J.ophthalmol.(Ukraine).2021;6:31-40.

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http://doi.org/10.31288/oftalmolzh202163140

Received: 10 September 2021; Published on-line: 21 December 2021

 

Longitudinal changes in neuroophthalmological abnormalities in patients who underwent surgery for skull-base epidermoid cysts

V. O. Fedirko,  K. S. Iegorova,  O. M. Lisianyi,  A. G. Naboichenko,  P. M. Onishchenko,  D. M. Tsiurupa,  M. V. Iegorov, V. V. Shust, A. O. Lisianyi

The State Institution "Romodanov Neurosurgery Institute, National Academy of Medical Sciences of Ukraine"; Kyiv (Ukraine)

E-mail:  iegorova_katya@ukr.net

TO CITE THIS ARTICLE: Fedirko VO,  Iegorova KS,  Lisianyi OM,  Naboichenko AG,  Onishchenko PM,  Tsiurupa DM,  Iegorov MV, Shust VV, Lisianyi AO. Longitudinal changes in neuroophthalmological abnormalities in patients who underwent surgery for skull-base epidermoid cysts. J.ophthalmol.(Ukraine). 2021;6:31-40. http://doi.org/10.31288/oftalmolzh202163140


Background: Even if current technologies are used in removal of a skull-base epidermoid cyst, the maintenance of function of the cranial nerves is still an important issue.

Purpose: To assess changes in ophthalmological abnormalities after surgery for skull base epidermoid cysts.

Material and Methods: We retrospectively reviewed the medical records of 21 patients who underwent surgery for epidermoid skull base cysts and had either ophthalmological abnormalities (abnormal visual, ocular motor functions and/or abnormal blood supply to the eye) or an involvement of the cranial nerves (CN; i.e., the ophthalmic, ocular motor, trigeminal, abducens and/or facial nerves). The surgical strategy was to aim for total tumor removal in order to prevent the development of postoperative meningitis and reduce the risk of tumor recurrence. Cranial nerve manipulations were performed under the highest available microscope magnification and with the use of endoscope imaging. In addition, intraoperative monitoring of the relevant cranial nerves was performed. All surgical procedures were video recorded. Long-term outcomes of surgery were determined either by outpatient examination or via a phone call using a standard checklist.

Results: Total removal was achieved in 7 patients (33.3%), near total removal in 2 patients (9.5%), and subtotal removal in 12 patients (57.2%). Ocular motor functions were normal after surgery in 11 patients (52.4%). In addition, abnormalities in the early postoperative period were observed in 10 patients (47.6%), but the functions subsequently normalized in 3 patients and improved but not normalized in 7 patients. All the three patients with trigeminal neuralgia showed regression of pain syndrome.

Conclusion: We determined the ophthalmological abnormalities that had been present before and after surgery, and the time required for function recovery. We found that endoscopic-assisted radical removal of the epidermoid cyst under the highest available microscope magnification with intraoperative cranial nerve monitoring was safe and effective for preserving cranial nerve functions in the late time points after surgery.

Keywords: skull-base epidermoid cysts, ophthalmological abnormalities

 

References

1.You E, Bokhari R, Sirhan D. Split-Pons Syndrome by Epidermoid Cyst: A Case Report and Review of the Literature. World Neurosurg. 2019 Nov;131:275-280.e1.

Crossref   PubMed

2.Podeur P, Okhremchuk I, Morvan JB, Vatin L, Rivière D, de Faria A, et al. [Multiple intracranial epidermoid cysts: Case report]. Rev Laryngol Otol Rhinol (Bord). 2015;136(4):159-62. French.

3.Berger MS, Wilson CB. Epidermoid cysts of the posterior fossa. J Neurosurg. 1985 Feb;62(2):214-9.

Crossref  PubMed

4.Zhou F, Yang Z, Zhu W, Chen L, Song J, Quan K, et al. Epidermoid cysts of the cavernous sinus: clinical features, surgical outcomes, and literature review. Neurosurg. 2018 Oct;129(4):973-83.

Crossref  PubMed

5.Yaşargil MG, Abernathey CD, Sarioglu AC. Microneurosurgical treatment of intracranial dermoid and epidermoid tumors. Neurosurgery. 1989 Apr;24(4):561-7.

Crossref  PubMed

6.Rehman L, Bokhari I, Siddiqi SU, Bagga V, Hussain MM. Intracranial Epidermoid Lesions: our Experience of 38 Cases. Turk Neurosurg. 2017 Oct 2.

Crossref  PubMed

7.Gelabert-González M. Intracranial epidermoid and dermoid cysts. Rev Neurol. 1998 Nov;27(159):777-82.

Crossref  PubMed

8.Caldarelli M, Massimi L, Kondageski C, Di Rocco C. Intracranial midline dermoid and epidermoid cysts in children. J Neurosurg. 2004 May;100(5 Suppl Pediatrics):473-80.

