School of Medicine and Health Sciences Poster Presentations

Title

Suprasellar Epidermoid Cyst Originating from the Infundibulum: Case Report and Literature Review

Document Type

Poster

Keywords

neurosurgery; epidermoid cyst; case report

Publication Date

4-2017

Abstract

Epidermoid cysts account for 1-2% of all brain tumors and are most commonly found in the cerebellopontine angle and parasellar cisterns. The slow growth of these tumors often results in them remaining asymptomatic until their size is large enough to compress surrounding structures, such as the pituitary stalk or optic chiasm. These cysts are believed to develop during the embryonal period of development, more specifically the 3rd to 5th weeks of gestation, with displacement of dorsal ectodermal cells normally residing in the midline. The incomplete separation of the neural and epidermal ectoderm allows for epiblast inclusion in the neural tube, which typically closes during this gestational period. A transsphenoidal approach for the removal of these tumors has been shown to reduce morbidity and mortality in these patients due to the better visualization of the neoplasm and surrounding anatomy and minimal (if any) brain retraction. Tumors and cysts of the pituitary stalk and hypothalamic region vary in presentation depending on their location, progression, and extension into the surrounding anatomy, in addition to the age and comorbidities of the patient; all of these factors must be addressed prior to surgery.

Here we present a rare case of an epidermoid cyst located in the suprasellar region, specifically originating from the infundibulum. Only one additional case with an epidermoid cyst originating within the pituitary stalk has been previously reported in the literature. The patient in this case presented with headaches, diplopia and blurred vision without any endocrinopathy. The only other reported case of an epidermoid cyst occurring within the infundibulum involved a young female patient who presented with a two year history of significant endocrine symptoms including amenorrhea, galactorrhea, polyuria and polydipsia. The similarities and differences between these cases highlight the variety of symptoms and clinical presentations of tumors residing within this region of the brain and the close attention to detail required in diagnosis.

As seen in our patient, tumors involving the pituitary stalk are challenging given the high risk for postoperative endocrinopathy, and management of surrounding structures including the hypothalamus, optic chiasm and vessels within the cavernous sinus. While other cases have presented with lesions intruding into the sellar region, epidermoid growth within the stalk itself is rare and our patient is an excellent example of the neurosurgical management of an epidermoid cyst residing in this specific location.

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Poster to be presented at GW Research Day 2017.

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Suprasellar Epidermoid Cyst Originating from the Infundibulum: Case Report and Literature Review

Epidermoid cysts account for 1-2% of all brain tumors and are most commonly found in the cerebellopontine angle and parasellar cisterns. The slow growth of these tumors often results in them remaining asymptomatic until their size is large enough to compress surrounding structures, such as the pituitary stalk or optic chiasm. These cysts are believed to develop during the embryonal period of development, more specifically the 3rd to 5th weeks of gestation, with displacement of dorsal ectodermal cells normally residing in the midline. The incomplete separation of the neural and epidermal ectoderm allows for epiblast inclusion in the neural tube, which typically closes during this gestational period. A transsphenoidal approach for the removal of these tumors has been shown to reduce morbidity and mortality in these patients due to the better visualization of the neoplasm and surrounding anatomy and minimal (if any) brain retraction. Tumors and cysts of the pituitary stalk and hypothalamic region vary in presentation depending on their location, progression, and extension into the surrounding anatomy, in addition to the age and comorbidities of the patient; all of these factors must be addressed prior to surgery.

Here we present a rare case of an epidermoid cyst located in the suprasellar region, specifically originating from the infundibulum. Only one additional case with an epidermoid cyst originating within the pituitary stalk has been previously reported in the literature. The patient in this case presented with headaches, diplopia and blurred vision without any endocrinopathy. The only other reported case of an epidermoid cyst occurring within the infundibulum involved a young female patient who presented with a two year history of significant endocrine symptoms including amenorrhea, galactorrhea, polyuria and polydipsia. The similarities and differences between these cases highlight the variety of symptoms and clinical presentations of tumors residing within this region of the brain and the close attention to detail required in diagnosis.

As seen in our patient, tumors involving the pituitary stalk are challenging given the high risk for postoperative endocrinopathy, and management of surrounding structures including the hypothalamus, optic chiasm and vessels within the cavernous sinus. While other cases have presented with lesions intruding into the sellar region, epidermoid growth within the stalk itself is rare and our patient is an excellent example of the neurosurgical management of an epidermoid cyst residing in this specific location.