Spontaneous Regression of Radiologically Diagnosed Epidermoid Cyst Originating from the Cerebellopontine Angle

Abstract The combined transpetrosal approach enables wide exposure around the petroclival region by cutting the tentorium and superior petrosal sinus. We often choose this approach for removal of tumors ventral to the facial and vestibulocochlear nerves, such as petroclival meningioma and epidermoid cyst, because complete removal of the tumor under direct visualization is required to prevent its later recurrence, especially in young patients. Recent reports revealed anatomical variations of the drainage of the superior petrosal sinus, and dural incision considering preservation of the superior petrosal vein was proposed.1-3 This 3-dimensional video shows a patient with an epidermoid cyst, which was surgically treated using the combined transpetrosal approach, with consideration of the variation of the superior petrosal sinus and preservation of the drainage route of the superior petrosal vein. The video was reproduced after informed consent of the patient. The patient is a 31-yr-old woman who presented with a left cerebellopontine angle epidermoid cyst extending into Meckel's cave. The superior petrosal sinus was of the lateral type, draining only laterally into the transverse–sigmoid junction without medial connection with the cavernous sinus.1 The combined transpetrosal approach was performed with cutting of the superior petrosal sinus medial to the entry point of the superior petrosal vein, in order to preserve its drainage into the transverse–sigmoid junction. Meckel’ cave was opened along its lateral margin, and tumor removal was accomplished, leaving only a minute part of the capsule strongly adhering to the neurovascular structures. The patient had no new permanent neurological deficits during follow-up. The figures in the video were modified from Matsushima et al1 by permission of the Congress of Neurological Surgeons.

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Epidermoid cyst with infiltrative malignant melanoma in the cerebellopontine angle

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2005.07.024 ◽

2006 ◽

Vol 13 (6) ◽

pp. 669-672 ◽

Cited By ~ 2

Author(s):

Fan-gang Meng ◽

Cheng-yuan Wu ◽

Zhao-hua Liu ◽

Shu-gan Zhu ◽

Yu-guang Liu

Keyword(s):

Malignant Melanoma ◽

Epidermoid Cyst ◽

Cerebellopontine Angle

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Physiopathological Aspects of Sellar Epidermoid Cyst Determining Endocrine Disturbances: A Case Report

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0039-1693684 ◽

2019 ◽

Vol 38 (03) ◽

pp. 210-214

Author(s):

Eduardo Cambruzzi ◽

Nelson Pires Ferreira ◽

Gabriel Barcellos ◽

Pablo Fruet

Keyword(s):

Epidermoid Cyst ◽

Cerebellopontine Angle ◽

Squamous Epithelium ◽

Visual Disturbance ◽

Epidermoid Cysts ◽

Endocrine Disturbances ◽

Tumoral Lesion ◽

The Central Nervous System ◽

Trapped Surface ◽

Endocrine Alterations

AbstractEpidermoid cysts (ECs) of the central nervous system (CNS) constitute benign circumscribed lesions that are more common in lateral than in midline sites. Epidermoid cysts of the CNS arise more frequently in the cerebellopontine angle, around the pons, near the sella, within the temporal lobe, in the diploe, and in the spinal canal. Most common tumoral lesion of sellar region is pituitary adenoma, and sellar cystic epithelial masses may be difficult to differentiate based only on clinical and imaging findings. Epidermoid cysts are covered by keratinized squamous epithelium and are usually filled with keratin lamellae. The process is, for the most part, maldevelopmental in origin, presumably arising from trapped surface ectodermal elements in association with the developing CNS during the closure of the neural groove or formation of the secondary cerebral vesicles. In the present study, the authors describe a case of sellar epidermoid cyst producing endocrine alterations and visual disturbance in a 35 years woman, and review the physiopathological and diagnostic criteria of this lesion.

