Kumar Sanjeev, Sahana Debabrata, Rathore Lavlesh, Sahu Rajiv Kumar, Jain Amit, Borde Praveen, Tawari Manish, Madhariya Satya Narayan
Department of Neurosurgery, Pt. JNM Medical College and DKS Post Graduate Institute and Research Center, Raipur, Chhattisgarh, India.
Department of Neurosurgery, Ramakrishna Care Hospital, Raipur, Chhattisgarh, India.
Asian J Neurosurg. 2021 Sep 14;16(3):470-482. doi: 10.4103/ajns.AJNS_539_20. eCollection 2021 Jul-Sep.
Epidermoid cysts are extra-axial, pearly white avascular lesions mostly found in the cerebellopontine region. They are slow-growing and mostly become symptomatic when they attain significant size. They do occur at other anatomical locations, but fourth ventricle is a rare location. Three representative cases with their outcomes are described here.
The systematic review was done with adherence to predefined criteria. The studied variables were age, gender, duration of symptoms (DOS), clinical features, hydrocephalus (HCP), extent of resection, postoperative complications, outcome, follow-up, and recurrence. Statistical analysis was done to identify predictive factors for outcome.
Final analysis included 58 studies containing 131 patients. The most common clinical feature was cerebellar dysfunction (93%). The most common cranial nerve involved was the abducens nerve ( = 37, 28.46%). Preoperative HCP was present in nearly a third (35%) of patients. The outcomes were not different with age ( = 0.23), gender ( = 0.74), DOS ( = 0.09), and HCP ( = 0.50). Improved outcomes were associated with total resections ( = 0.001), absence of preoperative cranial nerve dysfunctions ( = 0.004), and presentation with features of raised intracranial pressure ( = 0.005). Longer DOS (mean 76.74 months) was associated with significantly increased cranial nerve nuclei involvement ( = 0.03). Aseptic meningitis was reported in 14.5% of cases. Recurrences were infrequently reported ( = 9).
Although the fourth ventricular epidermoid lesions are difficult to detect in an innocuous stage, when found, they should be extirpated early and totally, as a longer DOS leads to cranial nerve dysfunctions and suboptimal outcomes.
表皮样囊肿是轴外的、珍珠白色的无血管病变，大多位于桥小脑区。它们生长缓慢，大多在达到相当大的尺寸时出现症状。它们确实会发生在其他解剖位置，但第四脑室是一个罕见的部位。本文描述了三例具有代表性的病例及其结果。
按照预先确定的标准进行系统评价。研究变量包括年龄、性别、症状持续时间（DOS）、临床特征、脑积水（HCP）、切除范围、术后并发症、结果、随访和复发情况。进行统计分析以确定结果的预测因素。
最终分析纳入了58项研究，共131例患者。最常见的临床特征是小脑功能障碍（93%）。最常受累的颅神经是展神经（n = 37，28.46%）。近三分之一（35%）的患者术前存在脑积水。年龄（p = 0.23）、性别（p = 0.74）、症状持续时间（p = 0.09）和脑积水（p = 0.50）对结果没有影响。手术全切（p = 0.001）、术前无颅神经功能障碍（p = 0.004）以及表现为颅内压升高（p = 0.005）与较好的结果相关。症状持续时间较长（平均76.74个月）与颅神经核受累显著增加相关（p = 0.03）。14.5%的病例报告有无菌性脑膜炎。复发报告较少（n = 9）。
尽管第四脑室表皮样病变在早期难以察觉，但一旦发现，应尽早彻底切除，因为症状持续时间较长会导致颅神经功能障碍和预后不佳。
