Neurosurgery 97:351–360, 2025
This retrospective study of 146 patients with intracranial epidermoid cysts found that recurrence is common after subtotal resection, but most patients experience significant symptomatic improvement post-surgery. Intraoperative lumbar drain placement increased 30-day readmission risk, and malignant transformation was exceedingly rare. Mortality was not observed.
• Intracranial epidermoid cysts are rare, slow-growing tumors, often presenting with cranial nerve dysfunction, headaches, vertigo, and seizures.
• Surgical resection is standard, but complete removal is often limited by adherence to critical neurovascular structures, leading to frequent residual tumor.
• Recurrence is common, especially after subtotal resection; radiologic evidence of residual tumor predicts shorter recurrence-free survival.
• Most patients show significant symptomatic improvement after surgery, with over half asymptomatic at latest follow-up, even if reoperations are needed.
• 30-day readmission rate is over 10%, mainly due to CSF leaks and aseptic meningitis; intraoperative lumbar drain placement increases readmission risk.
• Malignant transformation to squamous cell carcinoma is exceedingly rare (less than 0.05%).
• No deaths related to tumor or treatment were observed in this large cohort.
• Maximal safe resection is recommended to minimize recurrence, but complete capsule removal is often not feasible.
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