Navigating the challenges of lateral ventricle epidermoid cysts: Diagnostic insights and surgical strategies. patient series

TL;DR

This paper presents three cases of rare brain cysts in the lateral ventricle, highlighting the importance of accurate diagnosis and tailored surgical approaches for better outcomes.

Contribution

The paper contributes a case series with insights into diagnostic imaging and surgical techniques for lateral ventricle epidermoid cysts.

Findings

Diffusion-weighted imaging (DWI) is essential for accurate diagnosis of lateral ventricle epidermoid cysts.

Combined microscopic-endoscopic surgical approaches improve resection and reduce neurological risks.

Delayed intervention can lead to persistent neurological deficits despite successful surgery.

Abstract

Epidermoid cysts of the lateral ventricle are rare, benign intracranial lesions originating from ectopic embryonic epithelial cells, comprising only 0.2% of intracranial neoplasms. Although often asymptomatic initially, they may eventually cause mass effects or cerebrospinal fluid (CSF) obstruction as they enlarge. Accurate diagnosis—typically achieved via diffusion-weighted imaging (DWI)—is essential, as these cysts can mimic other intraventricular pathologies. Surgical resection remains the definitive treatment, though their deep-seated location and proximity to critical neurovascular structures pose significant challenges. This series describes 3 cases of lateral ventricle epidermoid cysts in patients presenting with progressive symptoms, including headaches, visual deficits, and neurological impairments, consistent with elevated intracranial pressure. Preoperative imaging, notably DWI, confirmed the diagnoses by demonstrating characteristic restricted diffusion. Near-total resection was achieved using microsurgical and endoscopic techniques, preserving vital structures and resulting in favorable postoperative outcomes with symptom resolution. However, 1 patient experienced persistent visual deficits due to delayed intervention. Advanced imaging, particularly DWI, is indispensable for precise diagnosis, while combined microscopic-endoscopic approaches optimize resection and reduce neurological risks. Early diagnosis and tailored surgical strategies are crucial for optimal outcomes. This series underscores the need for standardized management guidelines and identifies barriers to long-term follow-up, such as financial constraints.

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