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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2017; 36(03): 145-152
DOI: 10.1055/s-0037-1606292
Original Article | Artigo Original
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Surgical Strategy for Dermoid and Epidermoid Tumors of the Posterior Fossa - Experience with 21 Patients

Melhor estratégia cirúrgica para tumores dermoides e epidermoides da fossa posterior - experiência em 21 pacientes
José Carlos Lynch
1   Neurocirurgia, Hospital Federal Servidores do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
,
Leonardo C. Welling
2   Neurocirurgia, Universidade Estadual de Ponta Grossa, Ponta Grossa, PR, Brazil
,
Antonio Aversa
3   Neurocirurgia, Instituto Nacional do Câncer/INCA, Rio de Janeiro, RJ, Brazil
,
Celestino Esteves
1   Neurocirurgia, Hospital Federal Servidores do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
,
Jânio Nogueira
3   Neurocirurgia, Instituto Nacional do Câncer/INCA, Rio de Janeiro, RJ, Brazil
,
Mariângela Gonçalves
1   Neurocirurgia, Hospital Federal Servidores do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
,
Hélio Lopes
1   Neurocirurgia, Hospital Federal Servidores do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
› Author Affiliations
Further Information

Publication History

19 May 2017

01 August 2017

Publication Date:
23 August 2017 (online)

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Abstract

Objective The aim of this paper is to describe our surgical strategy and technique and to identify the best management for posterior fossa dermoid and epidermoid tumors (PFDETs).

Methods We retrospectively identified 21 consecutive patients (11 males and 10 females), with a mean age of 33.2 years, a mean follow-up of 6.1 years, and pathologically confirmed PFDETs. Total 17 patients were submitted to the extended retrosigmoid approach. This approach incorporates transverse sigmoid sinus exposure and a generous mastoidectomy.

Results Gross total tumor removal was achieved in 16 (76.1%) cases, with no surgical mortality and a recurrence rate of 9.5%.

Conclusions The surgical strategies used in this group of patients enabled the total removal of most tumors without surgical mortality and with minimal morbidity and recurrence rates. The extended retrosigmoid approach used is an alternative path regarding cranial base approaches. This approach is quick, simple and safe, and decreases the retraction of the cerebellum.

Resumo

Objetivos O objetivo deste estudo é descrever a técnica operatória para a melhor abordagem dos tumores dermoides e epidermoides da fossa posterior.

Métodos Foram analisados retrospectivamente 21 pacientes (11 masculinos e 10 femininos), com idade média de 33,2 anos e acompanhamento de 6,1 anos, com diagnóstico histopatológico de tumor dermoide ou epidermoide de fossa posterior. Nesse grupo, 17 pacientes foram submetidos a abordagem retrossigmoide estendida. Esta abordagem inclui exposição do seio transverso e sigmoide, além de ampla mastoidectomia.

Resultados Remoção cirúrgica total foi alcançada em 16 (76,1%) casos sem mortalidade e com recidiva em 9,5% dos casos.

Conclusões As abordagens cirúrgicas utilizadas nesta série permitiram a ressecção total na maioria dos pacientes, sem mortalidade cirúrgica e com morbidade e recorrência mínima. A craniotomia retrossigmoide estendida utilizada é uma boa alternativa para abordagens da base do crânio. É uma abordagem simples, rápida, segura, e que minimiza a retração do cerebelo.

Keywords

dermoid tumor - epidermoid tumor - intracranial tumor - microsurgery - posterior fossa

Palavras-chave

tumor dermoide - tumor epidermoide - tumor intracraniano - microcirurgia - fossa posterior
 

