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İntrakraniyal epidermoid tümörlerin cerrahi tedavisi: cerrahi olarak tedavi edilen 29 hastanın retrospektif analizi

Yıl 2020, Cilt: 13 Sayı: 3, 677 - 686, 18.09.2020

Kadir Oktay , Ebru Guzel , Adnan Demirci , Özlem Nuray Sever , Vildan Kaya , Elif Akpınar , Mustafa Yıldırım , Aslan Güzel , Hakan Seçkin

https://doi.org/10.31362/patd.670647

Öz

Amaç: İntrakraniyal epidermoid tümörler iyi huylu, yavaş büyüyen ve nadir görülen tümörlerdir. Beynin ve kranyumun farklı bölgelerine görülebilmelerine rağmen, ağırlıklı olarak serebellopontin açı ve temporal bölgede yerleşirler. Bu çalışmada epidermoid tümörlerin klinik bulguları ve tümör yerleşimleri, cerrahi yöntemleri ve sonuçları incelendi.
Materyal ve Metod: 2012-2019 yılları arasında tanı konulan intrakraniyal epidermoid tümörü bulunan 29 hastanın tıbbi kayıtları retrospektif olarak incelendi.
Bulgular: Çalışma grubunda 16 kadın ve 13 erkek hasta vardı. Tümörler 16 hastada serebellopontin açıda ve 13 hastada diğer bölgelerde yerleşmişti. Serebellopontin açıdan köken alan tümörleri olan 16 hastanın ikisinde hem infra hem de supratentoryal uzanım mevcuttu. Bu hastalardan birine retrosigmoid ve subtemporal yaklaşımlarla iki seansta subtotal rezeksiyon uygulandı. Tümör, belirgin vasküler yapılara yapışan kapsülü dışında eksize edildi. Diğer hastaya ise subtemporal yaklaşımla tek seansla gros total rezeksiyon uygulandı. Diğer 14 olguda sadece infratentoryal yerleşim mevcuttu. 25 hastaya gros total rezeksiyon ve 4 hastaya subtotal rezeksiyon uygulandı. Dört hastada postoperatif komplikasyon gelişti. Tümörü beyin sapına yapışan bir hasta postoperatif dönemde kaybedildi. Hiçbir hastada nüks görülmedi.
Sonuç: İntrakraniyal epidermoid tümörlerin tedavisinin temel amacı cerrahi müdahale ile gros total tümör rezeksiyonu olmalıdır. Bununla birlikte, subtotal rezeksiyon morbidite ve mortaliteye neden olabilecek durumlarda hayati nörovasküler yapılara yapışık kapsüller bırakılarak yapılabilir. Total rezeksiyon yapılan tümörlerin nüks riski çok düşüktür.

