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Pearl in interhemispheric fissure: A rare phenomenon
Vivek Agarwal1, Abhishek Vijayan, Vernon Velho
1Department of Neurosurgery, Grant Medical College and Sir J. J. Group of Hospitals, Mumbai, India.
Asian Journal of Neurosurgery
|April 6, 2013
Summary
Interhemispheric epidermoid cysts are rare brain tumors. Complete surgical excision, aided by endoscopy, is crucial to prevent recurrence and chemical meningitis, leading to good patient outcomes.
Area of Science:
- Neurosurgery
- Neuropathology
Background:
- Epidermoid cysts are benign congenital lesions, typically found in specific brain regions.
- Interhemispheric epidermoid cysts are exceptionally rare and pose significant surgical challenges due to their location.
Observation:
- A 10-year study analyzed 8 interhemispheric epidermoid cases (4.27% of all intracranial epidermoids).
- Common presenting symptoms included seizures (50%), headache (37%), and weakness (25%).
- Neurological examination revealed decreased Mini-Mental State Examination (MMSE) scores (50%), motor deficits (25%), and visual acuity reduction (25%).
Findings:
- The interhemispheric surgical approach was used in 7 out of 8 patients; one underwent a transcortical approach.
- Microscope and endoscopic assistance were employed to ensure complete tumor resection and prevent spillage.
- Post-operative outcomes were favorable, with 7 patients improving and no instances of chemical meningitis or recurrence during an average 6.8-year follow-up.
Implications:
- Complete excision without spillage is the primary surgical goal for interhemispheric epidermoids.
- Endoscopic assistance can enhance surgical outcomes, reducing the incidence of chemical meningitis and recurrence.
- These rare tumors require specialized surgical techniques for safe and effective management.
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