Dermoid and epidermoid cysts of the midline in the posterior cranial fossa

Clinical features and surgical outcome of 16 patients with dermoid or epidermoid cysts on the midline of the posterior cranial fossa are compared. Salient points in the comparison are the younger age, presence of associated malformations and better prognosis of dermoid cyst.     

Arachnoid cysts of the posterior fossa

A series of 6 patients with arachnoid cysts of the posterior fossa who were treated surgically is presented. The diagnosis of the nature of the lesion and of the exact location within the posterior fossa could not be established on a clinical basis. CT scanning is the best method for diagnosing the lesion and for observing the postoperative evolution. Treatment consisted of removing the cyst walls, shunting the cyst to the peritoneum, or both. The differential diagnosis of arachnoid cysts of the posterior fossa from other cerebrospinal fluid collections, such as the megacisterna magna or the Dandy-Walker malformation, are discussed.     

Brain abscess secondary to intracranial extradural epidermoid cyst

A case of brain abscess in the right temporal lobe secondary to an intracranial extradural epidermoid cyst in the right parasellar region is reported. The etiology of the brain abscess in this particular case was deduced using the findings of computed tomography, carried out several times over a 3-year period, after an initial operation to remove the epidermoid cyst. One of the scans showed a very-low-density spot in the right parasellar region compatible with air, suggesting a communication between the intracranial space and the paranasal sinuses.     

Use of the prone oblique position in surgery for posterior fossa lesions

Summary Background. The lateral suboccipital approach has been conventionally performed with the lateral, park-bench, or sitting position and the midline suboccipital approach has been performed in the prone position. We attempt to show the advantages of the prone oblique position in the surgery for posterior fossa lesions.Methods. Twenty-two patients with posterior fossa lesions underwent surgery in the prone oblique position. The patients were fixed in the prone position while the operating table was rotated to raise the patients shoulder. The surgeon sat beside the downward-shifted contralateral shoulder of the patient. With the lateral suboccipital approach, the neck of the patient was rotated to the side of the lesion. With the midline sub-occipital approach, the neck was not rotated.Findings. With the lateral suboccipital approach, this position spread the transverse axis of the suboccipital triangle and eliminated the interference of the patients shoulder, providing an operative field that is wider than the lateral position or park bench position in all cases. With the midline suboccipital approach, this position enabled the surgeon to operate on lesions located in the upper half of the posterior fossa, such as fourth ventricular lesions or infratentorial lesions, without the need for a looking up posture with overhanging of the operative microscope.Conclusion. The prone oblique position offers the operator a panoramic view of the posterior fossa.     

Hydromyelia associated with a posterior fossa cyst

There are rare reports of children with hydromyelia in association with arachnoid cysts at the foramen of Magendie, and these cases have uniformly been associated with hydrocephalus. We report a case of a 45-year-old woman with a posterior fossa cyst associated with hydromyelia and normal ventricles. This was successfully treated with a cystoperitoneal shunt. We believe this unusual condition is of interest in elucidating potential mechanisms of hydromyelia.     

Neurenteric cyst of the posterior fossa. Case report and review of the literature

Intracranial neurenteric cysts are rare entities. The term is currently used to describe epithelial cysts that are lined with a presumed endodermal-derived epithelium and are mostly located in the posterior fossa.Preoperative diagnosis is often difficult because of their clinical presentation, which may resemble a subarachnoid hemorrhage, and the radiological aspect, which can mimic vascular pathologies.We describe a posterior fossa neurenteric cyst in a 27-year-old woman, who presented with sudden headache as the only symptom and who was addressed to our hospital for subarachnoid hemorrhage. Diagnostic angiography was negative and MRI revealed a prepontine cystic lesion. The patient underwent a posterolateral approach on the right side, with subtotal resection of the lesion.We discuss the embryologic, diagnostic and therapeutic aspects of these cysts and review the literature.     

Presacral epidermoid cyst: Report of a case

(Received for publication on Dec. 26, 1996; accepted on July 8, 1997)     

Craniopharyngioma extended into the posterior fossa

A 7-year-old girl with a craniopharyngioma with a rare extension into the posterior fossa is presented. MRI revealed a solid calcified mass in the sellar and suprasellar region with a cyst expanded to the posterior fossa up to the foramen magnum and causing hydrocephalus and brainstem displacement. The tumor was removed totally with right pterional approach.     

