Epidermoid Tumor Research Articles

Post-traumatic Sacral Epidermoid Cyst Masquerading as Chordoma on Imaging: A Case Report

Intradural spinal epidermoid cysts are rare, benign lesions either acquired from trauma, surgery, lumbar puncture or arise as congenital lesions, particularly associated with spinal dysraphism. Epidermoid cyst arising from the spine with expansile destruction of vertebrae has not been reported yet in the literature. We report a case of 36-years male presented with history of fall 8 years back with progressive symptoms of lower back pain, weakness of left lower limb and bladder/bowel incontinence. Computed tomography revealed large lytic expansile, midline sacral vertebral lesion with soft tissue component and multiple calcific foci. Magnetic resonance imaging demonstrated large non-enhancing heterogeneous mass showing restricted diffusion on diffusion weighted images. The patient underwent biopsy confirming the diagnosis of an epidermoid cyst. The possibility of an epidermoid tumor should be kept in the differential diagnosis in patients presenting with post-traumatic sacral mass.

Surgical management of spinal intramedullary tumors: Ten-year experience in a single institution

Despite their rare occurrence, intramedullary spinal cord tumors can cause considerable morbidity and mortality without treatment. Timing of surgery, extent of resection and selection of favorable treatment option are important considerations for a good surgical outcome. In this clinical study, we report our patient series and convey our treatment strategy. We retrospectively reviewed 91 patients with primary intramedullary spinal cord tumors who underwent microsurgical resection at our institution between 2008 and 2018. Data were collected consisting of age, sex, location and histology of tumor, extent of resection, presenting symptoms and neurological outcomes. Modified McCormick Scale was used to assess neurological status of patients. 47 female and 44 male patients were followed-up for a mean period of 35.7 months. The most frequent pathological diagnosis was ependymoma in 56 patients, followed by astrocytoma in 21 and hemangioblastoma in 5 patients. The rest of the tumors consisted of 3 cavernomas, 3 mature cystic teratomas, 2 PNET, one epidermoid tumor. Gross total resection was achieved in 67 patients, while subtotal resection and biopsy was performed in 15 and 9 respectively. The most commonly involved localization was cervical (n = 39), followed by thoracic region (n = 24). Despite immediate postoperative worsening of neurological status, a great number of patients improved at the last follow-up. Gross total resection remains the primary goal of treatment while adjuvant radiation and/or chemotherapy may be alternative options for high grade tumors. Preoperative neurological status was the most important and the strongest predictor of functional outcome.

ROLE OF MRI IN EVALUATION OF INTRACRANIALAS WELLAS SPINAL EPIDERMOIDS AND ITS CORRELATION WITH POST OPERATIVE HISTOPATHOLOGY.

Background: - Epidermoid tumors are benign slow-growing tumors that usually manifest as insinuating masses. MRI evaluation is most sensitive radiological modality available in evaluation & characterization of intracranial epidermoid tumors. It can be accurately differentiated from arachnoid cyst from various characteristic features on MRI. However, post operative histopathology is the gold standard for diagnosis as well as confirmation of MRI findings. Conclusion: - Epidermoid tumors can be accurately diagnosed with MR imaging with our study showing around 91% sensitivity and 75% specificity, positive predictive value 95% and negative predictive value 60%.

Clinico-Surgical Outcomes of Giant Intracranial Epidermoids: Gross Total Resection vs Subtotal Resection Which is Better?

