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1
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Nair I, Zammit A, Williamson T, Sadasivan AP. Complete resection of a giant epidermoid cyst of the occipital bone: case report and systematic review. CNS Oncol 2024; 13:2415279. [PMID: 39561245 PMCID: PMC11581160 DOI: 10.1080/20450907.2024.2415279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Accepted: 10/08/2024] [Indexed: 11/21/2024] Open
Abstract
Epidermoid cysts are uncommon accounting for less than 1% of all intracranial tumors. Among them, giant intradiploic epidermoid cysts of the posterior fossa i.e. those exceeding 5 cm are an even rarer entity. Here we report on the complete resection of a 7 cm posterior fossa epidermoid cyst involving the occipital bone in a 32-year-old female presenting with an acute on chronic exacerbation of headaches and vertigo. Complete resection including the cyst wall is crucial in preventing recurrence and malignant transformation. We add to limited existing data by reporting on the first systematic review to date assessing 25 cases of giant epidermoid cysts of the posterior fossa to discuss presentation, clinical and radiographic features and definitive management strategies.
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Affiliation(s)
- Ishwarya Nair
- Department of Neurosurgery, Princess Alexandra Hospital, Brisbane, QLD 4102, Australia
| | - Adrian Zammit
- Department of Neurosurgery, Princess Alexandra Hospital, Brisbane, QLD 4102, Australia
| | - Timothy Williamson
- Department of Neurosurgery, Princess Alexandra Hospital, Brisbane, QLD 4102, Australia
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2
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Yufeng Z, Xiaoqing J, Lulu X, Pei H, Shengwu L, Zhongsheng L. Giant epidermoid cyst penetrating the skull: a case report and literature review. Br J Neurosurg 2023; 37:1693-1698. [PMID: 34320894 DOI: 10.1080/02688697.2021.1950635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
Abstract
Intracranial epidermoid cyst is a rare pseudotumor of the nervous system, accounting for 0.2%-1.8% of all intracranial tumors. It is usually located in the cerebellopontine Angle or parasellar area, with insipid onset, slow growth and usually less than 2 cm in diameter. Giant epidermoid cysts that invade the bone have rarely been reported in the literature. Herein, we report a case of giant ECs extradural to the parietal bone, penetrating the skull and continuing to expand outward. In addition, a systematic search of four authoritative databases was conducted to collect the relevant reports of giant epidermoid cyst with diameter > 5cm for the first time, and to discuss the clinical and radiographic features of patients with giant epidermoid cyst and the influence of treatment options.
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Affiliation(s)
- Zhu Yufeng
- Department of Graduate School, Qinghai University, Xining, China
| | - Jin Xiaoqing
- Department of neurosurgery, Qinghai Provincial People's Hospital, Xining, China
| | - Xu Lulu
- Department of Geriatric Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Han Pei
- Department of neurosurgery, Qinghai Provincial People's Hospital, Xining, China
| | - Lin Shengwu
- Department of Graduate School, Qinghai University, Xining, China
| | - Lu Zhongsheng
- Department of neurosurgery, Qinghai Provincial People's Hospital, Xining, China
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3
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Catapano JS, Singh R, Lawton MT, Stevens SM, Porter RW. Rare Giant Infected Intradiploic Skull Epidermoid Cysts. Cureus 2022; 14:e29375. [PMID: 36299917 PMCID: PMC9586716 DOI: 10.7759/cureus.29375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2022] [Indexed: 11/08/2022] Open
Abstract
Infections associated with giant intradiploic cranial epidermoid cysts are rare. This case report describes the successful surgical management of a 71-year-old diabetic man with a giant intradiploic cranial epidermoid cyst associated with a secondary infection. The patient underwent successful resection of the infected lesion with washout, debridement, and obliteration of the eustachian canal and external auditory canal. At the six-month follow-up, the infection was resolved and the patient was doing well clinically. Intradiploic epidermoid cysts are rare, and the presence of a superimposed otogenic infection is exceptionally rare and infrequently reported in the neurosurgical literature.
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4
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Gu MZ, Xu HM, Chen F, Xia WW, Li XY. Pediatric temporal fistula: Report of three cases. World J Clin Cases 2021; 9:7811-7817. [PMID: 34621831 PMCID: PMC8462237 DOI: 10.12998/wjcc.v9.i26.7811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 06/21/2021] [Accepted: 07/30/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pediatric temporal fistulae are rarely reported in the literature. Dissemination of these cases can help inform future diagnosis and effective treatment.