Testicular epidermoid cyst in Klinefelter''s syndrome

A 38-year-old Japanese man was referred to our outpatient clinic for treatment of infertility. Semen analysis showed azoospermia. Chromosome analysis revealed a 47XXY karyotype, and non-mosaic Klinefelter's syndrome (KFS) was diagnosed. Upon physical examination, the patient's right testicular volume was 30 mL and the left testicular volume was 3 mL. Laboratory tests showed normal levels of lactate dehydrogenase, alpha-fetoprotein, and human chorionic gonadotropin beta-subunit. The plasma luteinizing hormone and follicle-stimulating hormone levels were increased to 15.7 mIU/mL and 45.9 mIU/mL, respectively. The plasma testosterone was decreased to 0.25 ng/mL. Magnetic resonance imaging showed a right testicular mass of low-signal intensity on the T1-weighted image and of high-signal intensity on the T2-weighted image. Therefore, the final diagnosis was KFS with a right testicular tumor. Thus, a right high orchiectomy was performed. Histological examination revealed an epidermoid cyst of the right testis. Epidermoid cysts in cases of KFS are rare. To our knowledge, only seven cases, including ours, have been reported in the literature.     

Chronic extradural hematomas of the posterior cranial fossa

During the past 6 years, seven patients with chronic extradural hematomas have been observed at these hospitals. All had a history of occipital injury. Occipital fracture was demonstrated in five cases (by skull x-ray in three cases, at operation in two). The diagnosis was obtained by computed tomography scan in six cases and by iodoventriculography in one. One patient had an associated cerebral lesion, namely, a contralateral temporoparietal contusion. The interval between injury and operation ranged from 27 to 13 days with a mean of 19 days. Only one patient was not operated on, because he was free from symptoms and the hematoma was small. The course was excellent in all seven cases.     

颅后窝胆脂瘤显微外科治疗

目的 为了提高颅后窝胆脂瘤的手术治疗效果。方法 回顾性总结１６２例颅后窝胆脂瘤的临床症状、诊断方式、显微手术入路与疗效。 结果 １４９例（９２．０％）肿瘤获全切除;１３例（８．０％）为次全切除。４例（２．５％）于术后２周内因脑干缺血、水肿或肺部感染而死亡。１３４例获长期随访（平均４．５年）,其中１２９例（９６．３％）恢复良好,２例（１．５％）肿瘤复发。 结论 采用显微手术治疗颅后窝胆脂瘤是一种安全     

Growing skull fracture of the posterior cranial fossa and of the orbital roof

Summary.  Background: Growing Skull Fractures (GSF) are rare complications of head trauma, primarily reported in infancy and early childhood. GSF are commonly located on calvaria, and rarely in other locations, including the skull base.  Method: In this study, we report two cases of GSF occurring in unusual locations. The first, a 8-month old girl, with a GSF of the suboccipital posterior fossa region, and the second, a 4-year old boy with a GSF of the right orbital roof. Both cases underwent operative treatment of the GSF, with microsurgical dissection and excision of the protruding gliotic brain tissue, watertight duraplasty and autologous bone cranial repair. The authors conducted a Medline search of the relevant English literature from 1966 to 2002.  Findings: From the search, three cases of suboccipital posterior fossa region GSF and twelve series of orbital GSF, describing a total of 22 cases, have been found.  Interpretation: A survey of the pathogenic mechanisms underling this entity in these locations is reported. A review of suboccipital posterior fossa and orbital roof GSF cases, of nosological, ophthalmological and neurological data, neuroradiological and operative findings, and results of different treatment strategies are described. Published online March 3, 2003  Correspondence: Antonino Germanò, M.D., Neurosurgical Clinic, Policlinico, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy.     

Malignant transformation of posterior fossa epidermoid cyst

The authors report the case of a 45-year-old man who presented with a short duration of a painful ophthalmoparesis. Initial magnetic resonance imaging revealed an extraaxial petroclival mass characteristic of an epidermoid cyst, with the exception of a contiguous contrast-enhancing lobule. A subtotal resection was performed with the histopathological diagnosis revealing malignant transformation of an epidermoid cyst. Despite aggressive postoperative adjuvant therapy, the patient developed leptomeningeal metastasis and died shortly thereafter. The presence of contrast enhancement at the site of an epidermoid cyst combined with an acute, progressive neurological deficit should alert the treating physician to the possibility of a malignant transformation. When transformation does occur, the clinical and radiological course is quite aggressive as compared with the indolent growth of epidermoid cysts. Treatment options include surgery with adjuvant chemotherapy or radiotherapy. We review the pertinent features of this case along with the relevant literature regarding primary intracranial squamous cell carcinomas.     

