Search

We report the case of a diploic epidermoid cyst in the left front-parietal bone of a 70-year-old woman. A skull x-ray showed an osteolytic lesion with a sclerotic border, and CT scan revealed a low/iso-density mass and the destruction of both inner and outer tables. MRI showed hypo-intensity on T1-weighted image, hyper-intensity on T2-weighted imaging and remarkably-strong intensity on the diffusion-weighted imaging. Gadolinium enhancement was seen in the tumor capsule and dura of the peripheral tumor. In the operative view, most of the bone edge was regular with a sclerotic border, but an irregular section was present. The tumor adhered strongly to the dura mater and periosteum. The tumor was totally extirpated with the peripheral skull, dura mater and periost. On the postoperative MRI, gadolinium enhancement of the nearby dura mater and disappeared. We have added a discussion of the radiological features of diploic epidermoid cysts.

An intradiploic epidermoid cyst of the skull in infancy is rare. We report a case of a 7-month-old girl with an intradiploic epidermoid cyst of the left parietal bone. The patient was admitted to the department of pediatrics in, our hospital in March, 2000, complaining of a lump in the scalp with a diameter of 1.5 cm. The pediatrician doubted that it was a case of Langerhans cell histiocytosis (LCH). In addition, as a result of further tests there were no systemic findings to suggest LCH. The skull x-ray showed round radiolucency of the left parietal bone. CT scans showed an iso density intradiploic mass with destruction of the outer table. Because of the fact that the mass was enlarging, the patient was admitted to our neurosurgical service in April, 2000. We excised the lesion to confirm the histological findings. The histological diagnosis was epidermoid cyst. We discuss the clinical feature and treatment strategy for intradiploic epidermoid cyst in infancy.

A case of diploic epidermoid in the right parietal bone was presented. A 66-year-old male was admitted to our hospital because of aphasia. Plain skull radiogram showed an osteolytic lesion in the right parietal bone. Computed tomography revealed a mass with destruction of the parietal bone extending from an inner to an outer table. The mass was shown by MR imaging as hypointensity on the T1-weighted image and as hyperintensity on the T2-weighted image. The hyperintensity became more remarkable by using a diffusion technique. Based on these findings, a preoperative diagnosis of right parietal epidermoid was made. The mass was totally removed and diagnosed pathologically as epidermoid. It was concluded that diploic epidermoid invading intradurally could be differentiated from other osteolytic tumors by using MR diffusion-weighted image.

We report a case of a 65-year-old man with intradipolic epidermoid cyst of the frontal bone. The patient presented with headache and swelling of the forehead. Skull x-ray showed massive destruction of the frontal bone. Magnetic resonance imaging (MRI) revealed an epidural mass without any encroachment of the dura mater. The cystic tumor was removed followed by cranipolasty with methylmethacrylate. Four years later, the tumor recurred in the same region. At the second surgery the bony defect was again replaced with methylemthacrylate plate. Four years after the second operation, the tumor reemerged with some subcutaneous fluid retention. At the third surgery, the remaining tumor capsule was removed as much as possible except for that part which adhered to the superior sagittal sinus. The authors discuss the relationship of tumor recurrence with utilization of methylmethacrylate for cranioplasty in this type of tumor.

A case of painful tic convulsif (trigeminal neuralgia and ipsilateral hemifacial spasm) caused by cerebellopontine angle epidermoid tumor is presented. This tumor was compressed to the trigeminal nerve, and became attached to the facial and auditory nerves. The facial nerve exit-zone of brain stem was also compressed by the tumor along with a branch of the posterior inferior cerebellar artery. Total removal of the tumor was carried out and neuralgia and facial spasm disappeared. Painful tic convulsif caused by brain tumor is rare (eight cases in the literature plus our case), but epidermoid tumor is not rare as a cause of this complaint (seven in eight cases). In preoperative examination of this case, we could not detect this epidermoid in the cerebellopontine angle, because this tumor was the same intensity as CSF liquid on magnetic resonance imaging (T1 and T2 weighted image) and exerting hardly any mass effect on the brainstem. On encountering a case of painful tic convulsif of unknown origin despite the usual preoperative examinations, it may be useful that same kind of brain tumor, especially, epidermoid might be concealed in the cerebellopontine angle lesion.

