Summary
Epidermoid cysts may occur simultaneously above and below the tentorium. Eleven patients with involvement of both infra- and supra-tentorial cisterns are presented. In two cases the epidermoid, located mainly in the cerebello-pontine angle, spread into the middle cranial fossa; in three the epidermoid extended from the parasellar cisterns to the posterior cranial fossa; in six patients the epidermoid, enlarging the tentorial notch, occupied extensively both cranial fossae.
The surgical approach was influenced both by the experience of the surgeon and by the main extension of the epidermoid. Total removal was feasible in two patients only but only one of the eleven patients had a recurrence of the epidermoid. The long term results appear to be unrelated to the size of the epidermoid and to the choice of approach.
Similar content being viewed by others
References
Albanese V, Tomasello F, Picozzi P, Sampaolo S, Spadaro A (1982) Paramedian hourglass epidermoid extending above and below the tentorium. Surg Neurol 18: 356–363
Alpers BJ (1939) Cerebral epidermoids (cholesteatomas). Am J Surg 43: 55–65
Bailey P (1924) Further observations on pearly tumours. Arch Surg 8: 524–534
Berger MS, Wilson CB (1985) Epidermoid cysts of the posterior fossa. J Neurosurg 62: 214–219
Black HA (1943) Intracranial epidermoids occurring simultaneously below and above the tentorium. Arch Neurol Psychiat 49: 214–222
Braun IF, Naidich TP, Leeds NE, Koslow M, Zimmerman HM, Chase NE (1977) Dense intracranial epidermoid tumors. Radiology 122: 717–719
Chambers AA, Lukin RR, Tomisck TA (1977) Cranial epidermoid tumors: diagnosis by computed tomography. Neurosurgery 1: 276–280
Chiasserini A, Chiasserini A Jr (1955) Epidermoidi e dermoidi del nevrasse. Chir Ital 10: 81–114
Cushing H (1932) Intracranial tumours: notes upon a series of two thousand verified cases with surgical mortality percentages pertaining thereto. Charles C Thomas, Springfield, Ill., pp 99–102
Davidson HD, Ouchi T, Steiner RE (1985) NMR imaging of congenital intracranial germinal layer neoplasms. Neuroradiology 27: 301–303
Davis KR, Roberson GH, Taveras JM, New PJF, Trevor R (1976) Diagnosis of epidermoid tumours by computed tomography. Radiology 119: 347–353
Dee RH, Kishore PRS, Young HF (1980) Radiological evaluation of cerebellopontine angle epidermoid tumors. Surg Neurol 13: 293–296
Derome PJ, Guiot G (1979) Surgical approaches to sphenoidal and clivus areas. In: Krayenbühl Het al (eds) Advances and technical standards in neurosurgery, vol 6. Springer, Wien New York, pp 102–136
de Souza CE, de Souza R, Da Costa S, Sperling N, Yoon TH, Abdelhamid MM, Sharma RR, Goel A (1989) Cerebellopontineangle epidermoid cysts: a report on 30 cases. J Neurol Neurosurg Psychiatry 52: 986–990
Drayer BP, Rosenbaum AE, Maroon JC, Bank WO, Woodford JE (1977) Posterior fossa extraaxial cyst: diagnosis with metrizamide CT cisternography. AJR 128: 431–436
Dunn RC, Archer CA, Rapport RL, Looi LM (1981) Unusual CT-dense posterior fossa epidermoid cyst. J Neurosurg 55: 654–656
Elster AD (1988) Extra-axial neoplasms. Epidermoids. In: Hurley RA (ed) Cranial magnetic resonance imaging. New York, pp 137–142
