Intracranial intradural epidermoids and dermoids

Summary This report covers 38 Cases of intradural dermoids (4 cases) and epidermoids (34 cases). In most cases the clinical course extended over several years. At the time of admission to the clinic only 9 patients had purely local symptoms; symptoms from adjacent areas were present in 15 cases and elevated intracranial pressure in 13.Of the 35 operated patients, 16 were able to work again, and 7 died after the operation. Best results are achieved in cases involving young patients, in cases where the tumor is situated in the cerebral hemisphere, and in cases where the tumor can be totally removed.In recent years advances in diagnostic, surgical and anaesthetic techniques have lowered the lethality rate. Computed tomography is especially useful for an early diagnosis.Dedicated to Prof. Dr. Dr. h. c. K. J. Zülch on occasion of his 70^th birthday     

Craniocerebral epidermoids and dermoids

Summary We review 40 epidermoids and 4 dermoids of the skull and brain treated surgically in our Department between 1976 and 1987. Fourteen were extradural and 30 intradural. The mean duration of symptoms was 3 years for extradural and 10 years for intradural tumours. Symptoms varied with tumour site, in some sites being helpful in differential diagnosis. Skull X-rays and CT were the key diagnostic investigations in extradural and CT in intradural lesions, the latter, with few exceptions, presenting a characteristic CT scan. In 7 cases MRI supplied important details on the tumour boundaries. All the diploic and orbital lesions were removed totally, with a good outcome. Twelve of the intradural lesions were removed totally, 9 subtotally and 9 partially, with a good outcome in 21 patients and a poor outcome in 4; 5 patients died. Outcome was unrelated to degree of removal.     

Kyste dermoïde intraorbitaire : un cas

Dermoid cysts account for 3–4 % of primary orbital tumors. The intraorbital location is relatively rare. The authors report a case of a 12-year-old male with an intraorbital dermoid cyst revealed by progressive right proptosis. The imaging aspects (CT scan and MRI) were consistent with intraconic dermoid cyst. The tumor was extirpated via a subfrontal approach. Histopathologic examination confirmed the diagnosis of dermoid cyst. The authors discuss the clinical symptoms, radiological aspects, and management.     

Orbital epidermoid cyst. Case report

Epidermoid tumors represent 1% of all primary intracranial tumors. Most of them occur intradurally in cerebellopontine angle and parasellar citerns. The intra-orbital location accounts for 4 to 5% of all primary intra-orbital tumors. We report the case of a 23-year-old girl with progressive right proptosis who had developed 6 months earlier. The tumor was removed via an external orbitotomy approach. Histology confirmed the diagnosis.     

Epidermoid tumors: Review of the literature

Reports of epidermoid tumors from 1965 through 1986 were reviewed with emphasis on new and unusual findings. Clinical data considered were rapid onset, rare symptoms, size and rate of growth, and complications. Uncommon locations included multiple sites in one patient and the anterior fontanelle. The radiologic data from computed tomography were the main contributors to diagnosis. An immunohistochemical test disclosed that cells of craniopharyngiomas are keratin-positive. Histologically benign epidermoids can behave as highly malignant tumors, and can become carcinomatous. Postoperative results for benign tumors were often excellent. Evidence was presented of the close relation among epidermoid and dermoid tumor, craniopharyngioma, ameloblastoma (adamantinoma), Rathke's cleft cyst, and aural cholesteatoma.     

Characteristic findings of metrizamide CT cisternography in epidermoids

Summary The characteristic findings of metrizamide CT cisternography in two cases of epidermoid are reported. The main finding was a cauliflower-like appearance and was thought to be caused by the irregular interstices of epidermoids.Metrizamide CT cisternography may be helpful in making a diagnosis of an epidermoid.     

Chemical meningitis in ruptured intracranial dermoid. Case report and review of the literature

A rare case of ruptured frontal dermoid tumor with typical magnetic resonance imaging and computed tomography appearances and presenting with chemical meningitis is reported.     

Congenital inclusion cysts of the subgaleal space

Congenital inclusion cysts of the subgaleal space in 23 white children are reported. Twenty-two cysts were dermoid and one was epidermoid in nature. The lesions were extracranial and had no intracranial extension. Their location in the subgaleal space was median or paramedian. Their clinical, radiologic, biochemical, and histologic characteristics are detailed and compared with those from Africa. This series counters the motion that such cysts are extremely rare in whites and that the anterior fontanel is their only site of location, as claimed by various authors from Africa.     