To analyze the clinical and surgical outcomes following gross total resection (GTR) and planned subtotal resection (STR) of giant intracranial epidermoid tumors. In this retrospective cohort study, all patients who were diagnosed with and operated for giant intracranial epidermoid tumors between January 2007 and May 2016 were included. The demographics, clinical outcomes, and surgical outcomes of these patients were analyzed. Forty-eight patients were enrolled in this study, and multicompartmental epidermoid tumors were observed in 23% of the patients. The mean size of the tumors was 6.2 cm (range, 4.0?9.0 cm). GTR and near-total resection (NTR) were performed in 34 (71%) patients. Fourteen patients (29%) underwent STR. Most patients (89%) had Glasgow Outcome Scale (GOS) of 5, whereas 8% had GOS of 4. The GTR/NTR group (23.5%) had more permanent complications than the STR group (7.1%). The mean follow-up period was 5.2 years (range, eight months to nine years). In the STR group, four patients (29%) showed an increase in the residual tumor, and only one patient (7%) was symptomatic and required reoperation. STR of giant intracranial epidermoid tumors is a safe surgical strategy with good surgical outcome. The requirement for reoperation is usually late and seldom required but can be done safely. The average time to recurrence was more than seven years.

Intrinsic Brainstem Epidermoid: Case Report and Literature Review

ABSTRACT Epidermoid cysts are rare lesions of the central nervous system, representing 1-2% of all intracranial tumours. These mass lesions are typically found in the parasellar region or cerebellopontine angle. As far as we are aware only 15 cases of an intrinsic brainstem epidermoid have been reported in the pediatric population to date. We report a case in which an 8-year-old male patient with an intrinsic brainstem epidermoid was misdiagnosed and treated as a diffuse intrinsic pontine glioma (DIPG). The child was subsequently referred to our unit failing response to treatment at the index hospital. Magnetic resonance imaging (MRI) revealed a well-defined lesion, with clearly distinct borders, that was hypointense on T1WI, hyperintense on T2WI, had minimal contrast enhancement and had restricted diffusion on the DWI/ADC map. With the aid of intra-operative neurophysiological monitoring he underwent surgical resection of the lesion. Histopathology revealed abundant nucleated and anucleated squamous cells, in keeping with an epidermoid tumor. Clinical follow up at 3 months post-surgery showed significant improvement in the child's pre-surgical neurological function. Follow up MRI at 3 months and a year post surgery revealed that the lesion is stable following near total resection. The objective of this case report is to highlight this unusual condition which may otherwise be misdiagnosed and to encourage a more universal acceptance of the need for either brainstem biopsies in atypical brainstem lesions or formal resection of lesions amenable to safe surgical resection.

Clinical, radiological and microneurosurgical aspects in the management of intracranial epidermoid cysts: Experience with 38 cases

Objectives: There is considerable debate in the surgical management of epidermoid cyst whether gross total or subtotal resection yields better long term outcomes. We present our institutional experience in evaluating the clinical presentation, diagnosis and surgical strategy and extent of resection in the management of intracranial epidermoid cyst.Methods: We retrospectively reviewed the case records of 38 patients with intracranial epidermoid tumors surgically treated at our institution between 2010 and 2019.Results: A total of 38 patients who underwent surgery for intracranial epidermoid lesions were identified. Of these 17 were supratentorial, 20 were infratentorial lesions and one case lesion was extending from cerebellopontine region to middle fossa. The mean duration from onset of symptoms to surgery was 3.9 years. Cranial nerve dysfunction was noted in 73% of patients preoperatively most of them being the Cerebellopontine angle epidermoids. Total removal was achieved in 28 patients, near-total removal in 8 patients, and subtotal removal in 2 patients. 6 patients developed recurrence radiologically of them only one patient became symptomatic. Of the six 2 were patients who underwent gross total resection and the remaining 4 were from near and subtotal resection. The mean duration of follow-up was 3.8 years. The content of the tumor was pearly white/white material in all cases. complications noted in the present series were not related to the completeness of excision. Mortality was noted in one patient.Conclusions: The present study highlights various precautions to be taken intraoperatively in the prevention of development of aseptic meningitis and concludes that total removal of epidermoids does not result in significantly increased morbidity and mortality and should be the goal of surgical treatment. However, near/subtotal resection oflesions that are densely adherent to neurovascular structures is justified, as there is no significant difference in the rate of recurrence. An endoscope can be used to assess the completeness of surgery.

