: 4 Surgical Outcome and Extent Of Tumor Resectionmentioning

confidence: 48%

“…The use of microsurgical techniques, skull base approaches, intraoperative neurophysiological monitoring, neuronavigation, and endoscope-assisted dissection facilitates complete removal of these lesions in many cases. 44,51,57 Our study shows that total capsule excision can be done in a large number of cases and not only minimizes future recurrence but is also associated with fewer complications after the first surgery. This approach also eliminates the added morbidity of repeated surgery that has such a drastic impact on patient quality of life, especially since patients are relatively young at their first presentation.…”

Section: Discussionmentioning

confidence: 62%

“…7,13,44 There is no alter- native to surgery for epidermoid cysts, 18,51,56,57 especially in younger patients. 2,20,42 Since the squamous stratified epithelium that constitutes the capsule is the real disease, total removal of the capsule is acknowledged to be the ultimate treatment.…”

Section: Discussionmentioning

confidence: 99%

“…2,20,42 Since the squamous stratified epithelium that constitutes the capsule is the real disease, total removal of the capsule is acknowledged to be the ultimate treatment. 8,18,51,57 Because the capsule adheres to the brainstem, CNs, and perforating arteries, however, a conservative attitude toward removal has prevailed, 6,22,40,44,46,51,56 and many surgeons leave part of the capsule behind, accepting a higher risk of recurrence, especially for tumors extending into multiple sites. 9,51 Deterred by the risk involved in dissecting the capsule, other authors have opted for a decompressive procedure by evacuating the contents 7,38,44 or have not even attempted to handle the capsule.…”

Section: Discussionmentioning

confidence: 99%

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Giant intracranial epidermoids: is total removal feasible?

Aboud¹,

Abolfotoh

Pravdenkova³

et al. 2015

JNS

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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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Section: 4 Surgical Outcome and Extent Of Tumor Resectionmentioning

confidence: 48%

Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Giant intracranial epidermoids: is total removal feasible?

Aboud¹,

Abolfotoh

Pravdenkova³

et al. 2015

JNS

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“…Parasellar extended cysts tend to express supratentorial symptoms, whereas mesencephalic extended epidermoids are characterized by higher disturbance rate, especially regarding the brainstem. Posterior fossa basal tumors usually manifest with seizure, whereas headache and gait ataxia are commonly observed in fourth ventricle epidermoids [6].…”

Section: Introductionmentioning

confidence: 99%

Cerebellopontine Angle Epidermoid Cyst: Case Report

Giustino¹,

Pecci²,

Giannoni³

et al. 2013

IJOHNS

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Epidermoid cysts are rare congenital tumors of the central nervous system (CNS), histologically benign and slowgrowing lesions. Their frequency among primitive intracranial tumors is about 1% and they account for 40% of all intracranial epidermoid of the cerebellopontine angle (CPA); there they constitute the third most frequent neoplasm (5%), after acoustic neuromas and meningiomas. We report the case of a patient with a paucisymptomatic epidermoid cyst of the CPA.

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