Epidermoid cysts of the cavernous sinus: clinical features, surgical outcomes, and literature review

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OBJECTIVE

Epidermoid cysts of the cavernous sinus (CS) are rare, and no large case series of these lesions has been reported. In this study, the authors retrospectively reviewed the outcomes of the surgical management of CS epidermoid cysts undertaken at their center and performed a review of any such cysts reported in the literature over the past 40 years.

METHODS

Clinical data were obtained on 31 patients with CS epidermoid cysts that had been surgically treated at the authors’ hospital between 2001 and 2016. The patients’ medical records, imaging data, and follow-up outcomes were retrospectively analyzed. The related literature from the past 40 years (18 articles, 20 patients) was also evaluated.

RESULTS

The most common chief complaints were facial numbness or hypesthesia (64.5%), absent corneal reflex (45.2%), and abducens or oculomotor nerve deficit (35.5%). On MRI, 51.6% of the epidermoid cysts showed low T1 signals and equal or high T2 signals. In the other lesions, the radiological findings varied considerably given differences in the composition of the cysts. Surgery was performed via the extradural approach (58.1%), intradural approach (32.3%), or a combined approach (9.7%). After the operation, symptoms remained similar or improved in 90.3% of patients and new oculomotor paralysis developed after the operation in 9.7% of patients. Seven patients (22.6%) developed meningitis postoperatively (5 aseptic and 2 septic), and all of them recovered. All patients achieved good recovery before discharge (Karnofsky Performance Status score ≥ 70). Over an average follow-up of 4.6 ± 3.0 years in 25 patients (80.6%), no recurrence or reoperation occurred, regardless of whether total or subtotal resection of the capsule had been achieved.

CONCLUSIONS

Both the extradural and intradural approaches can enable satisfactory lesion resection. A favorable prognosis and symptomatic improvement can be expected after both total and subtotal capsule resections. Total capsule resection is encouraged to minimize the possibility of recurrence provided that the resection can be safely performed.

ABBREVIATIONS CPA = cerebellopontine angle; CS = cavernous sinus; DWI = diffusion-weighted imaging; IF = infratemporal fossa; KPS = Karnofsky Performance Status; MCF = middle cranial fossa; PA = petrous apex; PCF = posterior cranial fossa; PF = pterygopalatine fossa.

Article Information

Correspondence Jianping Song, Department of Neurosurgery, Huashan Hospital, Fudan University, No. 12 Wulumuqi Zhong Rd., Shanghai 200040, People’s Republic of China. email: neurosurgerysong@foxmail.com.

INCLUDE WHEN CITING Published online December 22, 2017; DOI: 10.3171/2017.6.JNS163254.

Drs. Zhou and Yang contributed equally to this work.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Case 1. The lesion appeared hypointense on T1-weighted imaging (A) and hyperintense on T2-weighted imaging (B). Hyperintense signals appeared around the lesion on enhanced T1-weighted imaging (C–E). The lesion appeared hyperintense on DWI (F), which helped to distinguish it from an arachnoid cyst. No recurrence was observed on the follow-up MR images (G and H).

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    Case 2. The lesion appeared hyperintense on CT (A) and T1-weighted imaging (B), and a flow void sign (C) was seen on T2-weighted imaging. A hypointense lesion was observed on DWI (D). Computed tomography angiography (E) and digital subtraction angiography (F) demonstrate no cerebral aneurysm and no staining of the lesion.

  • View in gallery

    Case 3. The lesion showed mixed signals on T1-weighted (A) and T2-weighted (B) images. Heterogeneous enhancement appeared on enhanced T1-weighted images (C and D). The lesion presented a typical cholesteatoma-like appearance (E) and was completely removed (F). No recurrence was observed on follow-up MR images (G and H). Figure is available in color online only.

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