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Year : 2020  |  Volume : 9  |  Issue : 3  |  Page : 144-149

Clinical, radiological and microneurosurgical aspects in the management of intracranial epidermoid cysts: Experience with 38 cases

Department of Neurosurgery, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India

Correspondence Address:
Niranjan Vayyala
Assistant Professor, Department of Neurosurgery, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JCSR.JCSR_127_19

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Objectives: There is considerable debate in the surgical management of epidermoid cyst whether gross total or subtotal resection yields better long term outcomes. We present our institutional experience in evaluating the clinical presentation, diagnosis and surgical strategy and extent of resection in the management of intracranial epidermoid cyst. Methods: We retrospectively reviewed the case records of 38 patients with intracranial epidermoid tumors surgically treated at our institution between 2010 and 2019. Results: A total of 38 patients who underwent surgery for intracranial epidermoid lesions were identified. Of these 17 were supratentorial, 20 were infratentorial lesions and one case lesion was extending from cerebellopontine region to middle fossa. The mean duration from onset of symptoms to surgery was 3.9 years. Cranial nerve dysfunction was noted in 73% of patients preoperatively most of them being the Cerebellopontine angle epidermoids. Total removal was achieved in 28 patients, near-total removal in 8 patients, and subtotal removal in 2 patients. 6 patients developed recurrence radiologically of them only one patient became symptomatic. Of the six 2 were patients who underwent gross total resection and the remaining 4 were from near and subtotal resection. The mean duration of follow-up was 3.8 years. The content of the tumor was pearly white/white material in all cases. complications noted in the present series were not related to the completeness of excision. Mortality was noted in one patient. Conclusions: The present study highlights various precautions to be taken intraoperatively in the prevention of development of aseptic meningitis and concludes that total removal of epidermoids does not result in significantly increased morbidity and mortality and should be the goal of surgical treatment. However, near/subtotal resection oflesions that are densely adherent to neurovascular structures is justified, as there is no significant difference in the rate of recurrence. An endoscope can be used to assess the completeness of surgery.

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