METHODS: The case involved a 78-year-old man with a history of 2 surgeries for a left cerebellopontine angle typical epidermoid cyst 23 years earlier and SRS using the CyberKnife for recurrent trigeminal neuralgia (TN) 14 years earlier. The tumor with high intensity on T1-weighted imaging, low intensity on T2-weighted imaging, without restriction on diffusion-weighted imaging had gradually enlarged after SRS. Therefore, a salvage surgery was performed via a left suboccipital craniotomy, and the intraoperative findings showed a cyst with a brown, viscous liquid component, consistent with those of WECs. Histopathologically, keratin calcification and hemorrhage were identified, leading to a diagnosis of WEC. The postoperative course was uneventful, and the TN resolved. No tumor recurrence was recorded at 2 years postoperatively.
CONCLUSIONS: To the best of the authors\' knowledge, this is the first world case of WEC transformation from a typical epidermoid cyst after SRS, confirmed by radiological and pathological findings. Radiation effects could have been involved in this transformation.
方法:该病例涉及一名78岁的男性,23年前有2例左桥小脑角典型表皮样囊肿手术史,14年前使用射波刀进行SRS治疗复发性三叉神经痛(TN)。在T1加权成像上具有高强度的肿瘤,低强度的T2加权成像,无限制扩散加权成像在SRS后逐渐增大.因此,通过左枕下开颅术进行了抢救手术,术中发现有一个棕色囊肿,粘性液体成分,与WEC的一致。组织病理学,确定了角蛋白钙化和出血,导致WEC的诊断。术后进展顺利,TN解决了。术后2年无肿瘤复发。
结论:据作者所知,这是世界上首例典型表皮样囊肿经SRS后WEC转化的病例,通过放射学和病理学检查证实。辐射效应可能参与了这种转变。