CASE SUMMARY Three pediatric patients came to the clinic due to repeated infections of the skin and soft tissue of the temporal area. One patient presented with a temporal fistula that penetrated the temporal bone and reached the dura mater. Another patient presented with a temporal fistula that penetrated into the temporal muscle fascia. The third patient presented with a fistula that penetrated the lateral wall of the orbit and entered the orbit. All patients underwent surgical fistula resection informed by preoperative computed tomography (CT) evaluation. Histopathological evaluation was also performed. All three patients were surgically treated successfully. Histopathological evaluations confirmed the fistula diagnoses in all three cases.
CONCLUSION For patients who have temporal fistulae with repeated infections, surgical treatment should be performed as soon as possible to prevent serious complications. CT can be very useful for preoperative evaluation. B-mode ultrasound examination and evaluation also have a certain auxiliary role.
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Affiliation(s)
- Mei-Zhen Gu
- Department of Otorhinolaryngology-Head and Neck Surgery, Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai 200062, China
| | - Hong-Ming Xu
- Department of Otorhinolaryngology-Head and Neck Surgery, Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai 200062, China
| | - Fang Chen
- Department of Otorhinolaryngology-Head and Neck Surgery, Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai 200062, China
| | - Wei-Wei Xia
- Department of Radiology, Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai 200062, China
| | - Xiao-Yan Li
- Department of Otorhinolaryngology-Head and Neck Surgery, Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai 200062, China
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Pagkou D, Del Maestro M, Luzzi S, Morbini P, Foroglou N, Galzio RJ. Acute-onset diplopia from intracranial hypertension due to torcular herophili obstruction by an hemorrhagic intradiploic epidermoid cyst. Surg Neurol Int 2021; 12:100. [PMID: 33880205 PMCID: PMC8053460 DOI: 10.25259/sni_578_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 02/19/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Epidermoid cysts are benign slow-growing congenital lesions, constituting approximately 1% of all cranial tumors. Most of these lesions are located intradurally, while about 10-25% of them are located within the diploic spaces. Intradiploic epidermoid cysts are usually discovered incidentally and may remain asymptomatic for many years, but in rare instances, they may grow intracranially and produce brain compression. Sometimes, intradiploic epidermoid cysts may occlude the main cranial venous sinuses causing intracranial hypertension. CASE DESCRIPTION We present the case of a 24-year-old male harboring a paramedian right occipital intradiploic cyst with erosion of both outer and inner bony tables, which occluded the torcular herophili producing a worsening symptomatology with acute-onset diplopia from right sixth cranial nerve palsy; the patient also presented bilateral papilledema, but only reported mild headache and dizziness. Neuroradiological studies evidentiated a lesion compatible with intradiploic epidermoid cyst with intralesional hemorrhagic component, overlying and almost completely occluding the torcular herophili. Considering the fast worsening of symptomatology and the evidence of intracranial hypertension, the patient was operated on immediately after completion of clinical and radiological assessment. The lesion was radically removed with almost immediate reversal of signs and symptoms. Histopathology confirmed the diagnosis of epidermoid cyst with intralesional hemorrhagic components. CONCLUSION Intradiploic epidermoid cysts may cause intracranial hypertension by occlusion of main cranial venous sinuses; intralesional hemorrhage may act as precipitating factor in occlusion of the torcular herophili, producing rapidly worsening intracranial hypertension, which requires prompt surgical treatment to reverse symptomatology. Radical surgical resection is necessary to avoid recurrence.
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Affiliation(s)
- Diamantoula Pagkou
- Department of Neurosurgery, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Mattia Del Maestro
- PhD School in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia
| | - Sabino Luzzi
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Patrizia Morbini
- Department of Molecular Medicine, Unit of Pathological Anatomy, University of Pavia, Pavia, Lombardia, Italy
| | - Nikolaos Foroglou
- Department of Neurosurgery, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Renato Juan Galzio
- Department of Neurosurgery, Maria Cecilia Hospital, Cotignola, Province of Ravenna, Italy
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6
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Choo Y, Seo Y, Choi J. Giant Intradiploic Epidermoid Cyst in the Occipital Bone: A Case Report. Brain Tumor Res Treat 2021; 9:21-25. [PMID: 33913268 PMCID: PMC8082287 DOI: 10.14791/btrt.2021.9.e3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 11/20/2022] Open
Abstract
Epidermoid cysts are uncommon intracranial tumors. As one of the extradural types of epidermoid cysts, intradiploic epidermoid cysts are even rarer tumors and occur in any part of the skull. We herein report a rare case of a giant intradiploic epidermoid cyst of the occipital bone. A 57-year-old woman presented with a 1-year history of localized headache in the occipital area. CT and MRI showed an extradural mass measuring 50×70 mm in the occipital bone with bony destruction. The patient underwent surgical resection. The tumor was completely removed with its capsule. There was no extension to the intradural space. The pathological report confirmed that the tumor was an epidermoid cyst. Follow-up MRI 24 months after the operation showed no recurrence. The headache was well controlled without any medications. We report a rare case of intradiploic epidermoid cyst with clinical and radiologic features and surgical treatment. It is important to consider this diagnosis for a patient with persistent regional headache with or without a growing scalp mass.