Heating area control analysis of laser treatment of epidermoid tumor by pulse wave and surface cooling

Heating area control analysis of laser treatment of epidermoid tumor by pulse wave and surface cooling

Intradiploic epidermoid cyst of the skull

Not available.

Radiosurgery for Epidermoid Tumors: Dramatic Pain Relief from Trigeminal Neuralgia.

Purpose The purpose of this study is to discuss the long-term effects of radiosurgery for epidermoid tumors, including the symptoms of trigeminal neuralgia and/or facial spasm, which we have originally reported before.BackgroundIntracranial epidermoids are slow-growing tumors that can become symptomatic once they develop into large tumors. The mainstay of the treatment is surgery. However, eradicating the whole tumor is often difficult and some tumors may recur. In addition to their mass effects on the brain, these tumors are often associated with hyperactive nerve dysfunction syndromes such as trigeminal neuralgia, glossopharyngeal neuralgia, and/or facial spasm.Cases and methods We report 13 cases of epidermoid tumors, 12 of which were located in the cerebellopontine angle (CPA), which were treated using 14 radiosurgery procedures. The inclusion criteria for radiosurgery were the presence of well-localized small tumors and/or severe associated neuralgia or facial spasms. The mean target volume ranged from 0.17 to 9.5 cm3 with a mean of 2.85 cm3. The lesions were treated with a mean maximum and a marginal dose of 28.2 Gy and 14.2 Gy, respectively.ResultsAmong the 14 gamma knife procedures that were performed in 13 patients, dose planning to ensure total and partial coverage for relief from hyperactive cranial nerve dysfunction (HCND) was performed. Six cases were totally and another eight were partially covered at the dose planning. The irradiated tumors showed a minor decrease or no remarkable changes during a mean follow-up period of 86.1 months. Tumor progression requiring a second surgery was seen in two cases. The trigeminal neuralgias either improved or disappeared soon after the procedure, enabling the discontinuation of the medication.Conclusion Radiosurgery led to a dramatic improvement in HCND. In fact, the immediate cure of neuralgia after the radiosurgery was observed in several cases, even after partial coverage with radiosurgery. The interface between the tumor and the nerve was the main target. The definite mechanisms for this favorable outcome have not been verified yet, but the functional modulation by the radiosurgery could be one. Electrophysiological alteration at the interface between the tumor and nerve has been considered. When the tumors were totally covered with radiosurgery, persistent tumor control was expected. Sufficient tumor control is possible if the tumor can be covered entirely with radiosurgery. Functional modulation of trigeminal neuralgia and facial spasms can also be attained even by partial dose planning for the nerve-tumor interface.

Neuroanatomical Determinants of Secondary Trigeminal Neuralgia: Application of 7T Ultra-High-Field Multimodal Magnetic Resonance Imaging

Seven-Tesla (7T) magnetic resonance imaging (MRI) has demonstrated value for evaluating a variety of intracranial diseases. However, its utility in trigeminal neuralgia has received limited attention. The authors of the present study applied ultra-high field multimodal MRI to two representative patients with secondary trigeminal neuralgia due to epidermoid tumors to illustrate the possible clinical and surgical advantages of 7T compared with standard clinical strength imaging. Techniques included co-registration of multiple 7T sequences to optimize the detection of potential concurrent neurovascular and neoplasm-derived compression. 7T MRI studies were performed using a whole body scanner. Two- and three-dimensional renderings of potential neurovascular conflict were created by co-registering time-of-flight angiography and T2-weighted turbo spin echo images in MATLAB and GE software. Detailed comparisons of the various field strength images were provided by a collaborating neuroradiologist (B.D.). 7T MRI clearly illustrated minute tumor-adjacent vasculature. In contrast, conventional, low-field imaging did not consistently provide adequate details to distinguish cerebrospinal fluid pulsatility from vessels. The tumor margins, although distinct from the trigeminal nerve fibers at 7T, blended with those of the surrounding structures at 3T. Two- and three-dimensional co-registration oftime-of-flight angiography with T2-weighted MRI suggested that delicate, intervening vasculature may have contributed to these illustrative patients' symptomatology. 7T provided superior visualization of vital landmarks and subtle nerve and vessel features. Co-registration of various advanced 7T modalities may help to resolve complex disease etiologies. Future studies should explore the extent to which this dual etiology might persist across tumor types and utilize diffusion-based techniques to quantify what microstructural differences might exist between patients with trigeminal neuralgia from varying etiologies.

