Complications in Resections of Intracranial Epidermoid Cysts

Introduction: Epidermoid cysts are benign, non-neoplastic, congenital epithelial tumors and correspond to about 1% of all intracranial tumors and 7% of the cebellopontine angle tumors. The treatment of choice is gross total resection (GTR). Although well-established as the main treatment of these lesions, complications related to the procedure are poorly described in the literature.

Goal: To characterize the main complications related to intracranial epidermoid cysts resection surgeries and to identify predictors of worse prognosis.

Method: The study included all cases of patients with intracranial epidermoid cysts tumor, confirmed by an anatomic-pathological report, who underwent surgery at Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo between February 2009 and October 2015. The collection of data was retrospectively recorded in patient records (physical and electronic). The imaging exams will be reviewed pre- and postoperative (CTs and/or RNMs) through an electronic platform provided by the institution. Univariate analysis was performed for correlation between complications and possible predictors of prognosis.

Result: Twenty-one patients were analyzed, 11 males (52%). The mean age at treatment was 37.5 years (ranging from 15 to 60 years). Mean follow-up time was 2.83 years. The most common clinical manifestations are headache (52%) and cranial nerve deficits (43%). The most common location was APC (47%). Seven patients (33%) underwent RCT. There were no deaths in the perioperative period. Two patients died late postoperative, one of them with complications related to surgery. Eleven cases (54%) had some complications related to surgery; the main ones observed were worsening neurological deficit (33%), cerebrospinal fluid fistulas (24%) and hydrocephalus (19%). In the univariate analysis, we noticed that partial/subtotal resection showed an association with the number of complications in general (p = 0.001), but these tumors were larger than those with total resection (0.014).

Conclusion: This study demonstrated that treatment of the epidermoid cyst has a high rate of acute and late complications (56%), unlike what is generally described in the literature. The main factors associated with the complications were the degree of resection of the lesion (partial/subtotal), but the tumors of partial/subtotal resection appear to be larger, however the limitation of the sample did not allow show this association (p = 0.07).