阴囊内大体积表皮样囊肿1例报告并文献复习

目的:探讨阴囊内大体积表皮样囊肿的疾病特点,提高对阴囊内大体积表皮样囊肿的临床诊治水平。方法:回顾性分析1例阴囊内大体积表皮样囊肿患者临床资料,男,50岁,发现右侧阴囊内肿物40余年,呈进行性长大。右侧阴囊内可触及直径约为7.0cm大小椭圆形肿物,界清,质硬,触痛阴性。阴囊彩超提示右侧阴囊内有囊性肿物,大小约7.7cm×4.7cm×5.0cm,与睾丸界清。在腰硬联合麻醉下行右侧阴囊内肿物切除术。结果:术后患者预后良好。切除病变组织送病检,证实为阴囊内表皮样囊肿。结论:阴囊内表皮样囊肿是阴囊罕见的良性肿瘤,一般无明显不适,肿物可缓慢生长,目前确诊依赖于术后病检。对于阴囊内表皮样囊肿应尽早手术切除,但易复发,应长期随访。     

Extradural hematoma of the posterior cranial fossa

Fourteen cases of an extradural hematoma of the posterior fossa (EDHPF), are presented and the clinical and radiological findings are described. The onset of symptoms was acute in 10 patients and subacute in the other 4. Hematomas occurred in the younger age groups with a clear male predominance. Nine cases had suffered a blow to the head. A fracture of the occipital bone was seen in 86% of the patients. The bleeder could be identified in 10 cases, and in 6 of these the source was a bleeding transverse sinus. The overall mortality was 14.2%, but only patients with an acute course died (20%). All subacute cases survived. This study revealed that the most important factors influencing mortality were late diagnosis and late treatment. Coexisting intracranial lesions had no influence on mortality. According to the literature, there has been a certain decrease in mortality in the acute and subacute course patients since the introduction of computed tomography (CT) scanning. Emphasis is placed on the importance of occipital soft-tissue swelling and occipital fracture as clues to the possible presence of extradural hematomas, and of using the CT in all such patients even if no clinical symptoms are present.     

Huge epidermoid cyst of the spermatic cord in an adult patient

Tumors arising in the spermatic cord are uncommon and form a heterogeneous group of neoplasms. A variety of both benign and malignant lesions have been demonstrated. Benign tumors represent 80% of the total, but unfortunately clinical and sonographic features are not specific and they cannot safely differentiate a teratomatous or a malignant neoplasm from benign tumors. We report a case of a huge epidermoid cyst of the spermatic cord in an adult patient confirmed after local excision. The etiology, differential diagnosis, and management alternatives are discussed.     

Anaesthesia for posterior fossa surgery

Surgery on the posterior fossa is technically challenging and requires surgical skill and judgement. The anaesthetist through an understanding of the surgeon's problems, the provision of ideal operating conditions, the meticulous monitoring for changes in vital signs and good communication with the surgeon can make a crucial contribution to successful outcome for the patient. The positioning of patients poses particular problems. The prone and lateral positions, together with the supine for transoral surgery, can provide for appropriate access to all parts of the posterior fossa. Traditionally it has been argued that the sitting position offers specific advantages although it creates additional problems for the anaesthetist. In recent years the potential risks of sitting patients up have been extensively investigated and concern has focused in particular on the danger of paradoxical air embolism. Although its safety in recognized centres has been demonstrated, it is clear that this position is now falling out of favour.     

睾丸表皮样囊肿7例报告并文献复习

目的探讨睾丸表皮样囊肿的临床特点及诊治方案。方法回顾性分析2003年1月至2013年6月我院收治的7例睾丸表皮样囊肿的临床资料,结合文献复习进行讨论,其中6例采用肿瘤剜除术,1例采用睾丸切除术。结果术后随访6个月~10年,无肿瘤复发及转移。结论睾丸表皮样囊肿是少见的睾丸良性肿瘤,B超、CT、MRI检查对诊断本病有重要作用,推荐保留睾丸的单纯肿物剜除术作为主要的治疗方式。