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CC BY-NC-ND 4.0 · Asian J Neurosurg 2021; 16(03): 470-482
DOI: 10.4103/ajns.AJNS_539_20
Review Article

Fourth ventricular epidermoid cyst – Case series, systematic review and analysis

Sanjeev Kumar
Department of Neurosurgery, Pt. JNM Medical College and DKS Post Graduate Institute and Research Center, Raipur, Chhattisgarh
,
Debabrata Sahana
Department of Neurosurgery, Pt. JNM Medical College and DKS Post Graduate Institute and Research Center, Raipur, Chhattisgarh
,
Lavlesh Rathore
Department of Neurosurgery, Pt. JNM Medical College and DKS Post Graduate Institute and Research Center, Raipur, Chhattisgarh
,
Rajiv Sahu
Department of Neurosurgery, Pt. JNM Medical College and DKS Post Graduate Institute and Research Center, Raipur, Chhattisgarh
,
Amit Jain
Department of Neurosurgery, Pt. JNM Medical College and DKS Post Graduate Institute and Research Center, Raipur, Chhattisgarh
,
Praveen Borde
Department of Neurosurgery, Pt. JNM Medical College and DKS Post Graduate Institute and Research Center, Raipur, Chhattisgarh
,
Manish Tawari
Department of Neurosurgery, Pt. JNM Medical College and DKS Post Graduate Institute and Research Center, Raipur, Chhattisgarh
,
Satya Madhariya
1   Department of Neurosurgery, Ramakrishna Care Hospital, Raipur, Chhattisgarh
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Background: Epidermoid cysts are extra-axial, pearly white avascular lesions mostly found in the cerebellopontine region. They are slow-growing and mostly become symptomatic when they attain significant size. They do occur at other anatomical locations, but fourth ventricle is a rare location. Three representative cases with their outcomes are described here. Methods: The systematic review was done with adherence to predefined criteria. The studied variables were age, gender, duration of symptoms (DOS), clinical features, hydrocephalus (HCP), extent of resection, postoperative complications, outcome, follow–up, and recurrence. Statistical analysis was done to identify predictive factors for outcome. Results: Final analysis included 58 studies containing 131 patients. The most common clinical feature was cerebellar dysfunction (93%). The most common cranial nerve involved was the abducens nerve (n = 37, 28.46%). Preoperative HCP was present in nearly a third (35%) of patients. The outcomes were not different with age (P = 0.23), gender (P = 0.74), DOS (P = 0.09), and HCP (P = 0.50). Improved outcomes were associated with total resections (P = 0.001), absence of preoperative cranial nerve dysfunctions (P = 0.004), and presentation with features of raised intracranial pressure (P = 0.005). Longer DOS (mean 76.74 months) was associated with significantly increased cranial nerve nuclei involvement (P = 0.03). Aseptic meningitis was reported in 14.5% of cases. Recurrences were infrequently reported (n = 9). Conclusions: Although the fourth ventricular epidermoid lesions are difficult to detect in an innocuous stage, when found, they should be extirpated early and totally, as a longer DOS leads to cranial nerve dysfunctions and suboptimal outcomes.

Key-words:

Epidermoid cyst - fourth ventricular epidermoid cyst - fourth ventricular tumors

Financial support and sponsorship

Nil.




Publication History

Received: 12 November 2020

Accepted: 14 September 2021

Article published online:
16 August 2022

© 2021. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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