Fourth ventricle epidermoid tumour: an institutional review

Abstract :

Background: Intracranial epidermoids are uncommon tumours, with an incidence of around 0.5-2 % of all intracranial tumours. Age of presentation is 3rd - 4th decade. Most common sites of involvement are the basal cisterns with Fourth ventricle involvement being rarely reported. Methods: Over a period of 9 years, a total of 13 cases of epidermoids located in the fourth ventricle were admitted in our Department of Neurosurgery. The history and clinical course was studied. Radiological diagnosis was established with CT and MRI Brain with contrast and was operated upon. Diagnosis was confirmed by histopathology. A retrospective study was carried out and results were reviewed. Results :A total of 13 cases were studied that included 10 males and 3 females. Age of presentation varied from 16 years to 55 years. Most cases presented with cerebellar signs and symptoms, mostly ataxia and incoordination. Only 2 patients had symptoms of raised intracranial pressure, that too, mild in manifestation. Subtotal resection was done in 11 patients, while total removal was possible in rest 2.Characteristic pearly appearance was found intraoperatively. Except two patients, all other faired well postoperatively. One had recurrence of symptoms later on. Conclusion: Fourth ventricle epidermoid tumours, although uncommon, have fairly good outcome, even if subtotal removal is done. If neglected, can be life threatening. Subtotal removal may result in recurrence, that can be detected by clinical assessment and MRI. Although total resection should be the goal, as growth is slow, even near total removal may suffice if tumour encases vital structures.

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