Fein JM, Lipow K, Taati F, Lansem T (1981) Epidermoid tumour of the cerebellopontine angle: diagnostic value of computed tomographic metrizamide cisternography. Neurosurgery 9: 179–182
Fleming JFR, Botterell EH (1959) Cranial dermoid and epidermoid tumors. Surg Gynecol Obstet 109: 403–411
Gagliardi FM, Vagnozzi R, Caruso R, Delfini R (1980) Epidermoids of the cerebellopontine angle (cpa): usefulness of CT scan. Acta Neurochir (Wien) 54: 271–281
Grant FC, Austin GM (1950) Epidermoids: clinical evaluation and surgical results. J Neurosurg 7: 190–198
Gros C, Vlahovitch B (1957) Les cholestéatomes de la fente de Bichat à expansion intraventriculaire et sous-tentorielle. Neurochirurgie 3: 327–329
Guidetti B, Gagliardi FM (1977) Epidermoid and dermoid cysts. Clinical evaluation and late surgical results. J Neurosurg 47: 12–18
Hamel E, Frowein RA, Karimi-Nejad A (1980) Intracranial intradural epidermoids and dermoids. Surgical results of 38 cases. Neurosurg Rev 3: 215–219
Hanamura T, Amano K, Hatanaka H, Tsukagoshi H (1978) A case of epidermoid of the fourth ventricle. J Neurol 219: 145–149
Handa J, Nakano Y, Aii H (1977) CT cisternography with intracranical arachnoidal cysts. Surg Neurol 8: 451–454
Hasegawa H, Bitoh S, Nakata M, Fujiwara M, Yasuda H (1981) Intracranial epidermoid mimicking meningioma. Surg Neurol 15: 372–374
Hiratsuka H, Okada K, Matsunaga M, Tanaka K, Fukai N, Inaba Y (1984) Diagnosis of epidermoid cysts by metrizamide CT cisternography. Neuroradiology 26: 153–155
Imamura Y, Ninchoji T, Nakajima S, Uemura K (1982) Epidermoid tumor in the fourth ventricle, with particular reference to Metrizamide CT cisternography findings. Surg Neurol 18: 444–447
Ishikawa M, Kikuchi H, Asato R (1989) Magnetic resonance imaging of the intracranial epidermoid. Acta Neurochir (Wien) 101: 108–111
Ito Y, Kakau M, Kodama T, Matsukada Y (1980) Intracranial high density epidermoid. No Shinkei Geka 8: 645–648
Kapila A, Steinbaum S, Chakeres DW (1984) Meckel's cave epidermoid with trigeminal neuralgia. CT findings. J Comput Assist Tomogr 8: 1172–1174
Keville FJ, Wise BL (1959) Intracranial epidermoid and dermoid tumors. J Neurosurg 16: 564–569
Laster DW, Moody DM, Ball MR (1977) Epidermoid tumors with intraventricular and subarachnoid fat: report of two cases. Am J Roentgenol 128: 504–507
Liguori R (1967) Cisti epidermoidi basilari ad espansione soprae sottotentoriale. Minerva Neurochir 11: 110–114
Love JG, Kernohan JW (1936) Dermoid and epidermoid tumors (cholesteatomas of central nervous system. JAMA 107: 1876–1883
Lunardi P, Rizzo A, Guidetti G (1988) Unusual CT-dense transtentorial epidermoid cyst. Neurochirurgia (Stuttg) 31: 219–221
MacCarty CS, Leavens ME, Love JG, Kernohan JW (1959) Dermoid and epidermoid tumors in the central nervous system of adults. Surg Gynecol Obstet 108: 181–198
MacKay IM, Bydder GM, Young IR (1985) MR imaging of central nervous system tumors that do not display increase in T1 o T2. J Comput Assist Tomogr 9: 1055–1061
Maiuri F, Donzelli R, Spaziante R, Gallicchio B, Briganti F, De Divitiis E, D'Andrea F (1986) Paramedian hourglass epidermoid cysts extending in the middle and posterior cranial fossa. J Neurosurg Sci 30: 187–196