3D printed microneedles for anticancer therapy of skin tumours.

In this study, novel 3D printed polymeric microneedle arrays were fabricated for enhanced cisplatin delivery to A-431 epidermoid skin tumours for cancer treatment. The microneedles were built by selectively photopolymerising consecutive layers of a biocompatible photopolymer resin using stereolithography (SLA), followed by coating of cisplatin formulations using inkjet dispensing on the needle surface. The printability via SLA was optimized to improve microneedle mechanical properties and optical coherence tomography analysis showed excellent piercing capacity of 3D printed microneedles to an 80% penetration depth. Franz cell diffusion studies revealed rapid cisplatin release rates of 80-90% within 1 h and in vivo evaluation with Balb/c nude mice presented sufficient cisplatin permeabilization with high anticancer activity and tumour regression. Histopathology analysis confirmed the tumour inhibition effect, showing demarcated lesions with thin fibrous capsules and necrotic cores. The use of 3D printed microneedles demonstrates the potential for in-vivo transdermal delivery of anticancer drugs.

Presentación sincrónica de tumor epidermoides intracraneal y absceso cerebral. Reporte de un caso

Introducción: Un paciente con tumor epidermoides intracraneal extradural con presentación sincrónica con absceso cerebral, sin antecedentes de trauma craneal penetrante, no ha sido reportado con anterioridad en la revisión del tema realizada por los autores. Se presenta un caso con estas características y se exponen consideraciones sobre el diagnóstico y el tratamiento. Caso clínico: Paciente femenina, de 48 años de edad, con antecedentes de cefalea crónica y tumor craneal palpable en región frontal izquierda. Los estudios humorales fueron normales. La RNM craneal mostró dos imágenes en anillo yuxtapuestas, extra e intraaxial de forma respectiva. En la cirugía se encontró tumor perlado extradural sin evidencia a la inspección de tumor intradural, se comprobó en el examen histopatológico tumor epidermoides. En los controles imagenológicos posoperatorios se descubrió la persistencia de la lesión intraaxial, en anillo, frontal izquierda. Una segunda cirugía evidenció un absceso cerebral de ubicación subcortical y se efectuó la resección radical. La evolución fue favorable, sin secuelas después de cuatro meses de seguimiento. Conclusiones: Se reportó un caso infrecuente, donde se presentó de forma sincrónica un tumor epidermoides extradural frontal izquierdo y absceso cerebral frontal ipsilateral, sin relación de continuidad ni comunicación fistulosa demostrada en las neuroimágenes ni en la exploración quirúrgica.

Extent of resection of epidermoid tumors and risk of recurrence: case report and meta-analysis.

