Neurosurgical management of intracranial epidermoid tumors in children

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Epidermoid tumors are benign lesions representing 1% of all intracranial tumors. There have been few pediatric series of intracranial epidermoid tumors reported previously. The authors present their experience in the management of these lesions.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The neurosurgical database at the Hospital for Sick Children was searched for children with surgically managed intracranial epidermoid tumors. The patients' charts were reviewed for demographic data, details of clinical presentation, surgical therapy, and follow-up. Ethics board approval was obtained for this study.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Seven children, all girls, were identified who met the inclusion criteria between 1980 and 2007. The average age at surgery was 11.2 years (range 8–15 years), and the mean maximal tumor diameter was 2.1 cm. Headache was the most common presenting symptom, and 1 tumor was found incidentally. Most patients had normal neurological examinations, but meningism was found in 2 cases. There were 3 cerebellopontine angle lesions, 1 pontomedullary lesion, and 3 supratentorial tumors. Hydrocephalus developed in 1 patient after aseptic meningitis, and she underwent shunt placement. There were no operative deaths. Complete resection could be performed in 2 patients. One patient experienced a small recurrence that did not require a repeated operation, while 1 subtotally resected lesion recurred and the patient underwent a second operation.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Intracranial epidermoid tumors are rare in the pediatric population. Total resection is desirable to minimize the risk of postoperative aseptic meningitis, hydrocephalus, and tumor recurrence. Aggressive neurosurgical resection may be associated with cranial nerve or ischemic deficits, however. In these cases, neurosurgical judgment at the time of surgery is warranted to ensure maximum resection while minimizing postoperative neurological deficits.</jats:p></jats:sec>

Giant intracranial epidermoids: is total removal feasible?

“…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. 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.…”

Ruptured pediatric cerebellopontine angle epidermoid cyst: a case report detailing radiographic evolution and clinical course

“…7,14 Less common complications include CSF leakage (4%-8%), symptomatic hydrocephalus (14%), vestibular or cerebellar dysfunction, and pseudomeningocele (5%). 2,3,14,15,21 conclusions Following CPA EC rupture causing pericystic brainstem edema, our patient experienced resolution of her presenting symptoms following subtotal resection without postoperative neurological deficits or complications. This case warrants attention because it is the first report to demonstrate that cyst rupture leads to radiographic findings that challenge the traditional description of a mass lesion without significant parenchymal edema.…”

“…The overall recurrence rate is reported to range from 0% to 36%. 2,3,20,21,27 The rate of reoperation due to recurrence ranges from 0% to 21%. 21,27 The natural history of recurrence in these lesions is difficult to ascertain from the literature, as the relatively short follow-up and slow growth pattern limit proper assessment.…”

Quiste epidermoide supraselar con rotura intraventricular: caso clínico

“…Otra forma de presentación clínica es la aguda, debido a la rotura del quiste, con diseminación de los cristales de colesterol hacia el espacio subaracnoideo o al sistema ventricular, como es el caso clínico que hemos expuesto, siendo esta última presentación infrecuente de acuerdo a lo descrito en la literatura 8,9,11,12 . La meningitis química es una manifestación clínica secundaria a la rotura espontánea del quiste o luego de la diseminación de contenido quístico durante la cirugía y se caracteriza por pleocitosis, altos niveles de proteínas y bajos niveles de glucosa en el LCR 3,9,10,11 , por lo que se recomienda el uso de corticoesteroides en el perioperatorio 4,6 . La hidrocefalia comunicante (por bloqueo de la circulación epicortical del LCR) es una complicación descrita que puede manifestarse luego de la meningitis química.…”

“…Sus localizaciones más frecuentes son a nivel del ángulo pontocerebeloso (40-50%), cuarto ventrículo, región supraselar y cisterna cuadrigeminal. También se han descrito casos en la Cisura de Silvio, región periquiasmática, ventricular, talámicos, región pineal, tronco cerebral y cuerpo calloso 2,4,5 . Estos tumores pueden presentarse clínicamente a cualquier edad, pero con un ligero predominio entre la 3ª y 5ª década de la vida y con una mayor frecuencia en el sexo masculino 1 .…”