特異なCT像を呈した頭蓋内類上皮腫の1例

診断と頭蓋内多発の機序に関する考察

抄録

A rare case of intracranial epidermoid with interesting computed tomography (CT) findings in a 59-year-old male is reported. The patient had a 13-year history of generalized seizures and syncope and presented with disorientation, amnesia, acalculia, emotional lability, apocleisis, and urinary incontinence. CT disclosed many low-density masses (-92 to -104 HU) in the subarachnoid space, the largest of which was in the left sylvian fissure. A left frontotemporal craniotomy revealed a cream-colored, pearly tumor in the sylvian fissure. The content of the cyst was soft and easily aspirated. Removal of the cyst and irrigation of the operative field resulted in relief of the preoperative symptoms. Histologically, the stratified squamous cell lining of the cyst wall did not exhibit keratinization but was immunoreactive for keratin. To date, only one other case of intracranial multiple epidermoids has been reported. In that case, cerebrospinal fluid analysis suggested chemical meningitis. Therefore, it is plausible that multiple epidermoids result from damage to the cyst wall and dissemination of the cyst content within the subarachnoid space.