{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T12:30:49Z","timestamp":1772109049490,"version":"3.50.1"},"reference-count":35,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec id=\"st1\">\n<jats:title>Background: <\/jats:title>\n<jats:p>Epidermoid cysts are benign slow-growing congenital lesions, constituting approximately 1% of all cranial tumors. Most of these lesions are located intradurally, while about 10\u201325% of them are located within the diploic spaces. Intradiploic epidermoid cysts are usually discovered incidentally and may remain asymptomatic for many years, but in rare instances, they may grow intracranially and produce brain compression. Sometimes, intradiploic epidermoid cysts may occlude the main cranial venous sinuses causing intracranial hypertension.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st2\">\n<jats:title>Case Description: <\/jats:title>\n<jats:p>We present the case of a 24-year-old male harboring a paramedian right occipital intradiploic cyst with erosion of both outer and inner bony tables, which occluded the torcular herophili producing a worsening symptomatology with acute-onset diplopia from right sixth cranial nerve palsy; the patient also presented bilateral papilledema, but only reported mild headache and dizziness. Neuroradiological studies evidentiated a lesion compatible with intradiploic epidermoid cyst with intralesional hemorrhagic component, overlying and almost completely occluding the torcular herophili. Considering the fast worsening of symptomatology and the evidence of intracranial hypertension, the patient was operated on immediately after completion of clinical and radiological assessment. The lesion was radically removed with almost immediate reversal of signs and symptoms. Histopathology confirmed the diagnosis of epidermoid cyst with intralesional hemorrhagic components.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st3\">\n<jats:title>Conclusion: <\/jats:title>\n<jats:p>Intradiploic epidermoid cysts may cause intracranial hypertension by occlusion of main cranial venous sinuses; intralesional hemorrhage may act as precipitating factor in occlusion of the torcular herophili, producing rapidly worsening intracranial hypertension, which requires prompt surgical treatment to reverse symptomatology. Radical surgical resection is necessary to avoid recurrence.<\/jats:p>\n<\/jats:sec>","DOI":"10.25259\/sni_578_2020","type":"journal-article","created":{"date-parts":[[2021,3,16]],"date-time":"2021-03-16T19:39:34Z","timestamp":1615923574000},"page":"100","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Acute-onset diplopia from intracranial hypertension due to torcular herophili obstruction by an hemorrhagic intradiploic epidermoid cyst"],"prefix":"10.25259","volume":"12","author":[{"given":"Diamantoula","family":"Pagkou","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mattia","family":"Del Maestro","sequence":"additional","affiliation":[{"name":"PhD School in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sabino","family":"Luzzi","sequence":"additional","affiliation":[{"name":"Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrizia","family":"Morbini","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine, Unit of Pathological Anatomy, University of Pavia, Pavia, Lombardia, Italy,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nikolaos","family":"Foroglou","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Aristotle University of Thessaloniki, Thessaloniki, Greece,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Renato Juan","family":"Galzio","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Maria Cecilia Hospital, Cotignola, Province of Ravenna, Italy."