Skull Base 2006; 16(2): 109-116
DOI: 10.1055/s-2005-926217
CASE REPORT

Copyright © 2006 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Early Recurrence of an Intracranial Epidermoid Cyst Due to Low-Grade Infection: Case Report

Scott A. Rutherford1 , Paul A. Leach1 , Andrew T. King1
  • 1Department of Neurosurgery, Hope Hospital, Salford, Manchester, United Kingdom
Further Information

Publication History

Publication Date:
13 February 2006 (online)

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.

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