Anahtar Kelimeler

Epidermoid tümör tedavi serebellopontin açı komplikasyon

Kaynakça

  • 1. Cumerlock MK. Epidermoid, dermoid and neuroenteric cysts. In: Winn HR, editor. Youmans Neurologic Surgery. 5th ed. Philadelphia: WB Saunders; 2003. pp. 1223-1230.
  • 2. Nagasawa D, Yew A, Safaee M, Fong B, Gopen Q, Parsa AT, et al. Clinical characteristics and diagnostic imaging of epidermoid tumors. J Clin Neurosci 2011;18(9):1158-1162.
  • 3. Hasegawa M, Nouri M, Nagahisa S, Yoshida K, Adachi K, Inamasu J, et al. Cerebellopontine angle epidermoid cysts: clinical presentations. Neurosurg Rev 2016;39(2):259-266.
  • 4. Schiefer TK, Link MJ. Epidermoids of the cerebellopontine angle: a 20-year experience. Surg Neurol 2008;70(6):584-590.
  • 5. Mohanty A, Venkatrama SK, Rao BR, Chandramouli BA, Jayakumar PN, Das BS. Experience with cerebellopontine angle epidermoids. Neurosurgery 1997;40(1):24-29.
  • 6. Yamakawa K, Shitara N, Genka S, Manaka S, Takakura K. Clinical course and surgical prognosis of 33 cases of intracranial epidermoid tumors. Neurosurgery 1989;24:568-573.
  • 7. Akar Z, Tanriover N, Tuzgen S, Kafadar AM, Kuday C. Surgical treatment of intracranial epidermoid tumors. Neurol Med Chir (Tokyo) 2003;43(6):275-280.
  • 8. Hassaneen W, Sawaya R. Epidermoid, dermoid and neuroenteric cysts. In: Winn HR, editor. Youmans Neurologic Surgery. 6th ed. Philadelphia: WB Saunders; 2011. pp. 1523-1528.
  • 9. Aribandi M, Wilson NJ. CT and MR imaging features of intracerebral epidermoid-a rare lesion. Br J Radiol 2008;81:e97-99.
  • 10. Kumari R, Guglani B, Gupta N, Chaturvedi S. Intracranial epidermoid cyst: magnetic resonance imaging features. Neurol India 2009;57(3):359-360.
  • 11. Li F, Zhu S, Liu Y, Chen G, Chi L, Qu F. Hyperdense intracranial epidermoid cysts: a study of 15 cases. Acta Neurochir (Wien) 2007;149(1):31-39.
  • 12. Love J, Kernohan J. Dermoid and epidermoid tumors (cholesteatomas) of central nervous system. JAMA 1936;107:1876-1883.
  • 13. Hao S, Tang J, Wu Z, Zhang L, Zhang J, Wang Z. Natural malignant transformation of an intracranial epidermoid cyst. J Formos Med Assoc 2010;109(5):390-396.
  • 14. Morishita T, Watanabe T, Ohta T, Fukushima M, Katayama Y. Atypical epidermoid cyst with repetitive hemorrhages in the supracallosal region: case report. Neurol Med Chir (Tokyo) 2009;49(10):492-494.
  • 15. Cornell SH, Graf C, Dolan KD. Fat-fluid level in intracranial epidermoid cyst. Am J Roentgenol 1977;128:502-503.
  • 16. Osborn AG, Preece MT. Intracranial cysts: radiologic-pathologic correlation and imaging approach. Radiology 2006;239:650-664.
  • 17. Nagashima C, Takahama M, Sakaguchi A. Dense cerebellopontine epidermoid cyst. Surg Neurol 1982;17:172-177.
  • 18. Maeda Y, Fujita T, Mabuchi E, Kanoh M, Tsujimura T. Epidermoid of the quadrigeminal cistern–case report. Neurol Med Chir (Tokyo) 1990;30(1):59-62.
  • 19. Alvord Jr EC. Growth rates of epidermoid tumors. Ann Neurol 1977;2(5):367-370.
  • 20. Link MJ, Cohen PL, Breneman JC, Tew JM Jr. Malignant squamous degeneration of a cerebellopontine angle epidermoid tumor. Case report. J Neurosurg 2002;97(5):1237-1243.
  • 21. Nosaka Y, Nagao S, Tabuchi K. Primary intracranial epidermoid carcinoma. Case report. J Neurosurg 1979;50(6):830-833.
  • 22. Czernicki T, Kunert P, Nowak A, Wojciechowski J, Marchel A. Epidermoid cysts of the cerebellopontine angle: Clinical features and treatment outcomes. Neurol Neurochir Pol 2016;50(2):75-82.
  • 23. Samii M, Tatagiba M, Piquer J, Carvalho GA. Surgical treatment of epidermoid cysts of the cerebellopontine angle. J Neurosurg 1996;84(1):14-19.
  • 24. Forghani R, Farb RI, Kiehl TR, Bernstein M. Fourth ventricle epidermoid tumor: radiologic, intraoperative, and pathologic findings. Radiographics 2007;27:1489-1494.
  • 25. Goel A, Shah A. Lateral supracerebellar transtentorial approach to a middle fossa epidermoid tumor. J Clin Neurosci 2010;17:372-373.
  • 26. Gormley WB, Tomecek FJ, Qureshi N, Malik GM. Craniocerebral epidermoid and dermoid tumours: a review of 32 cases. Acta Neurochir (Wien) 1994;128:115-121.
  • 27. Tomlinson BE, Walton JN. Granulomatous meningitis and diffuse parenchymatous degeneration of the nervous system due to an intracranial epidermoid cyst. J Neurol Neurosurg Psychiatry 1967;30:341-348.
  • 28. Yawn RJ, Patel NS, Driscoll CL, Link MJ, Haynes DS, Wanna GB, et al. Primary epidermoid tumors of the cerebellopontine angle: A review of 47 cases. Otol Neurotol 2016;37(7):951-955.
  • 29. Gupta S, Vaishya ND, Senger RL. Hyperdense intracranial epidermoid: an uncommon presentation. Neurol India 2000;48:158-160.
  • 30. Dechambre S, Duprez T, Lecouvet F, Raftopoulos C, Gosnard G. Diffusion-weighted MRI postoperative assessment of an epidermoid tumour in the cerebellopontine angle. Neuroradiology 1999;41(11):829-831.
  • 31. Hakyemez B, Aksoy U, Yildiz H, Ergin N. Intracranial epidermoid cysts: diffusion-weighted, FLAIR and conventional MR findings. Eur J Radiol 2005;54(2):214-220.
  • 32. Ikushima I, Korogi Y, Hirai T, Sugahara T, Shigematsu Y, Komohara Y, et al. MR of epidermoids with a variety of pulse sequences. Am J Neuroradiol 1997;18(7):1359-1363.
  • 33. Liu P, Saida Y, Yoshioka H, Itai Y. MR imaging of epidermoids at the cerebellopontine angle. Magn Reson Med Sci 2003;2(3):109-115.
  • 34. Yaşargil MG, Abernathey CD, Sarioglu AC. Microneurosurgical treatment of intracranial dermoid and epidermoid tumors. Neurosurgery 1989;24(4):561-567.
  • 35. Cherian A, Baheti NN, Easwar HV, Nair DS, Iype T. Recurrent meningitis due to epidermoid. J Pediatr Neurosci 2012;7(1):47-48.
  • 36. El-Shehaby AMN, Reda WA, Abdel Karim KM, Emad Eldin RM, Nabeel AM. Gamma knife radiosurgery for cerebellopontine angle epidermoid tumors. Surg Neurol Int 2017;8:258.
  • 37. Vasquez JA, Fonnegra JR, Diez JC, Fonnegra A. Treatment of epidermoid tumors with gamma knife radiosurgery: Case series. Surg Neurol Int 2016;7(Suppl 4):S116-120.

