Clinico-Surgical Outcomes of Giant Intracranial Epidermoids: Gross Total Resection vs Subtotal Resection Which is Better?

Aim: To analyze the clinical and surgical outcomes following gross total resection (GTR) and planned subtotal resection (STR) of giant intracranial epidermoid tumors.

Material And Methods: In this retrospective cohort study, all patients who were diagnosed with and operated for giant intracranial epidermoid tumors between January 2007 and May 2016 were included. The demographics, clinical outcomes, and surgical outcomes of these patients were analyzed.

Results: Forty-eight patients were enrolled in this study, and multicompartmental epidermoid tumors were observed in 23% of the patients. The mean size of the tumors was 6.2 cm (range, 4.0?9.0 cm). GTR and near-total resection (NTR) were performed in 34 (71%) patients. Fourteen patients (29%) underwent STR. Most patients (89%) had Glasgow Outcome Scale (GOS) of 5, whereas 8% had GOS of 4. The GTR/NTR group (23.5%) had more permanent complications than the STR group (7.1%). The mean follow-up period was 5.2 years (range, eight months to nine years). In the STR group, four patients (29%) showed an increase in the residual tumor, and only one patient (7%) was symptomatic and required reoperation.

Conclusion: STR of giant intracranial epidermoid tumors is a safe surgical strategy with good surgical outcome. The requirement for reoperation is usually late and seldom required but can be done safely. The average time to recurrence was more than seven years.