Epidermoid, Intracranial
H&P
- HPI:
- Presented to neurosurgery clinic
- Chronic headache x5 years
- Domestic violence with head injury
- CT head completed in the ED
- Obtained MRI afterwards
- PE: grossly normal
- Workup: CT head and brain MRI with and without contrast
Imaging
CT Head without Contrast
There is a large interhemispheric cystic lesion without calcification, more to the right.
Brain MRI without Contrast - DWI/ADC/FLAIR/GRE
Brain MRI - DWI
This tumor presents restricted diffusion on DWI sequences.
Brain MRI - Axial T2WI
The T2 signal does not follow CSF signal.
Brain MRI - Coronal T2WI
Brain MRI - T1WI, T2WI, T1WI w/ Contrast, T1WI w/ Contrast
There is no contrast enhancement of the tumor.
CTA Head - Thick Coronal
Bilateral ACAs are displaced laterally due to the mass effect of the tumor.
Differential Diagnosis
- Epidermoid cyst
- Dermoid cyst
- Craniopharyngioma
- Neurenteric cyst
- Arachnoid cyst
Surgical Intervention
- BrainLab intraoperative navigation
- Supine
- Head neutral in Mayfield holder
- Elevated for about 15°
- Bicoronal incision
- Bifrontal craniotomy, more to the right
- U-shape dural incision, based along the superior sagittal sinus
- Interhemispheric dissection between the falx and the right frontal lobe
- Separation of the tumor capsule from surrounding tissues
- Debulking of the tumor with CUSA (mainly fatty tissues)
- Left some capsule stuck to the normal brain
- Copious irrigation
- Hemostasis
- Dural closure
- Bone flap
- Scalp closure
Post-Op Course
- ICU for hourly neuro-checks overnight
- No new neurological deficits
- Transferred to regular floor on POD1
- Discharged home on POD2
- Pathology
- Epidermoid cyst
- CD68: Focally positive
- GFAP: Focally positive
Post-Op MRI
Brain MRI - Axial DWI
There was a near total resection with some cavity border ischemic changes.