Crossref  PubMed

9.Altschuler EM, Jungreis CA, Sekhar LN, Jannetta PJ, Sheptak PE. Operative treatment of intracranial epidermoid cysts and cholesterol granulomas: report of 21 cases. Neurosurgery. 1990 Apr;26(4):606-13; discussion 614.

Crossref  PubMed

10.Lynch JC, Aversa A, Pereira C, Nogueira J, Gonçalves M, Lopes H. Surgical strategy for intracranial dermoid and epidermoid tumors: An experience with 33 Patients. Surg Neurol Int. 2014 Nov 28;5:163.

Crossref  PubMed

11.Shear BM, Jin L, Zhang Y, David WB, Fomchenko EI, Erson-Omay EZ, et al. Extent of resection of epidermoid tumors and risk of recurrence: case report and meta-analysis. J Neurosurgery. 2019 Jul 5;1-11.

12.Moreno-Jimenez S, Tena-Suck ML, Collado-Ortiz MA, Castillejos-López M, Alvarado-Moreno D, Holland MK. Intracranial epidermoid cyst in a single Mexican institution, experience of over 16-years. Patología. 2012;50(3):182-189.

13.Ghartimagar D, Shrestha MK, Ghosh A. Recurrence of ruptured intracranial epidermoid cyst - A rare case report and presentation. Int J Surg Case Rep. 2020;76:310-314.

Crossref  PubMed

14.Baldia M, Gandham E, Prabhu K. Clinico-Surgical Outcomes of Giant Intracranial Epidermoids: Gross Total Resection vs Subtotal Resection. Which is Better? Turk Neurosurg. 2021;31(4):574-581.

Crossref  PubMed

15.Tamura K, Aoyagi M, Wakimoto H, Tamaki M, Yamamoto K, Yamamoto M, Ohno K. Malignant transformation eight years after removal of a benign epidermoid cyst: a case report. J Neurooncol. 2006 Aug;79(1):67-72.

Crossref  PubMed

16.Lopes M, Capelle L, Duffau H, Kujas M, Sichez J.-P, Van Effenterre R, et al. Surgery of intracranial epidermoid cysts. Report of 44 patients and review of the literature. Neurochirurgie. 2002 Feb;48(1):5-13.

17.Hu Z, Guan F, Kang T, Huang H, Dai B, Zhu G, et al. Whole Course Neuroendoscopic Resection of Cerebellopontine Angle Epidermoid Cysts. J Neurol Surg A Cent Eur Neurosurg. 2016 Sep;77(5):381-8.

Crossref  PubMed

18.Abramson RC, Morawetz RB, Schlitt M. Multiple complications from an intracranial epidermoid cyst: case report and literature review. Neurosurgery. 1989 Apr;24(4):574-8.

Crossref  PubMed

19.Becker WJ, Watters GV, de Chadarevian JP, Vanasse M. Recurrent aseptic meningitis secondary to intracranial epidermoids. Can J Neuro Sci.1984 Aug;11(3):387-9.

Crossref  PubMed

20.Achard JM, Lallement PY, Veyssier P. Recurrent aseptic meningitis secondary to intracranial epidermoid cyst and Mollaret's meningitis: two distinct entities or a single disease? A case report and a nosologic discussion.  Am J Med. 1990 Dec;89(6):807-10.

Crossref  

21.Pojskic M, Arnautovic KI. Microsurgical Resection of the Epidermoid Tumor in the Cerebellopontine Angle.  J Neurol Surg B Skull Base. 2019 Jun;80(Suppl 3):S327-S328. DOI: 10.1055/s-0038-1677499.Epub 2019 Jan 31.

Crossref  PubMed

22.Burnham JM, Lewis K. Intracranial Extension of an Orbital Epidermoid Cyst. Ophthalmic Plast Reconstr Surg. Nov/Dec 2016;32(6):e135-e136.

Crossref  PubMed

23.Lane CM, Ehrlich WW, Wright JE. Orbital dermoid cyst. Eye (Lond). 1987;1 (Pt 4):504-11.

Crossref  PubMed

24.Mandal SK, Mandal A, Bandyopadhya A. Post Surgical Giant Epidermal Inclusion Cyst of the Lid and Orbit - A Rare Case. J Clin Diagn Res. 2015 Sep;9(9):ND01-3.

Crossref  PubMed

25.Miyagi A, Maeda K, Sugawara T. [Intraorbital conjunctival cyst after a penetrating orbital injury: a case report]. No Shinkei Geka.1996 Jul;24(7):649-53. Japanese.

26.König B, Vána V, Vojácek K. [Intracranial epidermoids. Characteristic observations concerning epidermoids in the region of the optic chiasm]. Klin Monbl Augenheilkd.1966;148(2):190-202. German.

Conflict of interest: The authors state that there is no actual or potential conflict of interest (financial, personal, professional and other interests) that could affect the opinion on the subject or materials described and discussed in this manuscript.

Disclaimer: The opinions expressed in the presented article are the authors' own, and not the official positions of the institution.