ABSTRACT
Intracranial epidermoid cysts are slow-growing lesions, which may recur after incomplete
resection, but do so over many years. The authors present the case of an epidermoid
that repeatedly recurred over a short period, which was discovered to be secondary
to a low-grade bacterial infection. A 30-year-old woman presented with signs and symptoms
related to brainstem and cranial nerve compromise from a large cerebellopontine angle
epidermoid cyst. She underwent a subtotal excision of a macroscopically and histologically
typical epidermoid. The lesion recurred within 1 year of surgery, but with atypical
radiological appearances. No systemic or local evidence of infection was found during
a second resection. A further large recurrence with the same atypical features occurred
after another 6 months, necessitating a third surgical resection. On this occasion,
the atypical cyst contents grew coagulase-negative Staphylococcus after prolonged culture in an enrichment medium. Following a course of appropriate
antibiotics, the residual cyst contents completely resolved. This case highlights
an unusual complication of an epidermoid cyst. Early recurrence of an epidermoid,
even in the absence of overt evidence of infection, should produce a high index of
suspicion that there may be a low-grade infective cause. Surgical excision coupled
with antibiotics resulted in a symptomatic and radiological recovery.
KEYWORDS
Epidermoid cyst - infection - recurrence
REFERENCES
- 1
Talacchi A, Sala F, Alessandrini F, Turazzi S, Bricolo A.
Assessment and surgical management of posterior fossa epidermoid tumors: report of
28 cases.
Neurosurgery.
1998;
42
242-251
- 2
Yasargil M G, Abernathey C D, Sarioglu A C.
Microneurosurgical treatment of intracranial dermoid and epidermoid tumors.
Neurosurgery.
1989;
24
561-567
- 3
Berger M S, Wilson C B.
Epidermoid cysts of the posterior fossa.
J Neurosurg.
1985;
62
214-219
- 4
Samii M, Tatagiba M, Piquer J, Carvalho G A.
Surgical treatment of epidermoid cysts of the cerebellopontine angle.
J Neurosurg.
1996;
84
14-19
- 5
Schroeder H W, Oertel J, Gaab M R.
Endoscope-assisted microsurgical resection of epidermoid tumors of the cerebellopontine
angle.
J Neurosurg.
2004;
101
227-232
- 6
Yamakawa K, Shitara N, Genka S, Manaka S, Takakura K.
Clinical course and surgical prognosis of 33 cases of intracranial epidermoid tumors.
Neurosurgery.
1989;
24
568-573
- 7
De Micheli E, Bricolo A.
The long history of a cerebello-pontine angle epidermoid tumour-a case report and
lessons learned.
Acta Neurochir (Wien).
1996;
138
350-354
- 8
Obrador S, Lopez-Zafra J J.
Clinical features of the epidermoids of the basal cisterns of the brain.
J Neurol Neurosurg Psychiatry.
1969;
32
450-454
- 9
Alvord Jr E C.
Growth rates of epidermoid tumors.
Ann Neurol.
1977;
2
367-370
- 10
Schwartz J F, Balentine J D.
Recurrent meningitis due to an intracranial epidermoid.
Neurology.
1978;
28
124-129
- 11
Cornell S H, Graf C J, Dolan K D.
Fat-fluid level in intracranial epidermoid cyst.
AJR Am J Roentgenol.
1977;
128
502-503
- 12
Abramson R C, Morawetz R B, Schlitt M.
Multiple complications from an intracranial epidermoid cyst: case report and literature
review.
Neurosurgery.
1989;
24
574-578
- 13
Dutt S N, Mirza S, Chavda S V, Irving R M.
Radiologic differentiation of intracranial epidermoids from arachnoid cysts.
Otol Neurotol.
2002;
23
84-92
- 14
Featherstone T.
Epidermoid tumour of the cerebellopontine angle: diagnosis by MRI.
J Laryngol Otol.
1994;
108
438-440
- 15
Kallmes D F, Provenzale J M, Cloft H J, McClendon R E.
Typical and atypical MR imaging features of intracranial epidermoid tumors.
AJR Am J Roentgenol.
1997;
169
883-887
- 16
Zamani A A.
Cerebellopontine angle tumors: role of magnetic resonance imaging.
Top Magn Reson Imaging.
2000;
11
98-107
- 17
Ikushima I, Korogi Y, Hirai T et al..
MR of epidermoids with a variety of pulse sequences.
AJNR Am J Neuroradiol.
1997;
18
1359-1363
- 18
Mikhael M A, Mattar A G.
Intracranial pearly tumors: the roles of computed tomography, angiography, and pneumoencephalography.
J Comput Assist Tomogr.
1978;
2
421-429
- 19
Dubois P J, Sage M, Luther J S et al..
Case report. Malignant change in an intracranial epidermoid cyst.
J Comput Assist Tomogr.
1981;
5
433-435
- 20
Lewis A J, Cooper P W, Kassel E E, Schwartz M L.
Squamous cell carcinoma arising in a suprasellar epidermoid cyst. Case report.
J Neurosurg.
1983;
59
538-541
- 21
Bartal A, Razon N, Avram J, Rochkind S, Doron A.
Infratentorial epidermoids.
Acta Neurochir Suppl (Wien).
1988;
42
142-146
- 22
Jaiswal A K, Mahapatra A K.
Giant intradiploic epidermoid cysts of the skull. A report of eight cases.
Br J Neurosurg.
2000;
14
225-228
- 23
Bejarano P A, Broderick D F, Gado M H.
Infected epidermoid cyst of the sphenoid bone.
AJNR Am J Neuroradiol.
1993;
14
771-773
- 24
Schijman E, Monges J, Cragnaz R.
Congenital dermal sinuses, dermoid and epidermoid cysts of the posterior fossa.
Childs Nerv Syst.
1986;
2
83-89
Scott A Rutherford
Department of Neurosurgery, Hope Hospital, Stott Lane
Salford, Manchester, M6 8HD, UK
Email: scott.rutherford@srht.nhs.uk