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Affiliation(s)
- Yoonhee Choo
- Department of Neurosurgery, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Korea
| | - Youngbeom Seo
- Department of Neurosurgery, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Korea.
| | - Joonhyuk Choi
- Department of Pathology, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Korea
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Spinato G, Gaudioso P, Falcioni M, Mosto MCD, Cocuzza S, Maniaci A, Fabbris C, Politi D, Volo T, Ferri E, Cristalli G, Mannelli L, Salvatore M, Rizzo PB, Frezza D. Giant Epidermoid Cyst of Posterior Fossa-Our Experience and Literature Review. Dose Response 2021; 19:15593258211002061. [PMID: 33815017 PMCID: PMC7995313 DOI: 10.1177/15593258211002061] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Intracranial epidermoid cysts are the most frequent congenital intracranial lesion. They rare and benign tumors that can present in different clinical situations depending on location and extension of the disease. Diagnosis is obtained with radiological imaging with RM and non-enhanced TC as elective investigating methods. Elective treatment is surgery, based on total/subtotal excision sparring healthy neurovascular structures, considering the benign nature of this lesion. CASE REPORT In this study we present the case of a 79-year-old woman affected by recidivist epidermal cyst of the posterior fossa. Clinical presentation was characterized by positional subjective vertigo, intense headache localized in the right part of the head increased by Valsalva maneuver and retroarticular subcutaneous swelling. Radiological investigation found a giant epidemoid cyst of the posterior fossa (8,4 x 4,8 x 5,8 cm), treated with surgery. In the postoperative, the patient was fine and no neurological deficit has been encounterd. REVIEW In this study, we present a review of the literature regarding giant epidermoid cysts of posterior fossa. Only 11 cases were reported before ours, which actually is one of the largest ever described.
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Affiliation(s)
- Giacomo Spinato
- Department of Neurosciences, Section of Otolaryngology and Regional Centre for Head and Neck Cancer, University of Padova, Treviso, Italy
- Department of Surgery, Oncology and Gastroenterology, Section of Oncology and Immunology, University of Padova, Padova, Italy
| | - Piergiorgio Gaudioso
- Department of Neurosciences, Section of Otolaryngology and Regional Centre for Head and Neck Cancer, University of Padova, Treviso, Italy
| | - Maurizio Falcioni
- Department of Head and Neck, University Hospital of Parma, Parma, Italy
| | - Maria Cristina Da Mosto
- Department of Neurosciences, Section of Otolaryngology and Regional Centre for Head and Neck Cancer, University of Padova, Treviso, Italy
| | - Salvatore Cocuzza
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section; University of Catania, Catania, Sicily, Italy
| | - Antonino Maniaci
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section; University of Catania, Catania, Sicily, Italy
| | - Cristoforo Fabbris
- Department of Neurosciences, Section of Otolaryngology and Regional Centre for Head and Neck Cancer, University of Padova, Treviso, Italy
| | - Doriano Politi
- Functional Department of Head and Neck, ENT Unit, ULSS3, Venice-Mestre Hospital, Venice, Italy
| | - Tiziana Volo
- Functional Department of Head and Neck, ENT Unit, ULSS3, Venice-Mestre Hospital, Venice, Italy
| | | | | | | | | | - Paolo Boscolo Rizzo
- Department of Neurosciences, Section of Otolaryngology and Regional Centre for Head and Neck Cancer, University of Padova, Treviso, Italy
| | - Daniele Frezza
- Otosurgery Unit, ULSS2, Treviso Hospital, Treviso, Italy
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Intradiploic epidermoid cyst with large osteolytic lesions of the skull vault treated surgically: Lifelong implications. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2020.100833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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9
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Mohan A, Unni C, Kannoth P, Parambil RM. A Rare Case of Giant Intradiploeic Epidermal Cyst of the Frontal Bone with Intracranial Extension. Asian J Neurosurg 2020; 15:670-673. [PMID: 33145225 PMCID: PMC7591193 DOI: 10.4103/ajns.ajns_78_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 03/29/2020] [Accepted: 05/06/2020] [Indexed: 11/04/2022] Open
Abstract
Calvarial intradiploeic epidermal cyst are very rare neoplasms which can have intracranial extension. These cysts can attain a large size and can cause lytic destruction of the calvarium resembling malignancy. Since these lesions are benign complete excision is curative. We report the case of a 77-year-old male patient who presented with a large swelling on the forehead. Computed tomography and magnetic resonance imaging showed an expansile lytic lesion with intracranial extension. Complete excision of the lesion with cranioplasty was done. Histopathology was consistent with the epidermal cyst. These cysts attaining gigantic proportions are very few in literature.