Matsuno H, Rhoton AL, Peace D (1988) Microsurgical anatomy of the posterior fossa cisterns. Neurosurgery 23: 58–80
Nagashima C, Takahama M, Sakaguchi A (1982) Dense cerebellopontine epidermoid cyst. Surg Neurol 17: 172–177
Netsky MG (1988) Epidermoid tumours. Review of the literature. Surg Neurol 29: 477–483
Olivecrona H (1932) On suprasellar cholesteatomas. Brain 55: 122–134
Olson JJ, Beck DW, Crawford SC, Menezes AH (1987) Comparative evaluation of intracranial epidermoid tumors with computed tomography and magnetic resonance imaging. Neurosurgery 21: 357–360
Osborne DR (1985) Epidermoid and dermoid tumors: Radiology. In: Wilkins RH, Rengachary SS (eds) Neurosurgery, vol 1. New York, pp 662–667
Peyton WT, Baker AB (1942) Arch Neurol Psychiat 47: 890–917
Reeves DL (1967) Epidermoid (Mixed) tumors of the central nervous system. J Neurosurg 26: 21–24
Rosario M, Becker DH, Conley FK (1981) Epidermoid tumors involving the fourth ventricle. Neurosurgery 9: 9–13
Rosenbluth PR, Lichtenstein BW (1960) Pearly tumor (epidermoid cholesteatoma) of the brain: clinicopathologic study of two cases. J Neurosurg 17: 35–42
Rubin G, Scienza R, Pasqualin A, Rosta L, Da Pian R (1989) Craniocerebral epidermoids and dermoids. Acta Neurochir (Wien) 97: 1–16
Sabin HI, Bordi LT, Symon L (1987) Epidermoid cysts and cholesterol granulomas centered on the posterior fossa: twenty years of diagnosis and management. Neurosurgery 21: 798–805
Salazar J, Vaquero J, Saucedo G, Bravo G (1987) Posterior fossa epidermoid cysts. Acta Neurochir (Wien) 85: 34–39
Schraeder PL, Cohen MM, Goldman W (1981) Bilateral internuclear opthalmoplegia associated with fourth ventricular epidermoid tumor. J Neurosurg 54: 403–405
Steffey DJ, De Filipp GJ, Spera T, Gabrielsen TO (1988) MR imaging of primary epidermoid tumors. J Comput Assist Tomogr 12: 438–440
Symon L (1982) Surgical approaches to the tentorial hiatus. In: Krayenbühl Het al (eds) Advances and technical standards in neurosurgery, vol 9. Springer, Wien New York, pp 69–112
Tampieri D, Melanson D, Ethier R (1989) MR imaging of epidermoid cysts. AJNR 10: 351–356
Tytus JS, Pennybacker J (1956) Pearly tumours in relation to the central nervous system. J Neurol Neurosurg Psychiatry 19: 241–259
Valavanis A, Schubiger O, Naidich TP (1987) Clinical imaging of the cerebello-pontine angle. Springer, Berlin Heidelberg New York, p 80
Vion-Dury J, Vincentelli F, Jiddane M, Van Bunnen Y, Rumeau C, Grisoli F, Salamon G (1987) MR imaging of epidermoid cysts. Neuroradiology 29: 333–338
Yamakawa K, Shitara N, Genka S, Manaka S, Takakura K (1989) Clinical course and surgical prognosis of 33 cases of intracranial epidermoid tumors. Neurosurgery 24: 568–573
Yaşargil MG (1984) Operative anatomy. Subarachnoid cysterns, in microneurosurgery, vol. 1. Thieme, Stuttgart New York, p 14
Yaşargil MG, Abernathey CD, Sarioglu AC (1989) Microneurosurgical treatment of intracranial dermoid and epidermoid tumors. Neurosurgery 24: 561–567
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Lunardi, P., Missori, P. Transtentorial epidermoid cysts. Acta neurochir 113, 125–130 (1991). https://doi.org/10.1007/BF01403197
Issue Date:
DOI: https://doi.org/10.1007/BF01403197