Surgical Strategy for Intracranial Endodermal Cyst-Two Case Reports-

Abstract

Two cases of endodermal cyst of the posterior fossa are reported. A 12-year-old girl presented with severe headache and vomiting caused by increased intracranial pressure. Computed tomography and magnetic resonance (MR) imaging showed a cystic mass occupying the ambient and quadrigeminal cisterns. A 65-year-old woman presented with dizziness, and MR imaging revealed a cystic mass in the posterior fossa. The two patients underwent surgery for decompression and resection of the cyst. Surgical specimens of the cyst walls consisted of a single layer of ciliated columnar epithelium. The diagnoses were endodermal cyst. The optimal surgical goal is total resection of the cyst wall, but the cyst wall sometimes tightly adheres to the adjacent nerves, vessels, and vital structures. The cyst must communicate adequately with the surrounding cerebrospinal fluid space, and a newly closed cyst space must be avoided, by the widest possible resection of the cyst wall.

Intraparenchymal endodermal cyst with spontaneous intracystic hemorrhage in the temporal lobe of an adult

“…[12] A review of recurrent intracranial ECs showed that cyst walls were left in part in the initial surgery of most cases and recurrence occurs at the same site from 2 months to 32 years. [12,13] Recurrent ECs could proliferate, migrate, or become malignant, and some of them could release cystic contents into subarachnoid space leading to chemical meningoencephalitis.…”

“…[12] A review of recurrent intracranial ECs showed that cyst walls were left in part in the initial surgery of most cases and recurrence occurs at the same site from 2 months to 32 years. [12,13] Recurrent ECs could proliferate, migrate, or become malignant, and some of them could release cystic contents into subarachnoid space leading to chemical meningoencephalitis. [12,13] In 1 case of frontal lobe EC, Kitamura et al [7] reported that the cyst recurred at 34 months after cyst aspiration and there was occasional intense headache during the disease process.…”

“…[12,13] Recurrent ECs could proliferate, migrate, or become malignant, and some of them could release cystic contents into subarachnoid space leading to chemical meningoencephalitis. [12,13] In 1 case of frontal lobe EC, Kitamura et al [7] reported that the cyst recurred at 34 months after cyst aspiration and there was occasional intense headache during the disease process. We performed a total cyst excision in the patient and 3-year follow-up found no recurrence of the lesion.…”

Giant petroclival endodermal cyst with xanthogranulomatous changes

“…When this occurs, the cysts are frequently located in the posterior fossa. 3,4,6,7,10,12,13 The most common locations are anterior to the brainstem or within the fourth ventricle. The cysts have also been found in the cerebellopontine angle and clivus, but endodermal cysts in the petroclival area are extremely rare.…”

“…In addition, they are hypertintense on FLAIR images and may show mild restriction on diffusion-weighted images. 6,7,9,[11][12][13][14] In general, the absence of contrast enhancement of the cyst wall and of bone destruction is useful for distinguishing endodermal cysts from other cystic lesions such as cystic schwannoma and cystic meningiomas. 9,11,12 Therefore, a cystic tumor was included in the differential diagnosis because our case showed bone destruction and rim enhancement, which are rare in intracranial cysts.…”