Neurosurgical management of intracranial epidermoid tumors in children

Clinical article

Ibrahim Ahmed M.D., Kurtis I. Auguste M.D., Shobhan Vachhrajani M.D., Peter B. Dirks M.D., Ph.D., James M. Drake M.B.Ch., M.Sc. and James T. Rutka M.D., Ph.D.
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  • Division of Neurosurgery, The Hospital for Sick Children, The University of Toronto, Ontario, Canada
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Object

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.

Methods

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.

Results

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.

Conclusions

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.

Abbreviations used in this paper: CN = cranial nerve; CPA = cerebellopontine angle; DW = diffusion weighted; MEG = magnetoencephalography; STR = subtotal resection.

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Contributor Notes

Address correspondence to: James T. Rutka, M.D., Ph.D., The Division of Neurosurgery, Suite 1503, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8. email: james.rutka@sickkids.ca.
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