A case of giant epidermoid which was mainly located in the right temporal lobe was presented. The intracranial epidermoid is commonly located in the CSF space, such as the cerebello-pontine (C-P) angle, parasellar region, middle cranial fossa and ventricles. The intramedullary epidermoid is extremely rare. We report the case of a 51-year-old female suffering from generalized convulsions. Having fallen into a semicoma due to the convulsions, she was referred to our department on August 5, 1992. Neurological examination revealed slight dementia but no other deficits. The tumor was mainly located in the temporal lobe but communicated with the CSF space of C-P angle through a narrow channel shown on MRI. She underwent an operation for tumor removal and left the hospital with no neurological deficits. Several cases of intracranial intramedullary epidermoid have been reported in the literature, but none of them proved to be completely intramedullary. On operation or on CT and MRI, all of them were shown to communicate with the CSF space. The possible occurrence of an epidermoid from medullary substance was discussed.

An unusual case of a congenital petrous bone epidermoid which resulted in a sudden deafness is reported. The patient was a 25-year-old man who suddenly developed a right deafness and tinnitus. Neurological examination on admission revealed slight hearing disturbance in the high sound area. Plain craniogram showed a destructive bone lesion in the middle portion of the petrous bone on the right side. Bone-window CT scan disclosed a bony destructive mass in the petrous bone, and enlargement of the internal auditory canal. The mass lesion was almost isodense on plain CT scan and was not enhanced by contrast media. T1 weighted imaging of MRI demonstrated an isointense mass in the petrous bone, and T2 weighted imaging demonstrated hyperintensity. Gd-DTPA MRI revealed no enhancement. Angiogram did not reveal abnormal findings. Right lateral suboccipital craniectomy was performed to remove the posterior wall of the internal auditory canal. The tumor existed extradurally originating from the dipole of petrous bone. The tumor appeared pearly and fragile. The pathological examination of the specimen was diagnosed as epidermoid. The postoperative course was uneventful except for right hearing loss on the 4th postoperative day. Epidermoid arising in the middle portion of the petrous bone is quite rare, so this case was hereby reported with some references.

A case of epileptic laughter associated with deep right temporal epidermoid cyst is reported. Interictal EEG with subdural grid electrodes demonstrated multifocal spike discharges in the right temporal lobe. Ictal EEG localized the epileptogenic foci at the base of the anterior medial temporal lobe. After standard temporal lobectomy, the tumor was completely removed. The patient is free from seizures postoperatively.

Primary epidermoid tumors comprise about 1% of all central nervous system neoplasms, although the diploic epidermoid tumor is comparatively rare. Two cases of diploic epidermoid tumor are reported in this paper. Case 1: A 70-year-old man presented with a headache. A plain craniogram showed an osteolytic lesion of the occipital bone with a well defined sclerotic margin. A contrast enhanced CT confirmed a cystic lesion with rim enhancement. On MRI, the tumor appeared hypointense surrounded with irregular hyperintensity on the T1WI and hyperintensity on the T2WI. Gd enhancement on the MRI showed no enhancement effect. The tumor was totally removed and cranioplasty was performed. No tumor invasion of the dura mater was noticed. Case 2: A 90-year-old woman presented with a giant tumor of the left parietal region. She noticed a painless swelling at the age of 20, and the tumor slowly grew over a period of 70 years. Plain craniogram showed a bony defect with a sclerotic margin. CT scan confirmed an extracranial giant tumor with destruction of the outer table under the tumor, and also falx meningioma. Aspiration and irrigation inside the cystic tumor were performed under local anesthesia. Previous authors have also said that the plain craniogram is characteristic and diagnostic in the case of diploic epidermoid. Typical round or polylobular bony defect with well defined sclerotic margins was visualized.

The authors report a case of a 61-year-old woman presenting with a giant mass on the occipital scalp. The patient had no neurological deficits and was of normal intelligence. The lesion was soft and covered by an unremarkable epidermis. The preoperative radiologic evaluation was made by CT, MR Imaging, and by cerebral angiogram. The mass produced an inhomogeneously low-intensity signal involving also a high-intensity signal. It was shown, on the T1 weighted image, that it did not communicate with the intracranial space, and there was no gadolinium-enhanced lesion. MR Imaging was superior to CT in the evaluation of the giant mass on the scalp and was particularly useful in surgical planning. At surgical resection, a soft fluffy, white-colored tumor which measured 16 x 10 x 7 cm was totally removed. Pathological diagnosis of the tumor was epidermoid cyst.

