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        "titulo" => "Resumen"
        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Se presentan 27 casos de quistes epidermoides y 5 casos de quistes dermoides intracraneales intradurales que fueron intervenidos quir&#250;rgicamente en nuestro Servicio durante un per&#237;odo de 18 a&#241;os&#46; Los pacientes fueron estudiados radiol&#243;gicamente mediante neumoencefalograf&#237;a en 5 casos&#44; angiograf&#237;a cerebral en 16&#44; tomograf&#237;a computadorizada &#40;T&#46;C&#46;&#41; en 24 casos y resonancia magn&#233;tica &#40;R&#46;M&#46;&#41; en 13 &#40;9 preoperatoriamente y 4 postoperatoriamente&#41;&#46; Se realiz&#243; un seguimiento posquir&#250;rgico en 30 pacientes durante un per&#237;odo medio de 4 a&#241;os&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">En ambos tipos de quiste la localizaci&#243;n predominante fue supratentorial &#40;un 59&#44;2 &#37; de los epidermoides y 60 &#37; de los dermoides&#41;&#46; Como localizaciones poco frecuentes de quiste epidermoide se presentan 2 intraventriculares &#40;IV ventr&#237;culo y regi&#243;n atrial&#41;&#44; 2 intradiencef&#225;licas&#44; una paratrigeminal y otra interhemisf&#233;rica supracallosa&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">En la mayor&#237;a de los quistes la ex&#233;resis se practic&#243; mediante t&#233;cnica microquir&#250;rgica&#46; Se consider&#243; total en 16 pacientes &#40;50 &#37; de los casos&#41;&#44; casi total en 7 &#40;21&#44;8 &#37;&#41; y parcial en 9 &#40;28&#44;1 &#37;&#41;&#46; Se consigui&#243; mejor&#237;a cl&#237;nica en 14 pacientes &#40;46&#44;6 &#37;&#41;&#44; estabilizaci&#243;n sintom&#225;tica en 11 &#40;36&#44;6 &#37;&#41; y empeoramiento en 5 &#40;16&#44;6 &#37;&#41;&#46; Cinco pacientes presentaron recidiva tras un intervalo posquir&#250;rgico medio de 7 a&#241;os&#46; Cuatro de ellos empeoraron cl&#237;nicamente y fueron reintervenidos&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">En nuestra experiencia observamos que la R&#46;M&#46; ofrece mayor informaci&#243;n diagn&#243;stica que la T&#46;C&#46; en la recidiva&#44; especialmente en la secuencia potenciada en densidad prot&#243;nica&#46; Asimismo hemos comprobado que varios pacientes con imagen radiol&#243;gica posquir&#250;rgica de restos qu&#237;sticos o recidiva pueden permanecer largo tiempo asintom&#225;ticos y nuestra actitud terap&#233;utica en estos casos ha sido expectante&#46;</p>"
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        "titulo" => "Summary"
        "resumen" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Thirty-two patients with intracranial intradural epidermoid &#40;27 cases&#41; and dermoid &#40;5 cases&#41; cysts were operated in our Service during the last eighteen years&#46; The patients were studied with pneumoencephalography &#40;5 cases&#41;&#44; cerebral angiography &#40;16 cases&#41;&#44; computed tomography &#40;24 cases&#41; and magnetic resonance imaging &#40;9 cases preoperatively and 4 postoperatively&#41;&#46; Follow-up was available in 30 patients &#40;average 4 years&#41;&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The most common location of the cyst was supratentorial &#40;59&#44;2 &#37; epidermoids and 60 &#37; dermoids&#41;&#44; but six appeared in uncommon locations&#58; 2 intraventricular &#40;IV ventricle and atrial region&#41;&#44; 2 intradiencephalic&#44; one paratrigeminal and one supracallosal interhemispheric&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Microsurgical resection was performed in most cases&#46; Cyst removal was considered total in 16 patients &#40;50 &#37; of cases&#41;&#44; near total in 7 &#40;21&#44;8 &#37;&#41; and partial in 9 &#40;28&#44;1 &#37;&#41;&#46; Fourteen patients &#40;46&#44;6 &#37;&#41; improved&#44; 11 remained unchanged &#40;36&#44;6 &#37;&#41; and 5 got worse &#40;16&#44;6 &#37;&#41;&#46; Five patients showed cyst&#39;s recurrence after an average time of 7 years&#46; Four of them presented neurological deterioration and they underwent reoperation&#46;</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">In our opinion M&#46;R&#46; is more useful than C&#46;T&#46; for determining the presence of recurrence&#44; especially by using proton density weighted sequences&#46; We have observed that some patients with postsurgical radiographic imaging of remaining cyst or recurrence may stay asymptomatic for a long time&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara">Ayerbe&#44; J&#46;&#59; D&#237;ez&#44; R&#46;&#59; Mu&#241;oz&#44; A&#46;&#59; Ortega&#44; J&#46;M&#46;&#59; Dom&#237;nguez&#44; J&#46;&#59; Rivas&#44; J&#46;J&#46;&#59; Castro&#44; S&#46; y Sandoval&#44; H&#46;&#58; Quistes epidermoides y dermoides intracraneales intradurales&#58; tratamiento quir&#250;rgico y seguimiento de 32 casos&#46; Neurocirug&#237;a 1993&#59; 4&#58; 19&#8211;32&#46;</p>"
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Vol. 4. Núm. 1.
Páginas 19-32 (enero 1992)
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Vol. 4. Núm. 1.
Páginas 19-32 (enero 1992)
Quistes epidermoides y dermoides intracraneales intradurales: tratamiento quirúrgico y seguimiento de 32 casos
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15567
J. Ayerbe, R. Díez Lobato, J.M. Ortega, J. Domínguez, J.J. Rivas, S. Castro, H. Sandoval
Servicio de Neurocirugía, Hospital «12 de Octubre». Madrid
A. Muñoz*
* Sección de Neurorradiología. Hospital «12 de Octubre». Madrid
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Resumen