Intracranial epidermoid tumors are slow-growing, histologically benign tumors of epithelial cellular origin that can be symptomatic because of their size and mass effect. Neurosurgical resection, while the treatment of choice, can be quite challenging due to locations where these lesions commonly occur and their association with critical neurovascular structures. As such, subtotal resection (STR) rather than gross-total resection (GTR) can often be performed, rendering residual and recurrent tumor potentially problematic. The authors present a case of a 28-year-old man who underwent STR followed by aggressive repeat resection for regrowth, and they report the results of the largest meta-analysis to date of epidermoid tumors to compare recurrence rates for STR and GTR. The authors conducted a systemic review of PubMed, Web of Science, and the Cochrane Collaboration following the PRISMA guidelines. They then conducted a proportional meta-analysis to compare the pooled recurrence rates between STR and GTR in the included studies. The authors developed fixed- and mixed-effect models to estimate the pooled proportions of recurrence among patients undergoing STR or GTR. They also investigated the relationship between recurrence rate and follow-up time in the previous studies using linear regression and natural cubic spline models. Overall, 27 studies with 691 patients met the inclusion criteria; of these, 293 (42%) underwent STR and 398 (58%) received GTR. The average recurrence rate for all procedures was 11%. The proportional meta-analysis showed that the pooled recurrence rate after STR (21%) was 7 times greater than the rate after GTR (3%). The average recurrence rate for studies with longer follow-up durations (≥ 4.4 years) (17.4%) was significantly higher than the average recurrence rate for studies with shorter follow-up durations (< 4.4 years) (5.7%). The cutoff point of 4.4 years was selected based on the significant relationship between the recurrence rate of both STR and GTR and follow-up durations in the included studies (p = 0.008). STR is associated with a significantly higher rate of epidermoid tumor recurrence compared to GTR. Attempts at GTR should be made during the initial surgery with efforts to optimize success. Surgical expertise, as well as the use of adjuncts, such as intraoperative MRI and neuromonitoring, may increase the likelihood of completing a safe GTR and decreasing the long-term risk of recurrence. The most common surgical complications were transient cranial nerve palsies, occurring equally in STR and GTR cases when reported. In all postoperative epidermoid tumor cases, but particularly following STR, close follow-up with serial MRI, even years after surgery, is recommended.

Purely endoscopic supracerebellar infratentorial approach for epidermoid cyst in third ventricle

Introducción: El Quiste Epidermoide como tumor de la región pineal es una patología infrecuente y poco descripta. Su prevalencia en el 3er ventrículo es de 0,0042% de los tumores primarios intracraneales. Para lograr la exeresis macroscópica total se utilizó el abordaje Supracerebeloso Infratentorial con Endoscopio rígido de Base de Cráneo, técnica descripta para abordaje de lesiones de la región pineal. El Objetivo del Trabajo es la presentación de la técnica quirúrgica del abordaje, con la resolución de la patología infrecuente que se presenta.Materiales y métodos: Paciente de 16 años de edad con antecedentes de DBT insípida y cefaleas crónicas intermitentes (m-RS 1). RMN de encéfalo evidencia lesión ocupante de espacio hiperintensa T2 e hipointensa en T1 con realce periférico y restricción en la difusión. Presenta refuerzo a nivel del tallo hipofisario. Se plantea diagnóstico de tumor germinal. Marcadores en LCR negativos. Se decide realizar abordaje puramente endoscópico de la región para toma de muestra. Congelación determina quiste epidermoide y se procede a realizar exeresis macroscópica total.Resultados: Se realizó exeresis macroscópica total de quiste de epidermoide en tercer ventrículo con abordaje supracerebeloso infratentorial a través de endoscópico rígido de base de cráneo, en paciente de 16 años, cursando postoperatorio tardío sin secuelas y mejoría sintomática con persistencia de DBT insípida (m-RS 1).Conclusión: El abordaje puramente endoscópico supracerebeloso infratentorial es una opción segura para el tratamiento quirúrgico de lesiones en el tercer ventrículo, en este caso, un quiste epidermoide.

N-glycosidesindolo[2,3,-a]pyrrolo[3,4,-c]carbazole derivatives chemical structure influence on antitumor activity

