Shen C C, Wang Y C, Wei S H, Chang C S, Chan Y C, Leu C H
Department of Surgery, Taichung Veterans General Hospital, Taiwan, ROC.
Zhonghua Yi Xue Za Zhi (Taipei). 1998 Jun;61(6):313-23.
Intracranial epidermoid cysts are slow-growing congenital neoplasms that usually spread and adhere to critical neurovascular structures along the basal cistern, particularly the cerebellopontine angle (CPA) and parasellar region. Clinical symptoms include trigeminal neuralgia, headache and dizziness, progressive hemiparesis, unstable gait and hemifacial spasm. With the aid of modern imaging techniques, such as computed tomography (CT) and magnetic resonance imaging (MRI), an effective microsurgical approach can be planned preoperatively to completely remove tumors and avoid complications.
Twenty-six patients with intracranial epidermoid cysts were microsurgically treated between July 1984 and June 1997. Diagnostic procedures included enhanced CT and/or CT cisternography and MRI. All patients underwent microsurgical treatment for tumor removal.
Total tumor removal was achieved in 12 patients (46.2%), near-total removal in seven (26.9%), partial removal in six (23.1%) and stereotactic biopsy in one patient (3.8%). Postoperative deterioration of the neurologic condition was found in three patients who required further surgery, aseptic meningitis in four patients and communicating hydrocephalus requiring shunting in three patients. The functional prognoses were excellent in 23 patients (88.5%), good in two patients (7.7%) and fair in one patient (3.8%). Among the 26 patients, three died of pneumonia three, six and nine months after surgery, respectively.
MRI is particularly useful for defining the anatomic limits of tumor tissue and surgical planning. The surgical results were excellent in patients with near-total tumor removal, as well as in patients with total removal. Aggressive surgical tumor removal may result in transient, but significant, cranial nerve palsy and should be avoided. Perioperative administration of steroids and wound protection may be beneficial for preventing the development of postoperative aseptic meningitis and hydrocephalus.
颅内表皮样囊肿是生长缓慢的先天性肿瘤，通常沿脑底池扩散并附着于重要的神经血管结构，尤其是桥小脑角（CPA）和鞍旁区域。临床症状包括三叉神经痛、头痛和头晕、进行性偏瘫、步态不稳和半面痉挛。借助现代成像技术，如计算机断层扫描（CT）和磁共振成像（MRI），可在术前规划有效的显微手术方法，以完全切除肿瘤并避免并发症。
1984年7月至1997年6月期间，对26例颅内表皮样囊肿患者进行了显微手术治疗。诊断程序包括增强CT和/或CT脑池造影以及MRI。所有患者均接受了显微手术切除肿瘤。
12例患者（46.2%）实现了肿瘤全切除，7例（26.9%）近全切除，6例（23.1%）部分切除，1例患者（3.8%）进行了立体定向活检。3例患者术后神经功能恶化，需要进一步手术；4例患者发生无菌性脑膜炎；3例患者发生交通性脑积水需要分流。23例患者（88.5%）功能预后良好，2例患者（7.7%）良好，1例患者（3.8%）一般。26例患者中，3例分别在术后3个月、6个月和9个月死于肺炎。
MRI对于确定肿瘤组织的解剖边界和手术规划特别有用。肿瘤近全切除和全切除的患者手术效果良好。积极的手术切除肿瘤可能导致短暂但严重的脑神经麻痹，应避免。围手术期使用类固醇和保护伤口可能有助于预防术后无菌性脑膜炎和脑积水的发生。
