Intracranial epidermoid tumours: thirty-seven years of diagnosis and treatment.

The clinical, operative and pathological characteristics of 102 consecutive cases of intracranial epidermoid tumours are reported. These cases constituted 1.1% of all intracranial tumours and 13.5% of congenital neoplasma admitted to our service in the period 1951-88. Of 91 (89.2%) intradural tumours, 74 (72.5%) were in the subarachnoid cisterns, especially in the cerebellopontine angle cistern (31 cases). The tumours were solid in 69 cases (67.6%) and cystic in 26 (25.5%); the remaining 7 cases were not recorded. There were no specific clinical features with which to identify the nature and extent of the tumour. Diagnosis and treatment are described, with an evaluation of CT and MRI. Before 1981, total removal rate of tumour was 29.3%; after that date it was 72.7% with the aid of microsurgery. The overall surgical mortality rate was 4.9% (5 cases), but there were no deaths in the microsurgical group. Follow-up for a period of 0.5-37 years (mean 13 years) was carried out in 68 patients (70.1%). Among 24 patients with incomplete removal, recurrence of tumour was verified in 4 cases; 3 underwent reoperation with excellent or good results. One patient refused operation and died. All the remaining 20 cases, save 3 who died of other diseases, returned to their normal activities without recurrent manifestations. The results suggest that the primary treatment of epidermoid tumours should be surgical removal including the contents and capsule of a tumour. With the aid of microsurgical technique, complete removal is possible. Patients with incomplete removal can also obtain a long-term favourable result.