Introduction . The report considers the prospect of rational approach to the new anticancer agents creation based on indolocarbazole derivatives.Objective . To conduct a comparative study of 12 domestic N-glycosides, indolo[2,3-a]pirrolo[2,3-a]carbazole derivatives in the course of “structure – activity” bond analysis.Materials and methods . The investigation of influence of 12 carbohydrate – containing indolocarbazoles, synthesized in N. N. Blokhin Russian Cancer Research Center of the Ministry of Health of Russia, performed on models of solid transplantable mouse tumors: lung Lewis epidermoid carcinoma and B16 melanoma. The antitumor effect was assessed by Lewis epidermoid carcinoma and B16 melanoma tumor growth inhibition (TGI %) criterion.Results . A variety of indolocarbazoles modifications allowed revealing the dependence of their antitumor properties on the structure of both, the aglycone and the glycoside residue. Imino-nitrogen interchange of atoms in upper heterocycle influences on indocarbazole derivatives antitumor activity change. During a comparative study of 12 N-glycosides indolocarbazole derivatives on lung Lewis epidermoid carcinoma and B16 melanoma models, 8 derivatives showed antitumor activity.Conclusion . The formulated concepts on the modification features in indolocarbazole derivatives structure can be used for more active compounds creation with greater action selectivity.

Characteristics intracranial epidermoid cyst between two hospital from developed vs developing institution and literature review

IntroductionIntracranial epidermoid tumors are slow-growing lesions, which may recur after incomplete resection (surgery), but may do so over many years. These slow growing benign tumors encase and surround nerves and arteries rather than displacing them and the treatment of choice is radical surgery. Therefore the clinical symptoms are varies. The incidence of intracranial epidermoids is between 0.3% and 1.8% of all brain tumors. Whether the characteristics of tumor are related with culture of clinical neurologic in different developed and developing institution has not been discussed yet. MethodsBetween 2015 until 2017, we collected data from two institutions, Keio University hospital Tokyo Japan and Hasan Sadikin Hospital Padjadjaran University Bandung Indonesia. We collect 16 patients from Keio University hospital (KUH) and 10 patients from Hasan Sadikin hospital (HSH). ResultsIn which the 11 cases is located in infratentorial and 5 cases were in supratentorial region at KUH. Meanwhile in HSH, we found that 10 patients were in infratentorial. The characteristic of cranial nerve palsy and/or neurological deficits are mainly similar in infratentorial region whether from KUH or HSH, including supratentorial epidermoid are also similar. At KUH, the location of epidermoid is located in the CPA (cerebellopontine angle) in 8 patients, 3 in suprasellar region, 1 in Meckel's cave, 1 in 4th ventricle, 1 in medulla, 1 in petroclival and 1 in occipital lobe. In HSH, the lesions are located in infratentorial in which 5 patient in CPA, 4 in petroclival region and 1 case in Meckel's cave. In infratentorial lesion the CNs (cranial nerves) palsy were found in CN IV, V, VI, VII, VIII, and none in IX, X, XI, XII. In supratentorial lesion the chief complaint was mainly headache. ConclusionThe epidermoid of the brain are mostly located in the infratentorial region rather than in supratentorial. The CNs deficit are commonly arose in infratentorial lesion meanwhile the supratentorial region symptom is headache. It is reasonable if the patient came with infratentorial multiple CNs palsy to be suspicious for epidermoid benign tumor in the intracranial. Those characteristics are found in both developed and developing hospitals.

Three-Dimensional Printed Model for Surgical Simulation of Combined Transpetrosal Approach

The combined transpetrosal approach is a complicated skull base surgery with a high degree of difficulty. Herein, we made a 3-dimensional (3D) printed petrous bone with color-coded anatomic sites and evaluated its usefulness as a model to practice drilling associated with combined transpetrosal surgery. To design a 3D model of the petrous bone, we chose a representative epidermoid petroclival tumor case who underwent combined transpetrosal surgery at our hospital. A 3D image of the petrous bone embedded with color-coded anatomic sites, including cranial nerves, brainstem, and internal carotid and vertebrobasilar arteries, was created based on preoperative computed tomography scan, magnetic resonance, and digital subtraction angiography images and was then 3D printed. Thirteen neurosurgeons from our department evaluated the anatomic reproducibility and estimated distance between each anatomic site of the 3D image and model and the usefulness of the model for drilling practice. The anatomic reproducibility of both the 3D image and model was high, and the 3D model was considered good for drilling practice (P < 0.05). The error in the estimated distance between anatomic sites in the 3D model was significantly smaller than that of the 3D image (P < 0.0001). These results indicate that our 3D printed model is very useful for practice with craniotomy and petrosectomy drilling, necessary in the combined transpetrosal approach.