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Affiliation(s)
- Akhil Mohan
- Department of Neurosurgery, Government Medical College. Kozhikode, Kerala, India
| | - Chandramohan Unni
- Department of Neurosurgery, Government Medical College. Kozhikode, Kerala, India
| | - Prakasan Kannoth
- Department of Neurosurgery, Government Medical College. Kozhikode, Kerala, India
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10
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Mimura T, Yamazaki H, Hayashi M, Kato H. Intraosseous Epidermoid Cyst of the Radius. J Hand Surg Am 2019; 44:996.e1-996.e5. [PMID: 30711194 DOI: 10.1016/j.jhsa.2018.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/15/2018] [Accepted: 12/10/2018] [Indexed: 02/02/2023]
Abstract
We report the rare case of an intraosseous epidermoid cyst of the distal radius associated with an acute infection in a 79-year-old woman.
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Affiliation(s)
- Tetsuhiko Mimura
- Department of Orthopaedic Surgery, Aizawa Hospital, Matsumoto, Japan
| | - Hiroshi Yamazaki
- Department of Orthopaedic Surgery, Aizawa Hospital, Matsumoto, Japan.
| | - Masanori Hayashi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hiroyuki Kato
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
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11
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Epidermoid Cyst with Torcular Herophili Obstruction and Unusual Venous Drainage. World Neurosurg 2019; 128:14-17. [PMID: 31054339 DOI: 10.1016/j.wneu.2019.04.223] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 04/24/2019] [Accepted: 04/25/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND An epidermoid cyst arising from diploic space in the skull can cause an intracranial mass effect with compression of the underlying venous sinuses. CASE DESCRIPTION A 66-year-old woman came to us with a persistent headache and unsteadiness. Computed tomography demonstrated an occipital bone cystic lesion with an intracranial mass effect overlying the torcular herophili, with high-intensity findings in diffusion-weighted magnetic resonance imaging. Cerebral angiogram demonstrated obstruction of the torcular herophili with development of diploic venous drainage. The patient underwent removal of the lesion and a cranioplasty procedure. The diagnosis was torcular epidermoid cyst. The postoperative course was uneventful, and the symptoms were resolved. CONCLUSIONS Development of diploic venous drainage contributed to avoidance of critical intracranial hypertension during slow growth of a torcular epidermoid cyst.
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12
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Moreira-Holguin JC, Medélez-Borbonio R, Quintero-Lopez E, García-González U, Gómez-Amador JL. Intradiploic epidermoid cyst with intracranial hypertension syndrome: Report of two cases and literature review. Int J Surg Case Rep 2015; 16:81-6. [PMID: 26433925 PMCID: PMC4643448 DOI: 10.1016/j.ijscr.2015.09.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 09/17/2015] [Accepted: 09/17/2015] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Intradiploic epidermoid intracranial cysts (IEIC) derive from ectodermal cells and are covered with stratified squamous epithelium. They are extremely rare, and most common locations are in the occipital, frontal and parietal bones. They have a very slow growth and can be asymptomatic until becoming evident by the deformation produced. The treatment is based on the removal of the lesion, and subsequent histopathological confirmation. PRESENTATION OF CASE Two cases are reported, with intracranial hypertension syndrome, which is very uncommon because of the slow growth of this type of pathology; however, decompensations occurring in the space-occupying lesions at intracranial level explain this type of clinical presentation. DISCUSSION The most common presentation of intracranial intradiploic epidermoid cysts (IEIC) is asymptomatically, which is made evident by the prominence at the level of the soft tissues and then presenting less frequently local pain and cephalea; rarely the size of the lesion can cause focal neurological signs. CONCLUSION These benign lesions, although they are of low incidence, are seen very rarely in intradiploic locations and above all, of significant size, may produce significant mass effect in patients, which was initially tolerated because of its slow growth, however, they may become decompensate and cause intracranial hypertension syndrome.
