- Department of Neurosurgery, SCB Medical College and Hospital, Cuttack, Odisha, India
Correspondence Address:
Satya B. Senapati
Department of Neurosurgery, SCB Medical College and Hospital, Cuttack, Odisha, India
DOI:10.4103/2152-7806.102350
Copyright: © 2012 Senapati SB. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.How to cite this article: Senapati SB, Mishra SS, Patnaik A, Patra SK. Pineal epidermoid. Surg Neurol Int 13-Oct-2012;3:125
How to cite this URL: Senapati SB, Mishra SS, Patnaik A, Patra SK. Pineal epidermoid. Surg Neurol Int 13-Oct-2012;3:125. Available from: http://sni.wpengine.com/surgicalint_articles/pineal-epidermoid/
Abstract
Background:Tumors of pineal region are uncommon, accounting for ≤1% of intracranial tumors in adults and 3–8% of pediatric brain tumors. Epidermoid cysts account for 0.2–1% of all intracranial tumors. The majority occur in and around the cerebellopontine angle and suprasellar area. Getting an epidermoid in pineal region is very rare.
Case Description:We report a case of pineal epidermoid, which was diagnosed correctly as epidermoid depending on computed tomography (CT) and magnetic resonance imaging (MRI) findings. Knowing its benign nature, we accordingly planned for its near-total removal.
Conclusion:Most cases of pineal tumors present as obstructive hydrocephalus. They either require pre- or postoperative ventriculoperitoneal (VP) shunt. If properly planned, many benign pineal tumors may be successfully excised and, most importantly, postoperative VP shunt could be avoided.
Keywords: Epidermoid tumors, pineal tumors, three-quarter prone position
INTRODUCTION
Pineal gland is made up different cell types, accounting for diverse pathology of tumors in this region. These tumors are classified into four main types, i.e. germ cell tumors, pineal parenchymal cell tumors, glial cell tumors, and other miscellaneous tumors. Pineal epidermoid tumor belongs to miscellaneous tumors of this region.
CASE REPORT
A 41-year-old male presented to us with complaints of holocranial headache for last 1 year, progressive diminution of vision for last 6 months, ataxia for last 3 months, and memory disturbance for last 1 month. On neurological examination, we found bilateral papilledema with impaired vision in both eyes. Computerized tomography (CT) scan revealed well-defined hypodense and nonenhancing mass in the pineal region, and patchy calcification in the peripheral part of the tumor, with hydrocephalus [
Figure 1
(a) CT brain: A large well-defined hypodense and nonenhancing mass in the pineal region, patchy calcification in the peripheral part of the tumor, with hydrocephalus. (b and c) MRI brain: A complex heterogeneous, ill-marginated mass in pineal region, with extension encroaching midbrain and infratentorium. The mass was compressing the aqueduct and causing obstructive hydrocephalus
DISCUSSION
Epidermal cysts arise when ectodermal remnants are trapped by two fusing ectodermal surfaces. Trauma and differentiation from multipotential cell rests are other mechanisms implicated in the origin of epidermoid tumor. Growth of epidermoid occurs at a linear rate as that of normal skin; because of slow growth rate, these tumors attain relatively large size before the patient becomes symptomatic. These tumors are commonly located within the basal subarachnoid cisterns. Extension of the tumor both above and below the tentorium is frequent.[
On T1- and T2-weighted images, these tumors have signal intensity as that of CSF, mimicking arachnoid cyst.[
Surgeries for pineal region tumors are done to get sufficient tissue sample for histological diagnosis, relieving hydrocephalus and mass effect.[
Choice of operative approach depends upon the extent of tumor and its relation to major vessels. As in our case the tumor had a major supratentorial part with displacement of major vessels downward, we chose occipital–transtentorial route.
CONCLUSION
Though germ cell tumors constitute a significant portion of pineal region tumors, still 35–50% of pineal tumors are benign, which are radio-resistant. Therefore, tissue diagnosis of pineal region tumor is mandatory for optimal management of these tumors. Most cases of pineal tumors present as obstructive hydrocephalus. They either require pre- or postoperative ventriculoperitoneal (VP) shunt. If properly planned, many benign pineal tumors may be successfully excised and, most importantly, postoperative VP shunt could be avoided.
References
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