[Long-term outcomes of surgical treatment for epidermoid]

Surgical strategies for epidermoids in our department is that the tumor capsule and surrounding arachnoid membrane should be sharply dissected and resected as much as possible. However, if total resection is not possible, because of the danger of surgical morbidity, partial resection should be carried out. The present study reports on long-term outcomes of surgical treatment for intracranial epidermoid in our department.

Since 1994, intracranial epidermoids have been resected in 13 patients in our department. The mean age at the time of surgery was 50.2 years and the mean postoperative follow-up period was 75.8 months. Surgical outcome, postoperative morbidity, Karnofsky Performance Status (KPS) during long-term follow-up, hydrocephalus, and regrowth rate were investigated.

Among the 13 patients, 5 underwent total resection, 5 subtotal resection, and 3 partial resection. No permanent morbidity occurred and KPS did not worsen postoperatively in any of the patients. Surgery for hydrocephalus was performed in 3 patients. However, hydrocephalus had been suspected before surgery in each patient. Regrowth occurred in 1 patient, showing malignant transformation 1 year after total resection. No regrowth during long-term follow-up was observed in the other 12 patients, and none showed exacerbation of KPS.

The present study indicates that regrowth does not necessarily occur in patients with epidermoids. Although total resection is ideal, to avoid any surgical morbidity is even more important. Partial resection should be performed if total resection is impossible.