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Affiliation(s)
- J C Moreira-Holguin
- Neurosurgery Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico City, Mexico.
| | - R Medélez-Borbonio
- Neurosurgery Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico City, Mexico
| | - E Quintero-Lopez
- Neurosurgery Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico City, Mexico
| | - U García-González
- Neurosurgery Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico City, Mexico
| | - J L Gómez-Amador
- Neurosurgery Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Mexico City, Mexico
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13
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Primary epidermoid cysts of the mastoid: clinical and treatment implications. Eur Arch Otorhinolaryngol 2015; 273:1055-9. [DOI: 10.1007/s00405-015-3644-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 05/01/2015] [Indexed: 11/25/2022]
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Abstract
Intracranial epidermoid cysts constitute about 1% of all intracranial tumors. They are usually congenital in origin and are thought to derive from ectodermal cell inclusions occurring during closure of the neural tube. Twenty-five percent of these are found in the skull as intradiploic epidermoid cysts. These intradiploic cysts are usually congenital, slow growing, and can grow to large size without causing symptoms. We present a case of intradiploic epidermoid cyst of frontal bone developed due to childhood trauma. The cyst expanded and eroded the walls of the frontal sinus causing proptosis, diplopia, and restricted eye movements with frontal headache. The bicoronal flap approach was used for complete removal of the cyst. Complete removal of the cyst wall is necessary to avoid recurrence.
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15
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Giant Intradiploic Epidermoid Cyst Presenting as Solitary Skull Mass With Intracranial Extension. J Craniofac Surg 2013; 24:2169-71. [DOI: 10.1097/scs.0b013e3182a2d820] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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16
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Bahl A, Lawson A, Cohen M, Sinha S. Solitary cholesteatoma of the parietal bone. Pediatr Neurosurg 2012; 48:129-30. [PMID: 23037636 DOI: 10.1159/000342683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 08/07/2012] [Indexed: 11/19/2022]
Affiliation(s)
- Anuj Bahl
- Department of Neurosurgery, Sheffield Children's Hospital, Western Bank Sheffield S10 2TF, UK.
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17
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Kurabe S, Okamoto K, Sasaki O, Fujii Y. Supratentrial extradural endodermal cyst involving the frontal bone. Acta Neurochir (Wien) 2011; 153:2493-4. [PMID: 21796361 DOI: 10.1007/s00701-011-1104-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 07/19/2011] [Indexed: 12/25/2022]
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19
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Rutherford SA, Leach PA, King AT. Early recurrence of an intracranial epidermoid cyst due to low-grade infection: case report. Skull Base 2011; 16:109-16. [PMID: 17077875 PMCID: PMC1502036 DOI: 10.1055/s-2005-926217] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Intracranial epidermoid cysts are slow-growing lesions, which may recur after incomplete resection, but do so over many years. The authors present the case of an epidermoid that repeatedly recurred over a short period, which was discovered to be secondary to a low-grade bacterial infection. A 30-year-old woman presented with signs and symptoms related to brainstem and cranial nerve compromise from a large cerebellopontine angle epidermoid cyst. She underwent a subtotal excision of a macroscopically and histologically typical epidermoid. The lesion recurred within 1 year of surgery, but with atypical radiological appearances. No systemic or local evidence of infection was found during a second resection. A further large recurrence with the same atypical features occurred after another 6 months, necessitating a third surgical resection. On this occasion, the atypical cyst contents grew coagulase-negative Staphylococcus after prolonged culture in an enrichment medium. Following a course of appropriate antibiotics, the residual cyst contents completely resolved. This case highlights an unusual complication of an epidermoid cyst. Early recurrence of an epidermoid, even in the absence of overt evidence of infection, should produce a high index of suspicion that there may be a low-grade infective cause. Surgical excision coupled with antibiotics resulted in a symptomatic and radiological recovery.
