Ahmed Ibrahim, Auguste Kurtis I, Vachhrajani Shobhan, Dirks Peter B, Drake James M, Rutka James T
Division of Neurosurgery, The Hospital for Sick Children, The University of Toronto, Ontario, Canada.
J Neurosurg Pediatr. 2009 Aug;4(2):91-6. doi: 10.3171/2009.4.PEDS08489.
Epidermoid tumors are benign lesions representing 1% of all intracranial tumors. There have been few pediatric series of intracranial epidermoid tumors reported previously. The authors present their experience in the management of these lesions.
The neurosurgical database at the Hospital for Sick Children was searched for children with surgically managed intracranial epidermoid tumors. The patients' charts were reviewed for demographic data, details of clinical presentation, surgical therapy, and follow-up. Ethics board approval was obtained for this study.
Seven children, all girls, were identified who met the inclusion criteria between 1980 and 2007. The average age at surgery was 11.2 years (range 8-15 years), and the mean maximal tumor diameter was 2.1 cm. Headache was the most common presenting symptom, and 1 tumor was found incidentally. Most patients had normal neurological examinations, but meningism was found in 2 cases. There were 3 cerebellopontine angle lesions, 1 pontomedullary lesion, and 3 supratentorial tumors. Hydrocephalus developed in 1 patient after aseptic meningitis, and she underwent shunt placement. There were no operative deaths. Complete resection could be performed in 2 patients. One patient experienced a small recurrence that did not require a repeated operation, while 1 subtotally resected lesion recurred and the patient underwent a second operation.
Intracranial epidermoid tumors are rare in the pediatric population. Total resection is desirable to minimize the risk of postoperative aseptic meningitis, hydrocephalus, and tumor recurrence. Aggressive neurosurgical resection may be associated with cranial nerve or ischemic deficits, however. In these cases, neurosurgical judgment at the time of surgery is warranted to ensure maximum resection while minimizing postoperative neurological deficits.
表皮样肿瘤是良性病变，占所有颅内肿瘤的1%。此前鲜有关于儿童颅内表皮样肿瘤的系列报道。作者介绍了他们处理这些病变的经验。
检索了病童医院的神经外科数据库，以查找接受手术治疗的颅内表皮样肿瘤患儿。查阅了患者病历以获取人口统计学数据、临床表现细节、手术治疗及随访情况。本研究获得了伦理委员会批准。
在1980年至2007年间，共确定了7名符合纳入标准的儿童，均为女孩。手术时的平均年龄为11.2岁（范围8 - 15岁），肿瘤最大直径平均为2.1厘米。头痛是最常见的首发症状，1例肿瘤为偶然发现。大多数患者神经学检查正常，但2例出现脑膜刺激征。有3例小脑脑桥角病变、1例脑桥延髓病变和3例幕上肿瘤。1例患者在无菌性脑膜炎后发生脑积水，并接受了分流术。无手术死亡病例。2例患者可实现完全切除。1例患者出现小的复发，无需再次手术，而1例次全切除的病变复发，该患者接受了二次手术。
颅内表皮样肿瘤在儿童中罕见。理想的做法是完全切除，以将术后无菌性脑膜炎、脑积水和肿瘤复发的风险降至最低。然而，积极的神经外科切除可能会导致脑神经或缺血性缺损。在这些情况下，手术时的神经外科判断对于确保最大程度切除同时将术后神经功能缺损降至最低是必要的。