  • References

  • 1 Zülch KJ. Brain tumors their biology and pathology. New York: Springer; 1965: 240-245
    Google Scholar
  • 2 Rubinstein LJ. Tumors of the nervous System. Washington. DC: Armed Forces Institute of Pathology; 1972: 288-292
    Google Scholar
  • 3 Russell DS, Rubinstein LJ. Pathology of Tumors of the Nervous System, ed 4. Baltimore: Williams & Wilkins; 1977: 29-32
    Google Scholar
  • 4 Yaşargil MG, Abernathey CD, Sarioglu AÇ. Microneurosurgical treatment of intracranial dermoid and epidermoid tumors. Neurosurgery 1989; 24 (04) 561-567
    CrossrefPubMedGoogle Scholar
  • 5 Grant FC, Austin GM. Epidermoids; clinical evaluation and surgical results. J Neurosurg 1950; 7 (03) 190-198
    CrossrefPubMedGoogle Scholar
  • 6 Guidetti B, Gagliardi FM. Epidermoid and dermoid cysts. Clinical evaluation and late surgical results. J Neurosurg 1977; 47 (01) 12-18
    CrossrefPubMedGoogle Scholar
  • 7 Schroeder HW, Oertel J, Gaab MR. Endoscope-assisted microsurgical resection of epidermoid tumors of the cerebellopontine angle. J Neurosurg 2004; 101 (02) 227-232
    CrossrefPubMedGoogle Scholar
  • 8 Lunardi P, Missori P, Innocenzi G, Gagliardi FM, Fortuna A. Long-term results of surgical treatment of cerebello-pontine angle epidermoids. Acta Neurochir (Wien) 1990; 103 (3-4): 105-108
    CrossrefPubMedGoogle Scholar
  • 9 Obrador S, Lopez-Zafra JJ. Clinical features of the epidermoids of the basal cisterns of the brain. J Neurol Neurosurg Psychiatry 1969; 32 (05) 450-454
    CrossrefPubMedGoogle Scholar
  • 10 Rubin G, Scienza R, Pasqualin A, Rosta L, Da Pian R. Craniocerebral epidermoids and dermoids. A review of 44 cases. Acta Neurochir (Wien) 1989; 97 (1-2): 1-16
    CrossrefPubMedGoogle Scholar
  • 11 Salazar J, Vaquero J, Saucedo G, Bravo G. Posterior fossa epidermoid cysts. Acta Neurochir (Wien) 1987; 85 (1-2): 34-39
    CrossrefPubMedGoogle Scholar
  • 12 Samii M, Tatagiba M, Piquer J, Carvalho GA. Surgical treatment of epidermoid cysts of the cerebellopontine angle. J Neurosurg 1996; 84 (01) 14-19
    CrossrefPubMedGoogle Scholar
  • 13 Ulrich J. Intracranial epidermoids. A study on their distribution and spread. J Neurosurg 1964; 21: 1051-1058
    CrossrefPubMedGoogle Scholar
  • 14 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 (04) 568-573
    CrossrefPubMedGoogle Scholar
  • 15 Talacchi A, Sala F, Alessandrini F, Turazzi S, Bricolo A. Assessment and surgical management of posterior fossa epidermoid tumors: report of 28 cases. Neurosurgery 1998; 42 (02) 242-251 , discussion 251–252
    CrossrefPubMedGoogle Scholar
  • 16 Ahmed I, Auguste KI, Vachhrajani S, Dirks PB, Drake JM, Rutka JT. Neurosurgical management of intracranial epidermoid tumors in children. Clinical article. J Neurosurg Pediatr 2009; 4 (02) 91-96
    CrossrefPubMedGoogle Scholar
  • 17 Berger MS, Wilson CB. Epidermoid cysts of the posterior fossa. J Neurosurg 1985; 62 (02) 214-219
    CrossrefPubMedGoogle Scholar
  • 18 Cobbs CS, Pitts LH, Wilson CB. Epidermoid and dermoid cysts of the posterior fossa. Clin Neurosurg 1997; 44: 511-528
    PubMedGoogle Scholar
  • 19 deSouza CE, deSouza R, da Costa S. , et al. Cerebellopontine angle epidermoid cysts: a report on 30 cases. J Neurol Neurosurg Psychiatry 1989; 52 (08) 986-990
    CrossrefPubMedGoogle Scholar
  • 20 Mohanty A, Venkatrama SK, Rao BR, Chandramouli BA, Jayakumar PN, Das BS. Experience with cerebellopontine angle epidermoids. Neurosurgery 1997; 40 (01) 24-29 , discussion 29–30
    PubMedGoogle Scholar
  • 21 Vinchon M, Pertuzon B, Lejeune JP, Assaker R, Pruvo JP, Christiaens JL. Intradural epidermoid cysts of the cerebellopontine angle: diagnosis and surgery. Neurosurgery 1995; 36 (01) 52-56 , discussion 56–57
    CrossrefPubMedGoogle Scholar
  • 22 Sanai N, McDermott MW. A modified far-lateral approach for large or giant meningiomas of the posterior fossa. J Neurosurg 2010; 112 (05) 907-912
    CrossrefPubMedGoogle Scholar
  • 23 Malis LI. Nuances in acoustic neuroma surgery. Neurosurgery 2001; 49 (02) 337-341
    PubMedGoogle Scholar
  • 24 Malis LI. Acoustic neuroma Surgery. Randolf: Codman; 1987: 1-20
    Google Scholar
  • 25 Quiñones-Hinojosa A, Chang EF, Lawton MT. The extended retrosigmoid approach: an alternative to radical cranial base approaches for posterior fossa lesions. Neurosurgery 2006; 58 (04) (Suppl. 02) ONS-208-ONS-214 , discussion ONS-214
    PubMedGoogle Scholar
  • 26 Gagliardi FM, Vagnozzi R, Caruso R, Delfini R. Epidermoids of the cerebellopontine angle (cpa): usefulness of CT scan. Acta Neurochir (Wien) 1980; 54 (3-4): 271-281
    CrossrefPubMedGoogle Scholar
  • 27 Altschuler EM, Jungreis CA, Sekhar LN, Jannetta PJ, Sheptak PE. Operative treatment of intracranial epidermoid cysts and cholesterol granulomas: report of 21 cases. Neurosurgery 1990; 26 (04) 606-613 , discussion 614
    CrossrefPubMedGoogle Scholar
  • 28 Kobata H, Kondo A, Iwasaki K. Cerebellopontine angle epidermoids presenting with cranial nerve hyperactive dysfunction: pathogenesis and long-term surgical results in 30 patients. Neurosurgery 2002; 50 (02) 276-285 , discussion 285–286
    PubMedGoogle Scholar
  • 29 Gormley WB, Tomecek FJ, Qureshi N, Malik GM. Craniocerebral epidermoid and dermoid tumours: a review of 32 cases. Acta Neurochir (Wien) 1994; 128 (1-4): 115-121
    CrossrefPubMedGoogle Scholar
  • 30 Talacchi A, Sala F, Alessandrini F, Turazzi S, Bricolo A. Assessment and surgical management of posterior fossa epidermoid tumors: report of 28 cases. Neurosurgery 1998; 42 (02) 242-251 , discussion 251–252 (Comments)
    CrossrefPubMedGoogle Scholar
  • 31 Sabin HI, Bordi LT, Symon L. Epidermoid cysts and cholesterol granulomas centered on the posterior fossa: twenty years of diagnosis and management. Neurosurgery 1987; 21 (06) 798-805
    CrossrefPubMedGoogle Scholar