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Affiliation(s)
- Scott A. Rutherford
- Department of Neurosurgery, Hope Hospital, Salford, Manchester, United Kingdom
| | - Paul A. Leach
- Department of Neurosurgery, Hope Hospital, Salford, Manchester, United Kingdom
| | - Andrew T. King
- Department of Neurosurgery, Hope Hospital, Salford, Manchester, United Kingdom
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20
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Enchev Y, Kamenov B, William A, Karakostov V. Posttraumatic giant extradural intradiploic epidermoid cysts of posterior cranial fossa : case report and review of the literature. J Korean Neurosurg Soc 2011; 49:53-7. [PMID: 21494364 DOI: 10.3340/jkns.2011.49.1.53] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Revised: 12/01/2010] [Accepted: 12/31/2010] [Indexed: 11/27/2022] Open
Abstract
We reported a unique case of posttraumatic giant infratentorial extradural intradiploic epidermoid cyst. A 54-year-old male, with a previous history of an open scalp injury and underlying linear skull fracture in the left occipital region in childhood, presented with a painful subcutaneous swelling, which had been developed gradually in the same region and moderate headache, nausea, vomiting and cerebellar ataxia. The duration of symptoms on admission was 3 months. Imaging studies revealed occipital bone destruction and giant extradural intradiploic lesion. The preoperative diagnosis was giant infratentorial extradural intradiploic epidermoid cyst. Surgery achieved total removal of the lesion, which was histologically confirmed and the postoperative course was uneventful. To our knowledge, this is the first case of giant infratentorial extradural intradiploic epidermoid cyst with a traumatic etiology described in the literature.
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Affiliation(s)
- Yavor Enchev
- Department of Neurosurgery, Medical University-Sofia, Sofia, Bulgaria
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Ichimura S, Hayashi T, Yazaki T, Yoshida K, Kawase T. Dumbbell-shaped intradiploic epidermoid cyst involving the dura mater and cerebellum. Neurol Med Chir (Tokyo) 2008; 48:83-5. [PMID: 18296878 DOI: 10.2176/nmc.48.83] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 55-year-old woman presented with an epidermoid cyst extending to the cerebellum manifesting as headaches and pain in the left eye. Magnetic resonance imaging showed an intradiploic part with ring enhancement and an intracerebellar part. Intraoperative inspection revealed erosion of the occipital bone and defective dura mater. The tumor was located both epidurally and subdurally and the cyst consisted of pearly white keratin. The tumor was totally removed and the patient was discharged with no neurological deficit. The intradiploic part of the tumor formed the body and the intracerebellar part was caused by inflammatory reaction, which resulted in the atypical enhancement of the intradiploic part.
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Affiliation(s)
- Shinya Ichimura
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan.
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22
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Prat Acín R, Galeano I. Giant occipital intradiploic epidermoid cyst associated with iatrogenic puncture. Acta Neurochir (Wien) 2008; 150:413-4. [PMID: 18301860 DOI: 10.1007/s00701-008-1490-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2007] [Accepted: 12/04/2007] [Indexed: 12/28/2022]
Abstract
The origin of cranial epidermoid cysts (EC) remains controversial, and although generally considered to be congenital, acquired origin has been reported. EC represent 0.2 to 1.8% of all brain tumours, and only one fourth are intradiploic in location. We report of a 44-year-old woman with a giant intradiploic EC of the occipital bone with intracranial extension confirmed on brain MRI. Three years previously, in the same location, she underwent resection of an intradermal melanocytic naevus of the skin under local anaesthesia with lidocaine infiltration of skin and periosteum. Brain CT scan performed at the time of naevus surgery because of associated headache did not show a lesion of the cranial vault. Iatrogenic epidermoid tumours are extremely rare, and although seeding of epidermal cells has been classically described only after lumbar puncture, the same mechanism may be involved after head injury, cranial surgery or cranial periosteal iatrogenic puncture.
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Affiliation(s)
- R Prat Acín
- Department of Neurosurgery, Hospital La Fe Avda, Valencia, Spain.
