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. 2025 Feb 17;15(1):5818.
doi: 10.1038/s41598-025-90333-4.

Long term management of intracranial epidermoids balancing extent of resection and functional preservation in a 20 year institutional experience

Mazin Omer  1 , Julia M Nakagawa  2 , Arthur H A Sales  2 , Theresa Bettina Loidl  2 , Christian Scheiwe  2 , Jürgen Beck  2 , Jürgen Grauvogel  2 , Christine J Gizaw  2
Affiliations

Long term management of intracranial epidermoids balancing extent of resection and functional preservation in a 20 year institutional experience

Mazin Omer et al. Sci Rep. .

Abstract

Epidermoid lesions account for 1% of intracranial neoplasms. Surgical management is challenging due to their adhesion to critical neurovascular structures and tendency for recurrence. The current study examines surgical outcomes, extent of resection, and recurrence rates during long-term follow-up. A retrospective analysis was conducted on patients treated for epidermoid lesions between 2000 and 2021, focusing on clinical and radiological outcome and long-term symptom development. Among 55 patients (56.4% male), the majority harbored lesions in the cerebellopontine angle (75.3%). The mean age at surgery was 41.3 years, with an average follow-up of 82 months. Total removal was achieved in 61% of cases, with 75% of them remaining recurrence-free. In comparison, 35% of near-total removal and 25% of subtotal removal remained recurrence-free. Immediate symptom improvement was similar after total and non-total removal (12.6% vs. 10.5%), but long-term improvement was higher after total removal (43% vs. 27%). Transient cranial nerve deficits occurred in 25% of total and in 32% of non-total removal cases, with similar rates of minor complications. Total removal provided better long-term symptom control and lower recurrence rates without significantly increasing neurological deficits, supporting it as the preferred surgical strategy while maintaining functional preservation.

Keywords: CPA epidermoid; Cerebellopontine angle; Functional preservation; Intracranial epidermoid lesions; Neurosurgical removal; Skull base surgery.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Preoperative and postoperative DWI MRI studies illustrating the classification of the extent of resection: (A) Total removal, (B) Near-total removal, and (C) Subtotal removal. (D) 3D-CISS sequence showing neurovascular structures surrounding an epidermoid tumor in the cerebellopontine angle (CPA). Specific structures labeled in (D1):1 – Basilar artery, 2 – Cranial nerves VII and VIII, 3 – Internal acoustic meatus.
Fig. 2
Fig. 2
Distribution of preoperative symptomatology.
Fig. 3
Fig. 3
Modified Rankin Score comparing Total vs. Not total removal groups; immediate postoperative and in follow-up after 1 year.
Fig. 4
Fig. 4
Kaplan–Meier recurrence/regrowth-free survival curve.
See this image and copyright information in PMC

References

    1. Iaconetta, G., Carvalho, G. A., Vorkapic, P. & Samii, M. Intracerebral epidermoid tumor: a case report and review of the literature. Surg. Neurol.55 (4), 218–222 (2001). - PubMed
    1. Ibrahim, M., Ziyal, B., Bozkurt, B. G. & Çataltepe, O. Gaye Güler Tezel, and Nejat Akalan. Epidermoid cyst of the brain stem symptomatic in childhood. Child’s Nerv. Syst.21, 1025–1029 (2005). - PubMed
    1. Shuji Niikawa, A. et al. Proliferative assessment of craniopharyngioma and epidermoid by nucleolar organizer region staining. Child’s Nerv. Syst.8, 453–456 (1992). - PubMed
    1. Francis, C., Grant, George, M. & Austin Epidermoids: clinical evaluation and surgical results. J. Neurosurg.7 (3), 190–198 (1950). - PubMed
    1. Gazi, M., Yaşargil, C. D., Abernathey, Ali, Ç. & Sarioglu Microneurosurgical treatment of intracranial dermoid and epidermoid tumors. Neurosurgery24 (4), 561–567 (1989). - PubMed

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