A case of intracerebral epidermoid associated with aspergillosis, which spread from the middle ear to the left temporal lobe, is reported. A 58-year-old woman was admitted on 6 June 1988, complaining of left temporalgia and motor aphasia. She had suffered from lt. chronic otitis media with cholesteatoma and had undergone a radical operation 11 years previously. CT scan revealed low density area with a mass effect in lt. temporal lobe. Bone image coronal CT scan revealed destruction of the roof of the pyramidal bone had resulted in communication between abscess cavity and external auditory meatus. On MRI scan lt. temporal lobe showed low signal intensity on T1WI, and high signal intensity on T2WI. In spite of strong antibiotic chemotherapy, mass effect on CT scan showed no sign of improvement. We performed total removal of the abscess on 15 July 1987. A number of characteristic aspergillus hyphae were recognized in the resected cyst. As the cyst wall consisted of keratinising squamous epithelium intermingled with granulation tissue, we had a diagnosis of epidermoid cyst. The diagnosis of epidermoid associated with aspergillosis was difficult. CT findings of epidermoid in general, show homogeneous low density without enhancement, but, in our case, CT scan showed heterogeneous low density area with capsular high dense. MRI of epidermoid usually shows a low signal intensity on T1WI, but our case showed iso-low signal intensity on T1WI. In spite of a poor prognosis of aspergillosis of the CNS, our patient has recovered well due to receiving prompt surgical treatment.

A case of pineal epidermoid cyst with interesting findings of magnetic resonance imaging (MRI) is reported referring to the literature. In our case, homogeneous high density area is seen on CT and high signal intensity is recognized on T1-weighted MRI and low signal intensity on T2-weighted MRI.

We have reported a case of paratrigeminal epidermoid originated in the Meckel's cave. A 30 years old man was admitted to the department of neurosurgery with chief complaints of continuous right facial pain and numbness of entire right side of the face of three years duration. The positive neurological findings were hypesthesia over the distribution of the right trigeminal nerve, absence of the right corneal reflex and nystagmus on left lateral gaze. Caloric response was absent on the right side, however the audiogram showed normal. Cerebrospinal fluid examination was within normal limit. Electromyography showed giant spike in the right masseter and temporal muscles. Radiogram of the skull revealed a bone-destroying lesion over the medial florr of the right middle fossa involving the apex of the petrous bone (Fig 1). Right carotid angiography showed straightening and forward displacement of C4- C5 portion of the carotid siphon in the lateral view, and vertebral angiography showed displacement of basilar artery to the left side, upward displacement of the right posterior cerebral and superior cerebellar artery in the frontal view (Fig. 2, 3). At the time of operation, an epidermoid was identified in the Meckel's cave and totally removed microsurgically. Small amount of the tumor extending into the posterior fossa was also removed (Fig. 4, 5, 6, 7). Postoperative course was uneventfull except for an episode of headache and high fever of short duration, suggesting the signs of meningial irritation. Two months postoperativelly patient was relived of facial pain and was discharged with sensory impairment of the right trigeminal nerve distribution. Only 11 cases of paratrigeminal epidermoid, including the cases localized in the Meckel's cave have been reported in the past literatures (Table 1). In this paper we have discussed about the symptomatology and clinical data of paratrigeminal epidermoid and compared with those of trigeminal neurinoma, and meningioma originated in the same region. We would like to emphasize that the importance of differentiating the idiopathic trigeminal neuralgia from the paratrigeminal epidermoid, if the initial symptom of this tumor were tic douloureux. The total removal of epidermoid with capsule is essential treatment following the early diagnosis, however the attempt of total removal is sometimes difficult because of the relationship between the origin, size and extension of this kind of tumor to other important brain structures. And if some of the tumor is left behind at the time of operation, cholesterin meningitis is an important complication.

The authors report a case of epidermoid tumor of the lateral ventricle. Epidermoid tumors are relatively uncommon intracranial lesions and the one situated in the lateral ventricle has not been reported in this country. A 42 year old house wife was admitted to Asahi Central Hospital on February 14, 1973, complaining of progressive right hemiparesis for 2 years. The patient had no headache and no other symptoms of increased intracranial pressure. Neurological examination revealed disorientation, dyscalculia, amnestic aphasia, morter dysphasia, right facial paresis (central type) and right hemiparesis. The laboratory findings, which included complete blood count, serum electrolytes, urinalysis, electrocardiogram and blood Wassermann, were normal. Initial pressure of the spinal tap was 410 mmH2O and crystal clear CSF was obtained. tplain craniogram showed no calcification and was normal. The left CAG showed clearly the signs of the temporal lobe tumor (Fig. 1, 2, 3, 4.), but showed no early veins and no tumor stains. The brain scintigram was normal. A left temporo-parietooccipital craniotomy was performed. The epidural Echogram (horizontal section-Fig. 5, coronall section-Fig. 6) revealed the clear demarcated, multicystic round tumor in the inferior horn of the left lateral ventricle. After the whitesoap like tumor was totaly removed, the all interior surface of the left inferior horn of the lateral ventricle was seen (Fig. 8). Tumor was 5.5 cm in diameter and 50 g in weight. Histological findings of the tumor showed typical epidermoid (Fig. 9, 10). The origin of the intravetricular epidermoids and the usefulness of echo-encephalorgaphy were briefly discussed.