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23
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Ajja A, Akhaddar A, Naama O, Guazzaz M, Belhachmi A, Asri Abad C, Elmoustarchid B, Boucetta M. [Intradiploic epidermoid cyst of the occipital bone]. Neurochirurgie 2007; 53:367-70. [PMID: 17692342 DOI: 10.1016/j.neuchi.2007.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2007] [Accepted: 06/22/2007] [Indexed: 12/27/2022]
Abstract
BACKGROUND A rare case of intradiploic epidermoid cyst of the occipital bone is described and recent literature, which emphasizes the radiological evaluation and surgical treatment of this lesion is reviewed. CASE DESCRIPTION A 56-year-old female patient complained of headache and occasional episodes of vertigo for one year. Computed tomographic scan and magnetic resonance imaging were performed. The patient underwent occipital right craniotomy followed by total removal of the cyst and its capsule. RESULT The postoperative course was uneventful and the patient was discharged 4 days later. CONCLUSION A review of the literature shows that intradiploic epidermoid cyst of the occipital bone is rare. Correct radiological assessment and complete excision of this lesion and its capsule provides complete recovery.
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Affiliation(s)
- A Ajja
- Service de Neurochirurgie, Hôpital Militaire d'Instruction Mohamed-V, Rabat, Maroc.
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24
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Cho JH, Jung TY, Kim IY, Jung S, Kang SS, Kim SH. A giant intradiploic epidermoid cyst with perforation of the dura and brain parenchymal involvement. Clin Neurol Neurosurg 2007; 109:368-73. [PMID: 17254702 DOI: 10.1016/j.clineuro.2006.12.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2006] [Revised: 12/16/2006] [Accepted: 12/18/2006] [Indexed: 12/18/2022]
Abstract
A patient with a long-standing intradiploic epidermoid cyst with perforation of the dura and brain parenchymal involvement is reported. A 69-year-old man, who had previously presented with a subcutaneous mass on the left frontoparietal scalp, developed a sudden grand mal seizure. Magnetic resonance imaging showed a well-defined mass in the frontoparietal scalp with destruction of the skull. Penetration of the dura allowed for communication with the intracranial structures. Surgical resection and cranioplasty were performed. There were no well-defined margins in the deep portion and the mass was subtotally removed. Histological examination showed that the cystic structure was lined by squamous epithelium containing laminated keratin material. The pathologic findings were consistent with the diagnosis of an epidermoid cyst.
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Affiliation(s)
- Jong-Ho Cho
- Department of Neurosurgery, Chonnam National University Hwasun Hospital and Medical School, Gwangju, Republic of Korea
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25
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Alberione F, Caire F, Fischer-Lokou D, Gueye M, Moreau J. Quiste epidermoide intradiploico infratentorial gigante. Neurocirugia (Astur) 2007. [DOI: 10.1016/s1130-1473(07)70270-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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26
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Patel K, Bhuiya T, Chen S, Kenan S, Kahn L. Epidermal inclusion cyst of phalanx: a case report and review of the literature. Skeletal Radiol 2006; 35:861-3. [PMID: 16416148 DOI: 10.1007/s00256-005-0058-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2005] [Revised: 10/15/2005] [Accepted: 10/31/2005] [Indexed: 02/02/2023]
Abstract
Epidermal cyst within a toe phalanx is an extremely rare condition. It is important to differentiate this benign lesion, which can be easily treated by curettage, from other benign and malignant lesions of the bone with a similar clinical presentation, and which may require amputation of the toe. This report describes one such lesion in the mid-phalanx of the fourth toe in a 48-year-old woman, and which was successfully identified by intra-operative frozen diagnosis and treated by curettage.
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Affiliation(s)
- Keyur Patel
- Pathology and Laboratory Medicine, Long Island Jewish Medical Center, 170-05 76th Ave, New Hyde Park, NY 11040, USA
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27
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Nambu A, Imanishi Y, Iwasaki Y, Fujikawa M, Hayashi T, Shinagawa T, Araki T. Intradiploic epidermoid cyst with focal internal enhancement. ACTA ACUST UNITED AC 2006; 24:224-7. [PMID: 16875312 DOI: 10.1007/s11604-005-1545-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We report a case of intradiploic epidermoid cyst with focal internal enhancement. The patient was a 55-year-old woman presenting with right temporal head protrusion and head heaviness. Skull radiography and computed tomography demonstrated an expansile mass in the right diploic space. On magnetic resonance imaging, the mass showed makedly high signal T2-weighted images (T2WI) and intermediate to low signal on T1WI. On contrast-enhanced T1WI, there was nodular internal enhancement, which corresponded to neovascularity on pathology, as well as rim-like enhancement. It should be noted that internal enhancement, an indicator of malignant transformation, may be seen even in a benign epidermoid cyst.
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Affiliation(s)
- Atsushi Nambu
- Department of Radiology, St. Marianna University Toyoko Hospital, Kosugi-cho, Nakahara-ku, Kawasaki 211-0063, Japan.