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10894","published-online":{"date-parts":[[2021,3,17]]},"reference":[{"key":"10.25259\/SNI_578_2020\/ref-1","doi-asserted-by":"crossref","first-page":"275","DOI":"10.2176\/nmc.43.275","article-title":"Surgical treatment of intracranial epidermoid tumors","volume":"43","author":"Akar","year":"2003","journal-title":"Neurol Med Chir (Tokyo)"},{"key":"10.25259\/SNI_578_2020\/ref-2","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1016\/S0190-9622(03)00035-5","article-title":"Epidermoid cyst with perforation of the skull","volume":"49","author":"Ambo","year":"2003","journal-title":"J Am Acad Dermatol"},{"key":"10.25259\/SNI_578_2020\/ref-3","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1007\/BF00596575","article-title":"Intradiploic epidermoid cysts","volume":"38","author":"Arana","year":"1996","journal-title":"Neuroradiology"},{"key":"10.25259\/SNI_578_2020\/ref-4","first-page":"167","article-title":"Intradiploic Epidermoid tumors of the cranium: Case report with review of the literature","volume":"78","author":"Arko","year":"2017","journal-title":"J Neurol Surg A Cent Eur Neurosurg"},{"key":"10.25259\/SNI_578_2020\/ref-5","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1016\/j.clineuro.2004.06.005","article-title":"Intradiploic epidermoid cysts of the skull: A report of four cases","volume":"107","author":"Bikmaz","year":"2005","journal-title":"Clin Neurol Neurosurg"},{"key":"10.25259\/SNI_578_2020\/ref-6","doi-asserted-by":"crossref","first-page":"e23","DOI":"10.1016\/j.ejrex.2010.12.006","article-title":"Intradiploic epidermoid cyst: Report of two cases with typical CT and MR imaging features","volume":"77","author":"Bulja","year":"2011","journal-title":"Eur J Radiol Extra"},{"key":"10.25259\/SNI_578_2020\/ref-7","first-page":"427","article-title":"Intracranial epidermoid cyst with hemorrhage: MR imaging findings","volume":"27","author":"Chen","year":"2006","journal-title":"AJNR Am J Neuroradiol"},{"key":"10.25259\/SNI_578_2020\/ref-8","doi-asserted-by":"crossref","first-page":"21","DOI":"10.4103\/1793-5482.110276","article-title":"Intracranial epidermoid tumor; microneurosurgical management: An experience of 23 cases","volume":"8","author":"Chowdhury","year":"2013","journal-title":"Asian J Neurosurg"},{"key":"10.25259\/SNI_578_2020\/ref-9","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1007\/BF01402183","article-title":"Intradiploic epidermoid cysts of the skull: Report of 10 cases and review of the literature","volume":"102","author":"Ciappetta","year":"1990","journal-title":"Acta Neurochir (Wien)"},{"key":"10.25259\/SNI_578_2020\/ref-10","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1017\/S0022215108003083","article-title":"Congenital cholesteatoma of occipital bone or intradiploic epidermoid cyst? One and the same disease","volume":"123","author":"Clark","year":"2009","journal-title":"J Laryngol Otol"},{"key":"10.25259\/SNI_578_2020\/ref-11","doi-asserted-by":"crossref","first-page":"1478","DOI":"10.1016\/j.jocn.2008.09.025","article-title":"Giant intradiploic epidermoid cyst of the occipital bone","volume":"16","author":"Duan","year":"2009","journal-title":"J Clin Neurosci"},{"key":"10.25259\/SNI_578_2020\/ref-12","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.1016\/j.jocn.2008.04.033","article-title":"A supratentorial, hemorrhagic, intraparenchymal epidermoid cyst","volume":"16","author":"Fox","year":"2009","journal-title":"J Clin Neurosci"},{"key":"10.25259\/SNI_578_2020\/ref-13","doi-asserted-by":"crossref","first-page":"480","DOI":"10.4103\/JPN.JPN_74_18","article-title":"A frontal giant intradiploic giant pearl (epidermoid cyst) with intracranial and extracranial extension: A rare entity","volume":"13","author":"Gollapudi","year":"2018","journal-title":"J Pediatr Neurosci"},{"key":"10.25259\/SNI_578_2020\/ref-14","first-page":"173","article-title":"Hemorrhage in intracranial epidermoid cyst","volume":"95","author":"Hsieh","year":"1996","journal-title":"J Formos Med Assoc"},{"key":"10.25259\/SNI_578_2020\/ref-15","doi-asserted-by":"crossref","first-page":"902","DOI":"10.3171\/jns.2001.95.5.0902","article-title":"An unusual middle fossa interdural epidermoid tumor. Case report","volume":"95","author":"Inoue","year":"2001","journal-title":"J Neurosurg"},{"key":"10.25259\/SNI_578_2020\/ref-16","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1080\/026886900408405","article-title":"Giant intradiploic epidermoid cysts of the skull. A report of eight cases","volume":"14","author":"Jaiswal","year":"2000","journal-title":"Br J Neurosurg"},{"key":"10.25259\/SNI_578_2020\/ref-17","first-page":"32","article-title":"Clinical presentation of intracranial epidermoids: A surgical series of 20 initial and four recurred cases","volume":"5","author":"Kato","year":"2010","journal-title":"Asian J Neurosurg"},{"key":"10.25259\/SNI_578_2020\/ref-19","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1186\/1752-1947-6-85","article-title":"Giant