Recurrence-Related Risk Factors Of Intracranial Epidermoid Cysts:A Retro-Analysis Of 141 Patients

Objective: To retrospectively analyze the recurrence-related risk factors of intracranial epidermoid cysts,improve the understanding of these postoperative complications and provide reference for the prevention and treatment of recurrence in clinical diagnosis and treatment.Patients and Methods: We retrospectively identified 141 patients who were operated and pathology diagnosed as intracranial epidermoid cyst in Tongji Hospital of HUST from October 2006 to October 2018.The items concerning gender,age,radiological findings,tumor site,biological features,surgical results and long-term conditions were collected and grouped.Univariate analysis was progressed with chi-square test Kruskal-Wallis test and Kaplan-Meier survival analysis.Multivariate analysis was progressed with COX survival analysis.P<0.05 was considered significant.For those P>0.1 were considered recurrent-uncorrelated.Results: Among the 141 cases,46 were male and 95 were female,and the ratio of male to female was 1:2.06.There are 33 recurrent cases at the last follow-up till October 2018,account for 23.4% of all.Univariate analysis shows that patients' age,gender are not correlated with recurrence.Cases with atypical radiological features have a higher recurrent rate(38.1.0%:17.2%)?higher recurrent risk and shorter progression-free survival period(P<0.05).Mean volume of the recurrent cysts is 38.7±25.3 cm3,larger than those were not.Large lesions mainly increased the risk of long-term postoperative recurrence,and the 5-year and 10-year progression-free survival rates were 67.8% and 16.5%,respectively.The risk of postoperative recurrence of supratentorial lesions was higher than that of infratentorial lesions(P<0.05),and the risk of postoperative recurrence was significantly variable for lesions located in different intracranial spaces(P<0.05).The risk of postoperative recurrence of invasively-growing lesions was higher than that of creeping-growth lesions,and the progressive-free survival period was shorter(P<0.05).Different degrees of residual lead to an increased risk of postoperative recurrence and a shortened progressive-free survival period(P<0.05).The independent risk factors affecting the degree of surgical resection are the size of the lesion and whether it adheres to the peripheral nerves and blood vessels.Multivariate analysis showed that the independent risk factors for postoperative recurrence were whether the radiological appearance of the lesion was typical,which intracranial space the lesion is located and the degree of surgical resection.The risk of recurrence of atypical radiological lesions was 5.966 folds higher than that of typical lesions.The recurrence risk of lesions in brain parenchymal was the highest,followed by subarachnoid,intraventricular and epidural/subdural lesions.The risk of postoperative recurrence of a small amount of residual tumor was 3.681 folds higher than that of total resection,while the risk of postoperative recurrence of residual capsule was not significantly higher than that of total resection(HR=1.078,P>0.05).Conclusion: There is a certain recurrence rate of intracranial epidermoid cyst after surgery,and postoperative recurrence is more common in patients with atypical imaging manifestations,lesions in brain parenchyma and a residual tumor of surgery.Total resection is the most important means to prevent recurrence,but the residual capsule does not significantly increase the risk of recurrence.