Surgical treatment of intracranial epidermoid tumors: a retrospective analysis of 29 surgically treated patients

Yıl 2020, Cilt: 13 Sayı: 3, 677 - 686, 18.09.2020

Kadir Oktay , Ebru Guzel , Adnan Demirci , Özlem Nuray Sever , Vildan Kaya , Elif Akpınar , Mustafa Yıldırım , Aslan Güzel , Hakan Seçkin

https://doi.org/10.31362/patd.670647

Öz

Objective: Intracranial epidermoid tumors are benign, slow-growing, rare tumors. Although they are placed in different regions of the brain and cranium, they are predominantly located in the cerebellopontine angle and temporal region. In the present study, clinical findings and tumor location of epidermoid tumors, surgical methods and their results were examined.
Materials and Methods: Medical records of 29 patients with intracranial epidermoid tumors diagnosed between 2012-2019 were retrospectively reviewed.
Results: There were 16 female and 13 male patients in the study cohort. Tumors were located in cerebellopontine angle in 16 patients and other regions in 13 patients. Two of the 16 patients with tumors originating from cerebellopontine angle had both infra and supratentorial extension. One of these patients underwent subtotal resection in two sessions via retrosigmoid and subtemporal approaches. The tumor was excised except for the capsule adherent to eloquent vascular structures. The other patient underwent gross total resection with a single session via subtemporal approach. The other 14 cases were only infratentorial. In 25 patients gross total resection was performed and subtotal resection was performed in 4 patients. There were postoperative complications in 4 patients. One patient, whose tumor was adherent to the brainstem was lost in the postoperative period. There was no recurrence in any of the patients.
Conclusion: The main purpose of treatment of intracranial epidermoid tumors should be gross total tumor resection by surgical intervention. However, subtotal resection may be performed by leaving a capsule adherent to eloquent neurovascular structures that may cause morbidity and mortality. The risk of recurrence of tumors in which total resection performed is very low.

