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Cyst-cisternal shunting for cystic multirecurrent brainstem epidermoid: case report and literature review

  • Technical Note - Neurosurgical Techniques
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

Surgical treatment of recurrent, posterior cranial fossa epidermoids in multioperated patients carries significant morbidity, mainly due to tumor adhesion to cranial nerves and vessels, and brainstem involvement. Radical resection is often not feasible; therefore surgery should aim to restore cerebrospinal fluid circulation, release engulfed neurovascular structures, and relieve brainstem compression. Intra-axial epidermoids are extremely rare. We present an innovative surgical technique of a cyst-cisternal shunting to treat cystic recurrent, unresectable brainstem epidermoids.

Methods

The surgical technique is stepwise described and a case illustration is reported. The pertinent literature has been reviewed.

Results

Few cases of brain stem epidermoid tumors have been described to date. The surgical steps of this technique and related intraoperative images are provided. One case illustration regarding the resection of a large recurrent cystic intra-axial brainstem epidermoid is reported to demonstrate the application of the technique in a clinical setting. The patient was followed up for 14 years and did not experience any recurrence, showing a stable disease at the last follow-up control. A systematic review of the competent literature has been provided.

Conclusions

Cyst-cisternal shunting in case of recurrent, brainstem epidermoid is a safe and long-term effective technique to relieve mass effect into the brainstem.

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Authors and Affiliations

  1. Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy

    Pietro Mortini, Michele Bailo, Alfio Spina, Stefania Acerno, Nicola Boari & Filippo Gagliardi

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  1. Pietro Mortini
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  2. Michele Bailo
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  3. Alfio Spina
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  4. Stefania Acerno
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  5. Nicola Boari
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  6. Filippo Gagliardi
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Correspondence to Alfio Spina.

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The authors report no conflicts of interest.

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No funding was received for this research.

Ethical standards

All procedures were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed patient consent was obtained from next of kin for inclusion in this technical note.

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Mortini, P., Bailo, M., Spina, A. et al. Cyst-cisternal shunting for cystic multirecurrent brainstem epidermoid: case report and literature review. Acta Neurochir 158, 1197–1201 (2016). https://doi.org/10.1007/s00701-016-2813-5

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  • DOI: https://doi.org/10.1007/s00701-016-2813-5

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