İntrakraniyal epidermoid tümörlerin cerrahi tedavisi: cerrahi olarak tedavi edilen 29 hastanın retrospektif analizi

Year 2020, Volume: 13 Issue: 3, 677 - 686, 18.09.2020

Kadir Oktay , Ebru Guzel , Adnan Demirci , Özlem Nuray Sever , Vildan Kaya , Elif Akpınar , Mustafa Yıldırım , Aslan Güzel , Hakan Seçkin

https://doi.org/10.31362/patd.670647

Abstract

Amaç: İntrakraniyal epidermoid tümörler iyi huylu, yavaş büyüyen ve nadir görülen tümörlerdir. Beynin ve kranyumun farklı bölgelerine görülebilmelerine rağmen, ağırlıklı olarak serebellopontin açı ve temporal bölgede yerleşirler. Bu çalışmada epidermoid tümörlerin klinik bulguları ve tümör yerleşimleri, cerrahi yöntemleri ve sonuçları incelendi.
Materyal ve Metod: 2012-2019 yılları arasında tanı konulan intrakraniyal epidermoid tümörü bulunan 29 hastanın tıbbi kayıtları retrospektif olarak incelendi.
Bulgular: Çalışma grubunda 16 kadın ve 13 erkek hasta vardı. Tümörler 16 hastada serebellopontin açıda ve 13 hastada diğer bölgelerde yerleşmişti. Serebellopontin açıdan köken alan tümörleri olan 16 hastanın ikisinde hem infra hem de supratentoryal uzanım mevcuttu. Bu hastalardan birine retrosigmoid ve subtemporal yaklaşımlarla iki seansta subtotal rezeksiyon uygulandı. Tümör, belirgin vasküler yapılara yapışan kapsülü dışında eksize edildi. Diğer hastaya ise subtemporal yaklaşımla tek seansla gros total rezeksiyon uygulandı. Diğer 14 olguda sadece infratentoryal yerleşim mevcuttu. 25 hastaya gros total rezeksiyon ve 4 hastaya subtotal rezeksiyon uygulandı. Dört hastada postoperatif komplikasyon gelişti. Tümörü beyin sapına yapışan bir hasta postoperatif dönemde kaybedildi. Hiçbir hastada nüks görülmedi.
Sonuç: İntrakraniyal epidermoid tümörlerin tedavisinin temel amacı cerrahi müdahale ile gros total tümör rezeksiyonu olmalıdır. Bununla birlikte, subtotal rezeksiyon morbidite ve mortaliteye neden olabilecek durumlarda hayati nörovasküler yapılara yapışık kapsüller bırakılarak yapılabilir. Total rezeksiyon yapılan tümörlerin nüks riski çok düşüktür.

Keywords

Epidermoid tümör, tedavi, serebellopontin açı, komplikasyon

Surgical treatment of intracranial epidermoid tumors: a retrospective analysis of 29 surgically treated patients

Abstract

Objective: Intracranial epidermoid tumors are benign, slow-growing, rare tumors. Although they are placed in different regions of the brain and cranium, they are predominantly located in the cerebellopontine angle and temporal region. In the present study, clinical findings and tumor location of epidermoid tumors, surgical methods and their results were examined.
Materials and Methods: Medical records of 29 patients with intracranial epidermoid tumors diagnosed between 2012-2019 were retrospectively reviewed.
Results: There were 16 female and 13 male patients in the study cohort. Tumors were located in cerebellopontine angle in 16 patients and other regions in 13 patients. Two of the 16 patients with tumors originating from cerebellopontine angle had both infra and supratentorial extension. One of these patients underwent subtotal resection in two sessions via retrosigmoid and subtemporal approaches. The tumor was excised except for the capsule adherent to eloquent vascular structures. The other patient underwent gross total resection with a single session via subtemporal approach. The other 14 cases were only infratentorial. In 25 patients gross total resection was performed and subtotal resection was performed in 4 patients. There were postoperative complications in 4 patients. One patient, whose tumor was adherent to the brainstem was lost in the postoperative period. There was no recurrence in any of the patients.
Conclusion: The main purpose of treatment of intracranial epidermoid tumors should be gross total tumor resection by surgical intervention. However, subtotal resection may be performed by leaving a capsule adherent to eloquent neurovascular structures that may cause morbidity and mortality. The risk of recurrence of tumors in which total resection performed is very low.

Keywords

Epidermoid tumor, treatment, cerebellopontine angle, complication

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