Intracranial Epidermoid Tumors

We are reporting our experience with 96 cases of epidermoid tumors treated between 1985 and 2010. Thirty-one cases were in supratentorial and 65 were in the infratentorial/transtentorial regions. There was male/female ratio of 3/1, with ages ranging from 15–52 years. The 31 cases in the suprasellar compartment were: 9 cases in suprasellar area, 14 in parasellar area, 2 intrasellar, and 2 parafalcine. Follow-up period ranged from 2.3–6.5 years. Various surgical approaches were used for excision in the suprasellar group. Morbidity in the supratentorial group included aseptic meningitis, behavioral changes, renal failure, and new seizure. There was no mortality. In the infratentorial/transtentorial group, the distribution of epidermoid tumors was as follows: 65 cases were in cerebellopontine angle, and 8 cases were confined in the fourth ventricle. A retrosigmoid approach in the sitting position was used in all cases. The morbidity in this group included aseptic meningitis, new seizure, pyramidal weakness, and one patient with CSF leak. There was no mortality in this group. We could achieve total resection in 34 out of 43 cases. There was no recurrence in the total excision group. In nine cases, subtotal excision was achieved with recurrence noticed in five patients. The general surgical outcome was excellent in 31/43 patients, good in 10/43, fair in 1/43, and poor in 1/43. Total excision of the contents and the capsule should be the aim of surgery for epidermoid tumors to avoid recurrence and/or malignant change.