Radiotherapy for recurrent epidermoid cyst
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CLINICAL STUDY
Radiotherapy for recurrent epidermoid cyst Jason M. Davies • Victoria T. Trinh • Penny K. Sneed • Michael W. McDermott
Received: 27 October 2012 / Accepted: 2 February 2013 / Published online: 12 February 2013 Ó Springer Science+Business Media New York 2013
Keywords Epidermoid cyst Radiotherapy Intensity-modulated radiotherapy
frequency among genders, and symptoms tend to be slowly progressive neurologic deficits due to chronic compression of neural structure [2, 3]. Epidermoid cysts contain keratin debris, water, and lipids that yield unique imaging characteristics: extreme hypodensity on CT, very low T1 signal, high T2 signal, and marked restriction on diffusion weighted imaging (DWI) [5–8]. Surgery has been the mainstay of treatment and is potentially curative [4, 9–11], although radiotherapy has been reported as salvage therapy in cases of recurrent epidermoid cyst [12, 13]. In this report, we present three patients with recurrent epidermoid cysts who were successfully treated with radiotherapy after multiple failed surgical resections.
Introduction
Case report
Intracranial epidermoid cysts account for 1–2 % of intracranial tumors [1, 2]. They are generally considered slowgrowing congenital lesions most frequently found in the cerebellopontine angle (CPA) or parasellar region [2–4]. Presentation is typically in the fourth decade, with equal
Patient A
Abstract Intracranial epidermoid cysts are rare benign congenital lesions for which the mainstay of treatment has been surgical resection. Due to a propensity to grow along the skull base, subtotal resection is often elected to avoid excessive surgical morbidity, but it comes with an increased risk of recurrence with its associated treatment difficulties. We here present the cases of three patients with recurrent epidermoid cyst who underwent multiple surgical resections followed by external beam radiation therapy with excellent results to date.
J. M. Davies V. T. Trinh M. W. McDermott (&) Department of Neurological Surgery, University of California, San Francisco, CA, USA e-mail: [email protected] V. T. Trinh e-mail: [email protected] P. K. Sneed M. W. McDermott Department of Radiation Oncology, University of California, San Francisco, CA, USA
A 37-year-old man presented in February 1995, with a several-year history of progressive left-sided hearing loss, headaches, and intermittent left facial tingling. Clinical examination demonstrated House-Brackmann II/VI left facial palsy and muffled hearing in the left ear. A CT scan of the head revealed a hypodense non-enhancing mass in the CPA occupying the left cistern and extending across midline to the right CPA. The patient underwent left combined retrolabyrinthine and middle fossa craniotomy for subtotal resection of the tumor, leaving capsule along the midbrain above the fourth nerve. The pathology was benign epidermoid cyst. Postoperatively, the patient had CSF rhinorrhea that was successfully treated with lumbar drainage. The patient represented nearly a dec
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