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28
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Shellenberger DL, Roehm PC, Gantz B. Large extradural epidermoid tumor of the temporal bone and posterior fossa cranium. Otol Neurotol 2006; 27:1043-4. [PMID: 16691151 DOI: 10.1097/01.mao.0000169052.46383.9d] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- D Luke Shellenberger
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242-1078, USA
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29
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Abstract
Intradiploic inclusion cyst of the skull presenting as a calvarial defect is fairly uncommon in the neuroscience practice. They are benign in nature, slow to grow, and clinically difficult to differentiate from other causes of calvarial defects. We present a case of a healthy 55-year-old woman who presented clinically for an asymptomatic lump over the right parieto-occipital region of the scalp of 4-month duration. The radiological features were suggestive of presence of a large intradiploic solitary cyst and additional multiple lytic defects with sclerotic borders, destroying the underlying bone. The gross and histomorphological features of the right parieto-occipital craniectomy specimen received were pathognomic of an intradiploic primary epithelial inclusion cyst of the skull bone. The importance of its benign nature, embryogenic origin, and differentiation from other cystic lesions with similar histology is stressed. We report this case for its unique histomorphology and first of its kind in the Indian literature.
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Affiliation(s)
- Alka Kalgutkar
- Department of Pathology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai 400022, India.
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30
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Borha A, Emery E, Khouri S, Hitier M, Derlon JM. Kyste épidermoïde extra-dural géant de la fosse postérieure. Neurochirurgie 2005; 51:599-603. [PMID: 16553334 DOI: 10.1016/s0028-3770(05)83636-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We report an unusual case of giant extradural epidermoid cyst of the posterior fossa in a 73-year-old man. The patient presented headache and gait disturbance for 3-4 months, cerebellar ataxia, left cerebellar dysmetria, and perturbed balance. The CT-scan showed a huge posterior fossa extradural lesion with a small area of peripheral contrast enhancement. Outcome was good after total resection of the lesion via a suboccipital approach. Pathology reported an epidermoid cyst. Extradural epidermoid cyst is a rare benign tumor of the skull which sometimes can reach considerable size. It is a slow growing lesion and may cause mild neurological deficits. The goal of surgical treatment is total resection of the tumor with its capsule. The long-term prognosis is excellent after successful resection.
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Affiliation(s)
- A Borha
- Service de Neurochirurgie, CHU de Caen.
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31
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Bikmaz K, Cosar M, Bek S, Gokduman CA, Arslan M, Iplikcioglu AC. Intradiploic epidermoid cysts of the skull: a report of four cases. Clin Neurol Neurosurg 2005; 107:262-7. [PMID: 15884157 DOI: 10.1016/j.clineuro.2004.06.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Epidermoid cysts are uncommon, benign and slow-growing lesions. They may often reach an enormous size without producing neurological symptoms. Intradiploic epidermoid cysts are nearly 25% of all epidermoids. They are derived from ectodermal remnants that stay within the cranial bones during embryonic development. Intradiploic epidermoid cysts can be located in any part of the skull. Two of our four cases were located in left occipital bone and the others were in the frontal bone. These tumours can occur at any age from the first to the seventh decade of life. Our cases had a mean age of 38.75 years (19-55 years). They may reach great sizes before the initial diagnosis and may produce major neurological signs. For good long-term prognosis, correct radiological assessment and complete removal of the tumour with its capsule are essential. We report four cases of intradiploic epidermoid cysts of the skull and analyse the clinical, radiological features and treatment of these lesions in the light of relevant literature.
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Affiliation(s)
- Kerem Bikmaz
- Department of Neurosurgery, Social Security Okmeydani Teaching Hospital, Istanbul, Turkey
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32
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Ozdemir HM, Senaran H, Ogun TC, Oltulu P. Intracortical epidermoid cyst of the tibia. Skeletal Radiol 2004; 33:481-4. [PMID: 14740184 DOI: 10.1007/s00256-003-0729-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2003] [Revised: 11/04/2003] [Accepted: 11/05/2003] [Indexed: 02/02/2023]
Abstract
Epidermoid cyst in a long bone is an extremely rare condition. The authors describe such a tumor located in the cortex of the tibia in a 21-year-old woman. She was successfully treated with curettage and autogenous bone grafting.
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Affiliation(s)
- H Mustafa Ozdemir
- Department of Orthopaedics and Traumatology, Selcuk University Meram School of Medicine, Konya, Turkey
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