Se presentan 27 casos de quistes epidermoides y 5 casos de quistes dermoides intracraneales intradurales que fueron intervenidos quirúrgicamente en nuestro Servicio durante un período de 18 años. Los pacientes fueron estudiados radiológicamente mediante neumoencefalografía en 5 casos, angiografía cerebral en 16, tomografía computadorizada (T.C.) en 24 casos y resonancia magnética (R.M.) en 13 (9 preoperatoriamente y 4 postoperatoriamente). Se realizó un seguimiento posquirúrgico en 30 pacientes durante un período medio de 4 años.

En ambos tipos de quiste la localización predominante fue supratentorial (un 59,2 % de los epidermoides y 60 % de los dermoides). Como localizaciones poco frecuentes de quiste epidermoide se presentan 2 intraventriculares (IV ventrículo y región atrial), 2 intradiencefálicas, una paratrigeminal y otra interhemisférica supracallosa.

En la mayoría de los quistes la exéresis se practicó mediante técnica microquirúrgica. Se consideró total en 16 pacientes (50 % de los casos), casi total en 7 (21,8 %) y parcial en 9 (28,1 %). Se consiguió mejoría clínica en 14 pacientes (46,6 %), estabilización sintomática en 11 (36,6 %) y empeoramiento en 5 (16,6 %). Cinco pacientes presentaron recidiva tras un intervalo posquirúrgico medio de 7 años. Cuatro de ellos empeoraron clínicamente y fueron reintervenidos.

En nuestra experiencia observamos que la R.M. ofrece mayor información diagnóstica que la T.C. en la recidiva, especialmente en la secuencia potenciada en densidad protónica. Asimismo hemos comprobado que varios pacientes con imagen radiológica posquirúrgica de restos quísticos o recidiva pueden permanecer largo tiempo asintomáticos y nuestra actitud terapéutica en estos casos ha sido expectante.

Palabras clave:
Quiste epidermoide
quiste dermoide
ángulo pontocerebeloso
resonancia magnética
Summary

Thirty-two patients with intracranial intradural epidermoid (27 cases) and dermoid (5 cases) cysts were operated in our Service during the last eighteen years. The patients were studied with pneumoencephalography (5 cases), cerebral angiography (16 cases), computed tomography (24 cases) and magnetic resonance imaging (9 cases preoperatively and 4 postoperatively). Follow-up was available in 30 patients (average 4 years).

The most common location of the cyst was supratentorial (59,2 % epidermoids and 60 % dermoids), but six appeared in uncommon locations: 2 intraventricular (IV ventricle and atrial region), 2 intradiencephalic, one paratrigeminal and one supracallosal interhemispheric.

Microsurgical resection was performed in most cases. Cyst removal was considered total in 16 patients (50 % of cases), near total in 7 (21,8 %) and partial in 9 (28,1 %). Fourteen patients (46,6 %) improved, 11 remained unchanged (36,6 %) and 5 got worse (16,6 %). Five patients showed cyst's recurrence after an average time of 7 years. Four of them presented neurological deterioration and they underwent reoperation.

In our opinion M.R. is more useful than C.T. for determining the presence of recurrence, especially by using proton density weighted sequences. We have observed that some patients with postsurgical radiographic imaging of remaining cyst or recurrence may stay asymptomatic for a long time.

Key words:
Epidernoid cyst
dermoid cyst
cerebellopontine angle
magnetic resonance

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