Early Recurrence of an Intracranial Epidermoid Cyst Due to Low-Grade Infection: Case Report

 

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ABSTRACT

Intracranial epidermoid cysts are slow-growing lesions, which may recur after incomplete resection, but do so over many years. The authors present the case of an epidermoid that repeatedly recurred over a short period, which was discovered to be secondary to a low-grade bacterial infection. A 30-year-old woman presented with signs and symptoms related to brainstem and cranial nerve compromise from a large cerebellopontine angle epidermoid cyst. She underwent a subtotal excision of a macroscopically and histologically typical epidermoid. The lesion recurred within 1 year of surgery, but with atypical radiological appearances. No systemic or local evidence of infection was found during a second resection. A further large recurrence with the same atypical features occurred after another 6 months, necessitating a third surgical resection. On this occasion, the atypical cyst contents grew coagulase-negative Staphylococcus after prolonged culture in an enrichment medium. Following a course of appropriate antibiotics, the residual cyst contents completely resolved. This case highlights an unusual complication of an epidermoid cyst. Early recurrence of an epidermoid, even in the absence of overt evidence of infection, should produce a high index of suspicion that there may be a low-grade infective cause. Surgical excision coupled with antibiotics resulted in a symptomatic and radiological recovery.

REFERENCES

• 1 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;  42 242-251
  CrossrefPubMedGoogle Scholar
• 2 Yasargil M G, Abernathey C D, Sarioglu A C. Microneurosurgical treatment of intracranial dermoid and epidermoid tumors.  Neurosurgery. 1989;  24 561-567
  CrossrefPubMedGoogle Scholar
• 3 Berger M S, Wilson C B. Epidermoid cysts of the posterior fossa.  J Neurosurg. 1985;  62 214-219
  CrossrefPubMedGoogle Scholar
• 4 Samii M, Tatagiba M, Piquer J, Carvalho G A. Surgical treatment of epidermoid cysts of the cerebellopontine angle.  J Neurosurg. 1996;  84 14-19
  CrossrefPubMedGoogle Scholar
• 5 Schroeder H W, Oertel J, Gaab M R. Endoscope-assisted microsurgical resection of epidermoid tumors of the cerebellopontine angle.  J Neurosurg. 2004;  101 227-232
  CrossrefPubMedGoogle Scholar
• 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
  PubMedGoogle Scholar
• 7 De Micheli E, Bricolo A. The long history of a cerebello-pontine angle epidermoid tumour-a case report and lessons learned.  Acta Neurochir (Wien). 1996;  138 350-354
  CrossrefPubMedGoogle Scholar
• 8 Obrador S, Lopez-Zafra J J. Clinical features of the epidermoids of the basal cisterns of the brain.  J Neurol Neurosurg Psychiatry. 1969;  32 450-454
  PubMedGoogle Scholar
• 9 Alvord Jr E C. Growth rates of epidermoid tumors.  Ann Neurol. 1977;  2 367-370
  CrossrefPubMedGoogle Scholar
• 10 Schwartz J F, Balentine J D. Recurrent meningitis due to an intracranial epidermoid.  Neurology. 1978;  28 124-129
  PubMedGoogle Scholar
• 11 Cornell S H, Graf C J, Dolan K D. Fat-fluid level in intracranial epidermoid cyst.  AJR Am J Roentgenol. 1977;  128 502-503
  PubMedGoogle Scholar
• 12 Abramson R C, Morawetz R B, Schlitt M. Multiple complications from an intracranial epidermoid cyst: case report and literature review.  Neurosurgery. 1989;  24 574-578
  PubMedGoogle Scholar
• 13 Dutt S N, Mirza S, Chavda S V, Irving R M. Radiologic differentiation of intracranial epidermoids from arachnoid cysts.  Otol Neurotol. 2002;  23 84-92
  CrossrefPubMedGoogle Scholar
• 14 Featherstone T. Epidermoid tumour of the cerebellopontine angle: diagnosis by MRI.  J Laryngol Otol. 1994;  108 438-440
  PubMedGoogle Scholar
• 15 Kallmes D F, Provenzale J M, Cloft H J, McClendon R E. Typical and atypical MR imaging features of intracranial epidermoid tumors.  AJR Am J Roentgenol. 1997;  169 883-887
  CrossrefPubMedGoogle Scholar
• 16 Zamani A A. Cerebellopontine angle tumors: role of magnetic resonance imaging.  Top Magn Reson Imaging. 2000;  11 98-107
  PubMedGoogle Scholar
• 17 Ikushima I, Korogi Y, Hirai T et al.. MR of epidermoids with a variety of pulse sequences.  AJNR Am J Neuroradiol. 1997;  18 1359-1363
  PubMedGoogle Scholar
• 18 Mikhael M A, Mattar A G. Intracranial pearly tumors: the roles of computed tomography, angiography, and pneumoencephalography.  J Comput Assist Tomogr. 1978;  2 421-429
  PubMedGoogle Scholar
• 19 Dubois P J, Sage M, Luther J S et al.. Case report. Malignant change in an intracranial epidermoid cyst.  J Comput Assist Tomogr. 1981;  5 433-435
  PubMedGoogle Scholar
• 20 Lewis A J, Cooper P W, Kassel E E, Schwartz M L. Squamous cell carcinoma arising in a suprasellar epidermoid cyst. Case report.  J Neurosurg. 1983;  59 538-541
  PubMedGoogle Scholar
• 21 Bartal A, Razon N, Avram J, Rochkind S, Doron A. Infratentorial epidermoids.  Acta Neurochir Suppl (Wien). 1988;  42 142-146
  PubMedGoogle Scholar
• 22 Jaiswal A K, Mahapatra A K. Giant intradiploic epidermoid cysts of the skull. A report of eight cases.  Br J Neurosurg. 2000;  14 225-228
  CrossrefPubMedGoogle Scholar
• 23 Bejarano P A, Broderick D F, Gado M H. Infected epidermoid cyst of the sphenoid bone.  AJNR Am J Neuroradiol. 1993;  14 771-773
  PubMedGoogle Scholar
• 24 Schijman E, Monges J, Cragnaz R. Congenital dermal sinuses, dermoid and epidermoid cysts of the posterior fossa.  Childs Nerv Syst. 1986;  2 83-89
  PubMedGoogle Scholar

Scott A Rutherford

Department of Neurosurgery, Hope Hospital, Stott Lane

Salford, Manchester, M6 8HD, UK

Email: scott.rutherford@srht.nhs.uk