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NEUROIMAGE
Year : 2022  |  Volume : 70  |  Issue : 2  |  Page : 832-833

Epidermoid Cyst of the Cavum Septum Pellucidum: A Case Report and Literature Review


1 Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
2 Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China

Date of Submission24-Feb-2021
Date of Decision05-May-2021
Date of Acceptance30-Sep-2021
Date of Web Publication3-May-2022

Correspondence Address:
Dr. Siqing Huang
No 37, Guo Xue Xiang, Chengdu - 610041, Sichuan Province
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.344627

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How to cite this article:
Hu Y, Tan H, Huang S. Epidermoid Cyst of the Cavum Septum Pellucidum: A Case Report and Literature Review. Neurol India 2022;70:832-3

How to cite this URL:
Hu Y, Tan H, Huang S. Epidermoid Cyst of the Cavum Septum Pellucidum: A Case Report and Literature Review. Neurol India [serial online] 2022 [cited 2022 Jun 27];70:832-3. Available from: https://www.neurologyindia.com/text.asp?2022/70/2/832/344627




A 29-year-old previously healthy male was admitted with a history of seizures and right lower-extremity weakness for 7 days. On examination, no neurological deficits were detected. Cranial computed tomography (CT) revealed a large, well-defined hypodense intraventricular mass with rim calcification [Figure 1]a. Subsequently, magnetic resonance imaging (MRI) of the brain demonstrated an expansive mass of size 6.8 × 3.6 × 6.2 cm3 located within the cavum septum pellucidum (CSP). The lesion was hypointense on T1-weighted (T1W), hyperintense on T2-weighted (T2W), and heterogeneous intense on fluid-attenuated inversion recovery (FLAIR) images with no contrast enhancement [Figure 1]b,[Figure 1]c,[Figure 1]d,[Figure 1]e,[Figure 1]f.
Figure 1: CT and MRI scans of the epidermoid cyst within the CSP. (a) Axial view of plain CT scan shows a hypodense cystic lesion with marginal calcification (arrowheads) located within the CSP. The lesion is hypointense signal on T1 (b), hyperintense signal on T2 (c), and heterogeneous signal on FLAIR sequences (d). Coronal (e) and sagittal (f) T1-weighted gadolinium-enhanced MRI shows a nonenhancing lesion with superior displacement of ACAs (solid arrows) and inferior displacement of the internal cerebral veins (outline arrows).

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The patient underwent microsurgery via a left frontal transcortical approach. Intraoperatively, a well-encapsulated pearly white lesion was seen, indicating a typical epidermoid cyst [Figure 2]a. We attained near-total resection. Histopathologic examination revealed typically thin anucleate squames without any skin appendages, confirming the diagnosis of an epidermoid cyst [Figure 2]b. The patient had an uneventful postoperative course and complete resolution of his symptoms.
Figure 2: Intraoperative and pathological features of the epidermoid cyst within the CSP. (a) intraoperative image displays a pearly-white appearance lesion with a thin capsule. (b) Histopathology reveals typical thin anucleate squames without any skin appendages.

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Epidermoid cysts should be considered in the differential diagnosis of lesions within the CSP although very rare.[1] They usually demonstrate somewhat heterogeneous signal intensity on FLAIR and characteristically hyperintense signals with restricted diffusion on diffusion-weighted imaging (DWI) sequences. The displacement of the anterior cerebral arteries and internal cerebral veins is helpful to determine the original site of deeply situated midline epidermoid cysts.[2] Gross total resection is advocated in epidermoid cysts of the CSP, and near-total resection with meticulous lesion monitoring should be performed in cases of tight adhesion.[3],[4]

Financial support and sponsorship

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Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Bikmaz K, Dinc C, Cakabay M, Iplikcioglu AC. Epidermoid cyst of the cavum septum pellucidum. Acta Neurochir (Wien) 2007;149:1271-2.  Back to cited text no. 1
    
2.
Das KK, Honna RM, Attri G, Khatri D, Gosal JS, Dixit P, et al. A Single-center surgical experience of interhemispheric epidermoids and proposal of a new radiological classification. World Neurosurg 2020;141:e606-14.  Back to cited text no. 2
    
3.
Nagasawa D, Yew A, Safaee M, Fong B, Gopen Q, Parsa AT, et al. Clinical characteristics and diagnostic imaging of epidermoid tumors. J Clin Neurosci 2011;18:1158-62.  Back to cited text no. 3
    
4.
Shear BM, Jin L, Zhang Y, David WB, Fomchenko EI, Erson-Omay EZ, et al. Extent of resection of epidermoid tumors and risk of recurrence: case report and meta-analysis. J Neurosurg 2019;133:291-301.  Back to cited text no. 4
    


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