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Infratentorial epidermoid cysts treatment: an overview of 94 observations
EANS Academy. Fedirko V. Sep 27, 2019; 276020; EP04122
Abstract
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Intracranial epidermoid tumors are rare entities accounting for 0.2-1% of all intracranial neoplasms. Majority of cases are located infratentorially.
Materials and methods: There were 94 patients with epidermoid tumors treated in Romodanov Neurosurgery Institute since 1955 till 2018. 68 (72.3%) were located in CPA, 26 (27.7%) - in the area of 4th ventricle and big cistern. 11 tumors (11.7%) had supratenrorial expansion.
Results: 60 years' experience demands to distinguish three periods on the basis of surgical and anesthesiological techniques. First - «premicrosurgical» 1955-1985 (31 observation). Postoperative morality 41.9% and 36% aseptic meningitis were concordant with more radical extent of resection. Total excision was done in 22%, subtotal - in 67%, partial - in 11% of cases. Next «microsurgical» period 1986-2005 included 22 observations. It was marked by more precise and meticulous microsurgical techniques introduced into routine practice together with advances in diagnostics and anesthesia, associated with introduction of prophylactic steroids use had led to dramatic drop of postoperative mortality to 9% as well as aseptic meningitis rate. There was a decline in surgical aggression with 14.2% of total, 62.3% subtotal and 23.5% of partial excisions. Recurrences was seen at 7.6% of patients during 1955-2005. 2006-2018 time-span was named as «micro-endoscopic» period with vast introduction and development of endoscopic techniques simultaneously with well-established microsurgical standards. It resulted in convergence of increased total resection rates and low mortality and morbidity. Total resection was achieved in 44%, subtotal - in 44%, partial - in 12%. Postoperative mortality reached 2.4% (1 patient). But aseptic meningitis is still an intimidating trouble with 12.1% morbidity rate (5 observations).
Conclusions: Epidermoid tumors are very specific pathology with tricky natural history and perioperative behavior. It mandates meticulous multifactorial assessment, balancing between neurological outcome and extent of resection with regards to aseptic meningitis prophylaxis and management.
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