Clinical, radiological, and pathological features of 24 atypical intracranial epidermoid cysts

Clinical article

View More View Less
  • 1 Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University; and
  • 2 Beijing Neurosurgical Institute, Beijing, China
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

Object

Most intracranial epidermoid cysts typically present with long T1 and T2 signals on MR images. Other epidermoid cysts with atypical MR images are often misdiagnosed as other diseases. In this study the authors aimed to analyze the incidence and the clinical, radiological, and pathological features of atypical epidermoid cysts.

Methods

Among 428 cases of intracranial epidermoid cysts that were surgically treated between 2002 and 2008 at Beijing Tiantan Hospital, cases with an atypical MR imaging appearance were chosen for analysis. Clinical and pathological parameters were recorded and compared in patients with lesions demonstrating typical and atypical MR appearance.

Results

An atypical epidermoid cyst accounts for 5.6% of the whole series. Radiologically, 58.3% of atypical epidermoids were misdiagnosed as other diseases. Compared with a typical epidermoid cyst, atypical epidermoid lesions were significantly larger (p = 0.016, chi-square test). Pathologically, hemorrhage was found in 21 patients with atypical epidermoid cyst and is significantly correlated with granulation (p = 0.010, Fisher exact test). Old hemorrhage was found in 13 cases and was significantly correlated with cholesterol crystals. Twenty-one patients were followed up for 1.3–8.6 years after surgery. The 5- and 8-year survival rates were both 100%. Three patients experienced cyst recurrence. The 5- and 8-year recurrence-free rates were 95% and 81.4%, respectively.

Conclusions

Radiologically, an atypical epidermoid cyst should be differentiated from dermoid cyst, teratoma, schwannoma, glioma, craniopharyngioma, and cavernous angioma. A tendency toward spontaneous hemorrhage is confirmed in atypical epidermoid cysts, and a hypothesis was proposed for spontaneously intracystic hemorrhage in atypical epidermoid cysts. Follow-up confirmed long-term survival of patients with atypical epidermoid cysts.

Abbreviations used in this paper: CPA = cerebellopontine angle; KPS = Karnofsky Performance Scale.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address correspondence to: Song Lin, M.D., Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantan Xili No 6, Beijing 100050, China. email: linsong2005@126.com.

Please include this information when citing this paper: published online December 16, 2011; DOI: 10.3171/2011.10.JNS111462.

  • 1

    Ahmad I, , Tominaga T, , Ogawa A, & Yoshimoto T: Ruptured suprasellar dermoid associated with middle cerebral artery aneurysm: case report. Surg Neurol 38:341346, 1992

    • Search Google Scholar
    • Export Citation
  • 2

    Chen CY, , Wong JS, , Hsieh SC, , Chu JS, & Chan WP: Intracranial epidermoid cyst with hemorrhage: MR imaging findings. AJNR Am J Neuroradiol 27:427429, 2006

    • Search Google Scholar
    • Export Citation
  • 3

    Ecker RD, , Atkinson JL, & Nichols DA: Delayed ischemic deficit after resection of a large intracranial dermoid: case report and review of the literature. Neurosurgery 52:706710, 2003

    • Search Google Scholar
    • Export Citation
  • 4

    Guidetti B, & Gagliardi FM: Epidermoid and dermoid cysts. Clinical evaluation and late surgical results. J Neurosurg 47:1218, 1977

  • 5

    Hasegawa H, , Bitoh S, , Nakata M, , Fujiwara M, & Yasuda H: Intracranial epidermoid mimicking meningioma. Surg Neurol 15:372374, 1981

  • 6

    Hsieh CH, , Huang KM, , Kao MC, , Peng S, & Wang CC: Hemorrhage in intracranial epidermoid cyst. J Formos Med Assoc 95:173175, 1996

  • 7

    Inoue Y, , Ohata K, , Nakayama K, , Haba T, & Shakudo M: An unusual middle fossa interdural epidermoid tumor. Case report. J Neurosurg 95:902904, 2001

    • Search Google Scholar
    • Export Citation
  • 8

    Lopes M, , Capelle L, , Duffau H, , Kujas M, , Sichez JP, & Van Effenterre R, : [Surgery of intracranial epidermoid cysts. Report of 44 patients and review of the literature.]. Neurochirurgie 48:513, 2002. (Fr)

    • Search Google Scholar
    • Export Citation
  • 9

    Miyagi K, , Imaizumi T, , Yamanouchi H, , Hayashi H, & Kobayashi S: [Unusual CT and MRI appearance of the epidermoid tumor—a case report.]. No To Shinkei 45:177181, 1993. (Jpn)

    • Search Google Scholar
    • Export Citation
  • 10

    Osborn AG, , Blaser SI, , Salzman KL, , Latzman GL, , Provenzale J, & Castillo M: Diagnostic Imaging: Brain Salt Lake City, UT, Amirsys, 2004

  • 11

    Osborn AG, & Preece MT: Intracranial cysts: radiologic-pathologic correlation and imaging approach. Radiology 239:650664, 2006

  • 12

    Ren XH, , Chu C, , Zeng C, , Tian YJ, , Ma ZY, & Tang K, : Delayed postoperative hemorrhage in 21 patients with intracranial epidermoid cysts. Clinical article. J Neurosurg 114:15921602, 2011

    • Search Google Scholar
    • Export Citation
  • 13

    Sanchez-Mejia RO, , Limbo M, , Tihan T, , Galvez MG, , Woodward MV, & Gupta N: Intracranial dermoid cyst mimicking hemorrhage. Case report and review of the literature. J Neurosurg 105:4 Suppl 311314, 2006

    • Search Google Scholar
    • Export Citation
  • 14

    Tomlinson BE, & Walton JN: Granulomatous meningitis and diffuse parenchymatous degeneration of the nervous system due to an intracranial epidermoid cyst. J Neurol Neurosurg Psychiatry 30:341348, 1967

    • Search Google Scholar
    • Export Citation
  • 15

    Tsurushima H, , Kamezaki T, , Tomono Y, & Nose T: Intracranial epidermoid cyst including elements of old hematoma. Neurol Med Chir (Tokyo) 37:861864, 1997

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 699 319 15
Full Text Views 299 61 1
PDF Downloads 195 44 0
EPUB Downloads 0 0 0