Clinical Features And Treatment Of Epidermoid Cyst In The Brain Parenchyma

Objective:In order to explore the clinical features and treatment of epidermoid cyst in the brain parenchyma.Methods:Retrospectively analyzed clinical manifestations, imaging findings, surgical treatment and the therapeutic effect of27cases of epidermoid cysts in the brain parenchyma which were treated in neurosurgery department of Qilu hospital of Shandong University and Provincial hospital affiliated to Shandong University in1995-2010. In the meantime we analyzed the clinical manifestations and the risk factors of aseptic meningitis, which is a common complication after surgery. All the data were analyzed by SPSS18.0software (SPSS Inc, Chicago, USA)Results:According to the diagnosis standards, we selected27cases which were qualified for the research. Among them17cases were male,10cases were female, and the sex ratio was1.7:1. Age of onset concentrated in the15-68years of age. The patients’average age was43.0±12.4. The disease duration ranged from0.5months to60months (average,26months). There were21cases located above the tentorium cerebelli. In the midst of them,15cases located in the temporal lobe,2cases located in the frontal lobe,3cases located in the callosum and1case located in the pineal body.7cases were under the tentorium cerebelli, of which4cases located in the cerebellar hemisphere, the other2in the vermis of cerebellum. Average diameter of these tumors was (4.88±1.56) cm.27cases have a common symptom which was the syndromes of increased intracranial pressure, such as headaches, dizziness, nausea and vomiting. Limb pain or weakness in10, dysbasia in6, epilepsy in6, ataxia and bucking in4, temporary disturbance of consciousness in4, facial nerve dysfunction in2, barylalia in2, and vision impaired in4. All the cases were checked by CT, and the showing was that 20cases were low density.5cases were mixed density and the other2were high density. The tumors had irregular shapes and marked massive effection, but had clear boundaries.2cases had peritumoral edema, while the other not. Enhanced CT scan showing2cases had ring enhancement. In12cases performed MRI scanning, the outcomes showed that6cases were hypointense on T1-weighted and hyperintense on T2-weighted images.3cases were hyperintense both on T1and T2weighted images.2cases had ring enhancement on enhanced MRI images.4cases were examined by FLAIR sequences, and the showing were mixed signal. Among3cases which were checked by DWI sequences,2cases were hyperintense, while the other1was hypointense. Tumors of20cases were completely removed, and7cases were sub-totally removed. After surgery,lcase died,7cases were improved and3patients had tumor recurrence.9cases appeared the syndromes of aseptic meningitis. Statistical analysis showed that aseptic meningitis was relate to these factors:the diameter of the tumor, using prophylactic lumbar puncture, complete resection and irrigating of tumor bed with the dexamethasone solution with normal saline. Logistic regression analysis showed the former two were the most important factors.Conclusions:This kind of epidermoid cyst is prone to the middle-aged people, and male with a slightly more than female. The locations of this kind of tumor are prone to the temporal lobe. Imaging studies are helpful to diagnosing, especially the FLAIR and DWI sequences images. Complete resection of tumors, using prophylactic lumbar puncture and irrigating of tumor bed with the dexamethasone solution with normal saline could reduce the occurrence of the aseptic meningitis. These measures can improve the patients’prognosis.