Orbital subperiotal hematoma associated with extradural hematoma: one case report

Subperiotal hematoma of the orbit associated with extradural hematoma has been rarely reported in the literature. We report a case of an 8-year-old girl who presented after traumatism, a subperiotal hematoma of the orbit with two extradural hematomas. During the first clinical examination realized while the patient was unconscious, left exophthalmia was found, but after conscious improvement, we discovered ophtalmoplegia and a grade I papilla edema. The CT scan showed two extradural hematomas and a left intraorbital hematoma. The intraorbital hematoma was drained by surgical way but the extradural hematomas were not surgical. The outcome has been marked by the neurological improvement and the oculomotricity recovering.     

Sacrococcygeal dermoids and teratomas: Historical review

Palpable rectally, when not externally visible, sacrococcygeal teratomas have been recognized since antiquity, but their histologic segregation from other sacrococcygeal masses lagged into the twentieth century. That these tumors are potentially malignant, and that the incidence of this complication increases with age during infancy, was realized early this century, but it is only in the last two decades that the importance of (1) early surgery, (2) excision of the coccyx, and (3) a combined abdominosacral approach for lesions with retroperitoneal extension has been realized.     

Congenital sublingual teratoid cyst: a case report and literature review

Head and neck dermoid cysts comprise less than 10% of all dermoid cysts. The sublingual location is very rare. One hypothesis for their etiology is that they arise from entrapment of epithelial debris or rests during the midline fusion of the first 2 branchial arches. They are classified as epidermoid, dermoid, and teratoid cysts. Sublingual cysts are slow-growing lesions generally seen in the second and third decades of life. They are rare in childhood. The cysts may interfere with swallowing and breathing. Rarely, they may show malignant transformation. Surgical extirpation is the treatment of choice.     

Primary meningioma intimately related to skull: Case report and review of the literature

A report is made of a primary meningioma intimately associated with the left sphenoid ridge and temporal bone of a 41-year-old woman. The lesion produced hyperostosis of the involved bones, ipsilateral proptosis, and reduced vision for 4.5 years. The radiotherapy yielded little improvement of the exophthalmos and vision. Review of 125 reported meningiomas intimately related to the skull and presenting primarily with hyperostosis and minimal soft tissue component, including the current case, disclosed that all but one affected the cranium proper, particularly the middle ear, temporal bone, frontal bone, and parietal bone. The exceptional one was in the mandible. They tended to occur between the fifth and seventh decades of life with the peak occurrence between the fifth and sixth decades. The average age was 46 years for overall. The female-to-male ratio was 2:1. Six of 125 primary meningiomas closely associated with the skull were malignant and two of these spread to the lungs. The pulmonary metastasis was spontaneous in one case.     

Intracranial dermoid cysts: variations of radiological and clinical features

Background  Intracranial dermoid cysts are uncommon, and their clinical features as well as surgical management differ from patient to patient. Dermoids are generally benign lesions, but may cause spontaneous complications such as meningitis and/or hydrocephalus due to rupture and epileptic seizures depending on their location. Little has been reported about characteristic imaging findings with resulting therapeutic considerations, and only a few reports exist about associated hydrocephalus. Imaging modalities have changed and can facilitate differential diagnosis and follow-up if applied correctly. In this paper, we attempt to contribute our clinical experience with the management of dermoid cysts. Patients and methods  The charts of five men and two women with intracranial dermoid cysts were retrospectively reviewed. The patients were treated between September 1993 and September 2006. Selected patients are presented in detail. Results  Tumour location, size and radiographic characteristics varied in each patient. Clinical presentations comprised focal neurological deficits as well as epileptic seizures, persistent headache, mental changes and psycho-organic syndromes. One patient underwent delayed ventriculo-peritoneal shunting after ruptured fatty particles caused obstructive hydrocephalus. Despite dermoid rupture into the subarachnoid space, three patients never developed hydrocephalus. Diffuse vascular supra-tentorial lesions were seen in one patient as a result of aseptic meningitis. Diffusion-weighted imaging (DWI) hyperintensity in dermoids is related to decrease of water proton diffusion and should be used for both the diagnosis and follow-up of this lesion. Conclusion  Although dermoid cysts are known to be benign entities per se, their rupture can cause a wide range of symptoms including aseptic meningitis and/or hydrocephalus. This may be due to intraventricular obstruction and/or paraventricular compression. While rupture does not necessarily bring about hydrocephalus, radical removal of the tumour and close monitoring of ventricular size is required. Although not widely recognised as such, DWI is considered to be a useful imaging modality in the diagnosis and follow-up of dermoids.