Anahtar Kelimeler

Epidermoid tumor treatment cerebellopontine angle complication

Kaynakça

  • 1. Cumerlock MK. Epidermoid, dermoid and neuroenteric cysts. In: Winn HR, editor. Youmans Neurologic Surgery. 5th ed. Philadelphia: WB Saunders; 2003. pp. 1223-1230.
  • 2. Nagasawa D, Yew A, Safaee M, Fong B, Gopen Q, Parsa AT, et al. Clinical characteristics and diagnostic imaging of epidermoid tumors. J Clin Neurosci 2011;18(9):1158-1162.
  • 3. Hasegawa M, Nouri M, Nagahisa S, Yoshida K, Adachi K, Inamasu J, et al. Cerebellopontine angle epidermoid cysts: clinical presentations. Neurosurg Rev 2016;39(2):259-266.
  • 4. Schiefer TK, Link MJ. Epidermoids of the cerebellopontine angle: a 20-year experience. Surg Neurol 2008;70(6):584-590.
  • 5. Mohanty A, Venkatrama SK, Rao BR, Chandramouli BA, Jayakumar PN, Das BS. Experience with cerebellopontine angle epidermoids. Neurosurgery 1997;40(1):24-29.
  • 6. Yamakawa K, Shitara N, Genka S, Manaka S, Takakura K. Clinical course and surgical prognosis of 33 cases of intracranial epidermoid tumors. Neurosurgery 1989;24:568-573.
  • 7. Akar Z, Tanriover N, Tuzgen S, Kafadar AM, Kuday C. Surgical treatment of intracranial epidermoid tumors. Neurol Med Chir (Tokyo) 2003;43(6):275-280.
  • 8. Hassaneen W, Sawaya R. Epidermoid, dermoid and neuroenteric cysts. In: Winn HR, editor. Youmans Neurologic Surgery. 6th ed. Philadelphia: WB Saunders; 2011. pp. 1523-1528.
  • 9. Aribandi M, Wilson NJ. CT and MR imaging features of intracerebral epidermoid-a rare lesion. Br J Radiol 2008;81:e97-99.
  • 10. Kumari R, Guglani B, Gupta N, Chaturvedi S. Intracranial epidermoid cyst: magnetic resonance imaging features. Neurol India 2009;57(3):359-360.
  • 11. Li F, Zhu S, Liu Y, Chen G, Chi L, Qu F. Hyperdense intracranial epidermoid cysts: a study of 15 cases. Acta Neurochir (Wien) 2007;149(1):31-39.
  • 12. Love J, Kernohan J. Dermoid and epidermoid tumors (cholesteatomas) of central nervous system. JAMA 1936;107:1876-1883.
  • 13. Hao S, Tang J, Wu Z, Zhang L, Zhang J, Wang Z. Natural malignant transformation of an intracranial epidermoid cyst. J Formos Med Assoc 2010;109(5):390-396.
  • 14. Morishita T, Watanabe T, Ohta T, Fukushima M, Katayama Y. Atypical epidermoid cyst with repetitive hemorrhages in the supracallosal region: case report. Neurol Med Chir (Tokyo) 2009;49(10):492-494.
  • 15. Cornell SH, Graf C, Dolan KD. Fat-fluid level in intracranial epidermoid cyst. Am J Roentgenol 1977;128:502-503.
  • 16. Osborn AG, Preece MT. Intracranial cysts: radiologic-pathologic correlation and imaging approach. Radiology 2006;239:650-664.
  • 17. Nagashima C, Takahama M, Sakaguchi A. Dense cerebellopontine epidermoid cyst. Surg Neurol 1982;17:172-177.
  • 18. Maeda Y, Fujita T, Mabuchi E, Kanoh M, Tsujimura T. Epidermoid of the quadrigeminal cistern–case report. Neurol Med Chir (Tokyo) 1990;30(1):59-62.
  • 19. Alvord Jr EC. Growth rates of epidermoid tumors. Ann Neurol 1977;2(5):367-370.
  • 20. Link MJ, Cohen PL, Breneman JC, Tew JM Jr. Malignant squamous degeneration of a cerebellopontine angle epidermoid tumor. Case report. J Neurosurg 2002;97(5):1237-1243.
  • 21. Nosaka Y, Nagao S, Tabuchi K. Primary intracranial epidermoid carcinoma. Case report. J Neurosurg 1979;50(6):830-833.