Correlation of Preoperative Cranial Nerve Diffusion Tensor Tractography with Intraoperative Findings in Surgery of Cerebellopontine Angle Tumors

Imaging to visualize nerves around tumors preoperatively could help the surgeon to plan the surgery and excise the tumor with preservation or improvement in patients' quality of life. In the present prospective study, we attempted to correlate the preoperative cranial nerves (i.e., trigeminal, abducens, facial, and vestibulocochlear diffusion tensor tractography and anatomic magnetic resonance imaging [MRI] findings) with intraoperative findings during cerebellopontine angle (CPA) tumor surgery. The 40 enrolled patients had CPA tumors (31 vestibular schwannomas, 5 epidermoid tumors, 2 meningiomas, 2 trigeminal schwannomas). All the patients were undergoing microsurgery for the first time. They underwent preoperative MRI for anatomic and diffusion tensor imaging (DTI) data. The imaging series were postprocessed, and 3-dimensional images were obtained. The location of the involved nerves around the tumors was recorded during surgery by the senior surgeon, who was kept unaware of the results of the fiber tracking, and a correlation was performed. We evaluated the correlation between the DTI and intraoperative findings for the nerve location in relation to the tumor in the CPA. The correlation between the DTI and intraoperative findings for the facial, trigeminal, and vestibulocochlear nerves was 85% (34 of 40), 85% (34 of 40), and 75% (12 of 16), respectively. The modified technical parameters proposed could lead to better preservation of cranial nerve function, especially for patients with large tumors. To the best of our knowledge, the present study is the first systematic study of relevant cranial nerves in 40 patients with demonstration of the vestibulocochlear bundle by preoperative MRI in the most common CPA tumors using advanced MRI sequences such as diffusion tensor tractography and capturing the data in a multiplanar format.

A case of trigeminal neuralgia caused by intracranial epidermoid tumor

A case of trigeminal neuralgia caused by intracranial epidermoid tumor

Posterior Approach to Meckel's Cave: Retrosigmoid Craniectomy with Endoscopic Assistance.

Background Meckel's cave involvement in tumors pose a challenge due to their surrounding neurovascular structure and deep location. Case Review A 24-year-old male presented with progressive headaches and right sided trigeminal neuralgia with a large epidermoid. The tumor extended from the ambient cistern to the cerebellomedullary cistern and involved Meckel's cave ( Fig. 1 ). Technical Note/Video Description A retrosigmoid craniectomy was performed. Cranial nerves 3, 4, 6, 7, and 10, and auditory brainstem responses were monitored. Once the craniectomy was completed the dura was opened and cerebrospinal fluid (CSF) was released from the cisterna magna to allow for the tumor resection to be done without the use of any retractors ( Fig. 2 ). Care was taken to ensure that cranial nerves in the posterior fossa were detethered to prevent any traction injury. Using ring curettes the pearly white epidermoid tumor was able to be debulked. After all the possible tumor was resected with the microscope, the 30-degree endoscope was used to identify the porus trigeminus. Malleable ring curettes and a malleable suction were used to remove the soft tumor from this location. The patient transiently had loss of hearing but this returned within 2 weeks after surgery. Conclusions The retrosigmoid approach is familiar to all neurosurgeons and with the adjunct of an angled endoscope, the posterior Meckel's cave can be easily reached. This is particularly useful for tumors with soft consistency. The assistance of the endoscope allows Meckel's cave visualization without additional drilling while still allowing safe resection of tumor from around the trigeminal nerve. The link to the video can be found at: https://youtu.be/01aqOyUmSW0 .