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Calcified Epidermoid Cyst at an Unusual Location in a 5-Year-Old Child with Intellectual Disability

Journal of Pediatric Neurology ◽

10.1055/s-0037-1606359 ◽

2017 ◽

Vol 16 (04) ◽

pp. 232-235

Author(s):

Pramod Giri ◽

Kirti Jaiswal ◽

Milind Bhatkule ◽

Vaibhav Chavan

Keyword(s):

Intellectual Disability ◽

Epidermoid Cyst ◽

Cerebellopontine Angle ◽

Clinical Presentation ◽

Unusual Site ◽

Suprasellar Region ◽

Interhemispheric Fissure ◽

Intracranial Neoplasm ◽

The Right ◽

Slow Growing

AbstractAn epidermoid cyst is a rare intracranial neoplasm. It is mostly found in cerebellopontine angle, suprasellar region, interhemispheric fissure, and is rarely found in other locations too. Epidermoid cyst at the parietooccipital area is rare, and calcification among epidermoids is very unusual and dystrophic in nature. The clinical presentation is usually in adults because of slow-growing nature of epidermoid cyst. Here, we present the case of a 5-year-old child with intellectual disability who presented with seizure and frequent crying episodes and was diagnosed with an intradural extra-axial calcified mass of size 8 × 5.5 × 5 cm in the right parietooccipital region which turned out to be a calcified epidermoid cyst and was excised successfully in toto. This is the youngest reported case of the calcified epidermoid cyst at an unusual site of our knowledge.

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Cerebellopontine Angle Epidermoid Cyst: Case Report

International Journal of Otolaryngology and Head &amp Neck Surgery ◽

10.4236/ijohns.2013.21002 ◽

2013 ◽

Vol 02 (01) ◽

pp. 5-7

Author(s):

Fabio Di Giustino ◽

Rudi Pecci ◽

Beatrice Giannoni ◽

Paolo Vannucchi

Keyword(s):

Case Report ◽

Epidermoid Cyst ◽

Cerebellopontine Angle

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Cerebellar Liponeurocytoma Mimicking Cerebellopontine Angle Epidermoid Cyst: A Case Report

Case Reports in Clinical Medicine ◽

10.4236/crcm.2014.34054 ◽

2014 ◽

Vol 03 (04) ◽

pp. 235-239

Author(s):

Oumar Coulibaly ◽

Seylan Diawara ◽

Nizar Fatemi ◽

Rachid Gana ◽

Amar Saïdi ◽

...

Keyword(s):

Case Report ◽

Epidermoid Cyst ◽

Cerebellopontine Angle ◽

Cerebellar Liponeurocytoma

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Endoscopic Resection of a Cerebellopontine Angle Epidermoid Cyst via a Retrosigmoid Approach

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0039-1677852 ◽

2019 ◽

Vol 80 (S 03) ◽

pp. S330-S330

Author(s):

Frederick Luke Hitti ◽

John Y.K. Lee

Keyword(s):

Magnetic Resonance Imaging ◽

Epidermoid Cyst ◽

Diffusion Weighted Imaging ◽

Facial Pain ◽

Cerebellopontine Angle ◽

Retrosigmoid Approach ◽

Resonance Imaging ◽

Sharp Dissection ◽

Magnetic Resonance Imaging Mri ◽

Tumor Debulking

A variety of lesions may arise within the cerebellopontine angle (CPA). Schwannomas and meningiomas are most commonly found in this location; however epidermoid cysts may also be found in this area. Here, we present the case of a 31-year-old man with severe right facial pain. Magnetic resonance imaging (MRI) demonstrated a right CPA mass that had heterogenous intensity on T2-weighted imagining and restricted diffusion on diffusion-weighted imaging. The patient was offered resection of the mass for treatment of his facial pain via an endoscopic retrosigmoid approach. We provide a video that illustrates the steps taken to resect this mass endoscopically. The mass was white and friable. The tumor was resected using a combination of sharp dissection with the microscissors and round knife and aspiration. As the tumor was removed, the 5th nerve was visualized deep to the tumor. The tumor was freed from any adhesions and was resected piecemeal. The round knife was used to free the tumor from surrounding venous structures. The brainstem and origin of the trigeminal nerve were visualized with further tumor debulking. We moved inferiorly to resect the remainder of the tumor. We worked around the surrounding vasculature to resect the tumor. Advancing the endoscope farther, we visualized Meckel's cave. The wound was irrigated and closed in standard fashion. Tissue pathology confirmed a diagnosis of epidermoid cyst. The vast majority of the mass was removed and the patient had resolution of his facial pain postoperatively.The link to the video can be found at: https://youtu.be/fSw5sw8xQz0.

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