  • 22. Czernicki T, Kunert P, Nowak A, Wojciechowski J, Marchel A. Epidermoid cysts of the cerebellopontine angle: Clinical features and treatment outcomes. Neurol Neurochir Pol 2016;50(2):75-82.
  • 23. Samii M, Tatagiba M, Piquer J, Carvalho GA. Surgical treatment of epidermoid cysts of the cerebellopontine angle. J Neurosurg 1996;84(1):14-19.
  • 24. Forghani R, Farb RI, Kiehl TR, Bernstein M. Fourth ventricle epidermoid tumor: radiologic, intraoperative, and pathologic findings. Radiographics 2007;27:1489-1494.
  • 25. Goel A, Shah A. Lateral supracerebellar transtentorial approach to a middle fossa epidermoid tumor. J Clin Neurosci 2010;17:372-373.
  • 26. Gormley WB, Tomecek FJ, Qureshi N, Malik GM. Craniocerebral epidermoid and dermoid tumours: a review of 32 cases. Acta Neurochir (Wien) 1994;128:115-121.
  • 27. Tomlinson BE, Walton JN. Granulomatous meningitis and diffuse parenchymatous degeneration of the nervous system due to an intracranial epidermoid cyst. J Neurol Neurosurg Psychiatry 1967;30:341-348.
  • 28. Yawn RJ, Patel NS, Driscoll CL, Link MJ, Haynes DS, Wanna GB, et al. Primary epidermoid tumors of the cerebellopontine angle: A review of 47 cases. Otol Neurotol 2016;37(7):951-955.
  • 29. Gupta S, Vaishya ND, Senger RL. Hyperdense intracranial epidermoid: an uncommon presentation. Neurol India 2000;48:158-160.
  • 30. Dechambre S, Duprez T, Lecouvet F, Raftopoulos C, Gosnard G. Diffusion-weighted MRI postoperative assessment of an epidermoid tumour in the cerebellopontine angle. Neuroradiology 1999;41(11):829-831.
  • 31. Hakyemez B, Aksoy U, Yildiz H, Ergin N. Intracranial epidermoid cysts: diffusion-weighted, FLAIR and conventional MR findings. Eur J Radiol 2005;54(2):214-220.
  • 32. Ikushima I, Korogi Y, Hirai T, Sugahara T, Shigematsu Y, Komohara Y, et al. MR of epidermoids with a variety of pulse sequences. Am J Neuroradiol 1997;18(7):1359-1363.
  • 33. Liu P, Saida Y, Yoshioka H, Itai Y. MR imaging of epidermoids at the cerebellopontine angle. Magn Reson Med Sci 2003;2(3):109-115.
  • 34. Yaşargil MG, Abernathey CD, Sarioglu AC. Microneurosurgical treatment of intracranial dermoid and epidermoid tumors. Neurosurgery 1989;24(4):561-567.
  • 35. Cherian A, Baheti NN, Easwar HV, Nair DS, Iype T. Recurrent meningitis due to epidermoid. J Pediatr Neurosci 2012;7(1):47-48.
  • 36. El-Shehaby AMN, Reda WA, Abdel Karim KM, Emad Eldin RM, Nabeel AM. Gamma knife radiosurgery for cerebellopontine angle epidermoid tumors. Surg Neurol Int 2017;8:258.
  • 37. Vasquez JA, Fonnegra JR, Diez JC, Fonnegra A. Treatment of epidermoid tumors with gamma knife radiosurgery: Case series. Surg Neurol Int 2016;7(Suppl 4):S116-120.
Toplam 37 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Cerrahi
Bölüm Araştırma Makalesi
Yazarlar

Kadir Oktay 0000-0003-2420-2734

Ebru Guzel

Adnan Demirci 0000-0003-1256-3428

Özlem Nuray Sever

Vildan Kaya

Elif Akpınar

Mustafa Yıldırım

Aslan Güzel

Hakan Seçkin

Yayımlanma Tarihi 18 Eylül 2020
Gönderilme Tarihi 5 Ocak 2020
Kabul Tarihi 29 Haziran 2020
Yayımlandığı Sayı Yıl 2020 Cilt: 13 Sayı: 3

Kaynak Göster

AMA Oktay K, Guzel E, Demirci A, Sever ÖN, Kaya V, Akpınar E, Yıldırım M, Güzel A, Seçkin H. Surgical treatment of intracranial epidermoid tumors: a retrospective analysis of 29 surgically treated patients. Pam Tıp Derg. Eylül 2020;13(3):677-686. doi:10.31362/patd.670647
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