Occipital Intradiploic Epidermoid Cyst with Intracranial Hypertension

  • Published : 2006.11.30

Abstract

Intradiploic epidermoid cysts of the cranium are rare, benign and slow growing lesion. However, these cysts may cause neurologic deficits due to mass effect. Intradiploic epidermoid cysts are thought to be derived from persistent ectodermal remnants present in the cranial bones during embryogenic development. Here, we report a case of an occipital intradiploic epidermoid cyst with posterior fossa extension. The patient developed intracranial hypertension associated with hydrocephalus due to aqueductal stenosis, and venous congestion secondary to compression of the torcular and the transverse sinus. The imaging studies included a computerized tomography[CT] venogram, which is essential for determining the pathophysiological mechanism of the clinical spectrum and for surgical planning. Near total removal was accomplished and the postoperative course was uneventful. Postoperative imaging studies demonstrated a reversal of the neural structures, but no patency of the sinus, which was presumably indicative of prolonged sinus stenosis. The patient gradually improved and was discharged free of symptoms.

Keywords

References

  1. Bikmaz K, Cosar M, Bek S, Gokduman CA, Arslan M, Iplikcioglu AC : Intradiploic epidermoid cysts of the skull : a report of four cases. Clin Neurol Neurosurg 107 : 262-267, 2005 https://doi.org/10.1016/j.clineuro.2004.06.005
  2. Ciappetta P, Artico M, Salvati M, Raco A, Gagliardi FM : Intradiploic epidermoid cysts of the skull : Report of 10 cases and review of the literature. Acta Neurochir (Wien) 102 : 33-37, 1990 https://doi.org/10.1007/BF01402183
  3. Constans JP, Meder JF, De Divitiis E, Donzelli R, Maiuri F : Giant intradiploic epidermoid cysts of the skull. Report of 2 cases. J Neurosurg 62 : 445-448, 1985 https://doi.org/10.3171/jns.1985.62.3.0445
  4. Demaerel P, Wilms C, Lammens M, Nuttin B, Plets C, Baert AL : Extradural epidermoid tumor of the frontal bone. Neuroradiology 33 : 349-351, 1991 https://doi.org/10.1007/BF00587822
  5. Djindjian M, Keravel Y, Lepresle E, Caron JP, Ruel M, Gaston A : Occipital intraosseous epidermoid cyst producing a clinical picture simulating benign intracranial hypertension : a clinical case. Neurochirurgie 33 :395-398, 1987
  6. Gumerlock MK : Epidermoid, dermoid, and neurenteric cysts, in Brem H, Sawaya R (eds) : Youmans Neurological Surgery. ed 5. Philadelphia : Saunders, 2004, Vol 1, pp1224
  7. Han GY, Won YS, Yang JY, Choi CS : Intradiploc epidermoid cyst of the skull. J Korean Neurosurg Soc 38 : 68-70, 2005
  8. Hoessly M, Lagier R : Anatomico-radiological study of intraosseous epidermoid cysts. Fortschr Rontgenstr 137 : 48-54, 1982 https://doi.org/10.1055/s-2008-1056157
  9. Jeong IH, Lee JK, Kim JH, Kim SH : Iatrogenic intrspinal epidermoid tumor. J Korean Neurosurg Soc 26 : 254-256, 2004
  10. Kveton JF, Glasscock ME 3rd, Christiansen SG : Malignant degeneration of an epidermoid of the temporal bone. Otolaryngol Head Neck Surg 94 : 633-636, 1986 https://doi.org/10.1177/019459988609400618
  11. Lam CH, Solomon RK, Clark HB, Casey SO : Reversal of increased intracranial pressure with removal of a torcular epidermoid : case report. Neurosurgery 48 : 929-932, 2001 https://doi.org/10.1097/00006123-200104000-00049
  12. Maiuri F, Del Basso De Caro M, D'Acunzi G, Tortora F, Esposito F :Giant intradiploic epidermoid cyst of the occipital bone. Zentralbl Neurochir 65 : 32-35, 2004 https://doi.org/10.1055/s-2004-44886
  13. Netsky MG : Epidermoid tumors. Review of the literature. Surg Neurol 29 : 477-483, 1988 https://doi.org/10.1016/0090-3019(88)90144-9
  14. Pear BL : Epidermoid and dermoid sequestration cysts. Radiology 110 :18-55, 1970
  15. Rengachary S, Kishore PRS, Watanabe I : Intradiploic epidermoid cyst of the occipital bone with torcular obstruction : case report. J Neurosurg 48 : 475-478, 1978 https://doi.org/10.3171/jns.1978.48.3.0475
  16. Piotin M, Gailloud P, Reverdin A, Schneider PA, Pizzolato G, Rufenacht DA : Epidermoid cyst of the skull with nonpulsatile tinnitus. Neuroradiology 40 : 452-454, 1998 https://doi.org/10.1007/s002340050622
  17. Rosario M, Becker DH, Conley FK : Epidermoid tumours involving the fourth ventricle. Neurosurgery 9 : 9-13, 1981 https://doi.org/10.1227/00006123-198107000-00003
  18. Sadato N, Numaguchi Y, Geisler FH, Kristt DA : Extradural epidermoid cyst occluding the transverse sinus : a case report. Comput Med Imaging Graph 15 : 129-132, 1991 https://doi.org/10.1016/0895-6111(91)90038-W
  19. Toglia JU, Netsky MG, Alexander E : Epithelial (epidermoid) tumors of the cranium. Their common nature and pathogenesis. J Neurosurg 23 : 384-393, 1965 https://doi.org/10.3171/jns.1965.23.4.0384
  20. Yanai Y, Tsuji R, Ohmori S, Tatara N, Kubota S, Nagashima C : Malignant change in an intradiploic epidermoid : report of a case and review of the literature. Neurosurgery 16 : 252-256, 1985 https://doi.org/10.1227/00006123-198502000-00026