Intracranial Epidermoids- Benign lesion,Interesting locations but difficult solutions

Congress:

ECR 2018

Poster Number:

C-1905

Type:

Educational Exhibit

Keywords:

Cysts, Imaging sequences, MR, CNS

Authors:

S. Arooj¹, S. Kadri², S. Sheikh¹, S. Hamid³; ¹Karachi/PK, ²Karachi, karachi/PK, ³Karachi, Sindh/PK

DOI:

10.1594/ecr2018/C-1905

DOI-Link:

https://dx.doi.org/10.1594/ecr2018/C-1905

Fig. 5: 34 year old man with syncope; T1W hypointense area in fourth ventricle

Fig. 6: 34 year old man with syncope; T2W hyperintense area in fourth ventricle

Fig. 7: 34 year old man with syncope; diffusion restriction is seen in fourth ventricle

Fig. 8: 34 year old man with syncope; diffusion restriction is seen in fourth ventricle

Learning objectives

Impotance of recognition of epidermoids in brain. To be able to recognize significance of various MR sequences in differentiating intracranial cystic lesions from eachother esp epidermoids. Importance of Diffusion weighted imaging for confirmation of epidermoids. To be aware of treatment options of epidermoids.

Background

Intracranial epidermoid cysts/ tumors were first described by Bailey and Cushing in the early 1920s. These account for 0.2– 1.8% of all intracranial neoplasms and approximately 50% of intracranial epidermoid cyst occurred in the cerebellopontine angle, followed by parasellar region, basal cistern, sylvian, pineal region and ventricle systems. It is postulated to originate from epithelial remnants that remain after neural tube closure, rarely acquired lesions are also reported. It is usually benign unless is ruptured. A lot of research has been done on these. It...

Findings and procedure details

We are sharing multiple cases of epidermoids. The diagnosis was formulated on the basis of MRI. MRI appears to be the modality of choice for radiological evaluation of epidermoids. Typically epidermoid tumors return signals similar to fluid i-e are hypointense on T1-weighted andhyperintense on T2-weighted images. No post-contrast enhancementis noted due to low vascularity. Fluid-Attenuated Inversion Recovery (FLAIR) sequences help distinguish them from similar-appearing arachnoid cysts, as the former are hyperintense. But the key sequence is DWI. Diffusion-weighted images further enhance the accuracy of preoperative...

Conclusion

Epidermoids are benign intracranial tumors which at times become a surgical dilemma due to their location. Their detection is best done with the help of MRI especially by using DWI.

Personal information

References

1.Multiple Complications from an Intracranial Epidermoid Cyst: Case Report and Literature Review 0 0 1 47 274 aku 2 1 320 14.0 Normal 0 false false false EN-US JA X-NONE Robert C. Abramson, M.D.Richard B. Morawetz, M.D.Michael Schlitt, M.D. Neurosurgery, Volume 24, Issue 4, 1 April 1989, Pages 574–578 2.Intracranial epidermoid cyst: Case report 0 0 1 18 109 aku 1 1 126 14.0 Normal 0 false false false EN-US JA X-NONE Simone Ulivieri, Giuseppe Filosomi, Clelia Miraco Ann. Ital. Chir., 2008;79:445-446 3.Clinical Course and...