intradiploic epidermoid cyst with large osteolytic lesions of the skull: A case report","volume":"6","author":"Krupp","year":"2012","journal-title":"J Med Case Rep"},{"key":"10.25259\/SNI_578_2020\/ref-20","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1177\/197140091002300611","article-title":"Giant intradiploic epidermoid cyst of occipital bone. A case report and literature review","volume":"23","author":"Kumaran","year":"2010","journal-title":"Neuroradiol J"},{"key":"10.25259\/SNI_578_2020\/ref-21","doi-asserted-by":"crossref","first-page":"38","DOI":"10.4038\/jdp.v9i2.7660","article-title":"Intradiploic epidermoid cyst-a pearl within the skull","volume":"9","author":"Lakshmi","year":"2014","journal-title":"J Diagn Pathol"},{"key":"10.25259\/SNI_578_2020\/ref-22","first-page":"929","article-title":"Reversal of increased intracranial pressure with removal of a torcular epidermoid: Case report","volume":"48","author":"Lam","year":"2001","journal-title":"Neurosurgery"},{"key":"10.25259\/SNI_578_2020\/ref-23","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1046\/j.1440-1622.2001.02135.x","article-title":"Pseudotumour cerebri due to a torcular epidermoid cyst","volume":"7","author":"Lee","year":"2001","journal-title":"ANZ J Surg"},{"key":"10.25259\/SNI_578_2020\/ref-24","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.ijscr.2015.09.022","article-title":"Intradiploic epidermoid cyst with intracranial hypertension syndrome: Report of two cases and literature review","volume":"16","author":"Moreira-Holguin","year":"2015","journal-title":"Int J Surg Case Rep"},{"key":"10.25259\/SNI_578_2020\/ref-25","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1007\/s11604-005-1545-x","article-title":"Intradiploic epidermoid cyst with focal internal enhancement","volume":"24","author":"Nambu","year":"2006","journal-title":"Radiat Med"},{"key":"10.25259\/SNI_578_2020\/ref-26","doi-asserted-by":"crossref","first-page":"930","DOI":"10.1016\/S0967-5868(03)00227-3","article-title":"A case of hyperdense diploic epidermoid cyst on CT scan mimicking meningioma","volume":"11","author":"Ng","year":"2004","journal-title":"J Clin Neurosci"},{"key":"10.25259\/SNI_578_2020\/ref-27","doi-asserted-by":"crossref","first-page":"514","DOI":"10.4103\/1793-5482.181146","article-title":"Giant occipital intradiploic epidermoid cyst","volume":"13","author":"Oommen","year":"2018","journal-title":"Asian J Neurosurg"},{"key":"10.25259\/SNI_578_2020\/ref-28","first-page":"377","article-title":"Occipital intradiploic epidermoid cyst with intracranial hypertension","volume":"40","author":"Park","year":"2006","journal-title":"J Korean Neurosurg Soc"},{"key":"10.25259\/SNI_578_2020\/ref-29","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1001\/archneur.1986.00520050089032","article-title":"Pseudotumor cerebri due to partial obstruction of the sigmoid sinus by a cholesteatoma","volume":"43","author":"Powers","year":"1986","journal-title":"Arch Neurol"},{"key":"10.25259\/SNI_578_2020\/ref-30","first-page":"102","article-title":"Intracranial epidermoid cyst: Characteristics, appearance, diagnosis, treatment and prognosis","volume":"3","author":"Reddy","year":"2015","journal-title":"Sci Lett"},{"key":"10.25259\/SNI_578_2020\/ref-31","first-page":"763","article-title":"Intracranial epidermoid lesions: Our experience of 38 cases","volume":"28","author":"Rehman","year":"2018","journal-title":"Turk Neurosurg"},{"key":"10.25259\/SNI_578_2020\/ref-32","doi-asserted-by":"crossref","first-page":"475","DOI":"10.3171\/jns.1978.48.3.0475","article-title":"Intradiploic epidermoid cyst of the occipital bone with torcular obstruction. Case report","volume":"48","author":"Rengachary","year":"1978","journal-title":"J Neurosurg"},{"key":"10.25259\/SNI_578_2020\/ref-33","first-page":"9483","article-title":"Study of intradiploic epidermoid cyst in the right occipital bone","volume":"12","author":"Wang","year":"2019","journal-title":"Int J Clin Exp Med"},{"key":"10.25259\/SNI_578_2020\/ref-34","doi-asserted-by":"crossref","first-page":"1338","DOI":"10.1177\/0271678X16648711","article-title":"Monro-Kellie 2.0 The dynamic vascular and venous pathophysiological components of intracranial pressure","volume":"36","author":"Wilson","year":"2016","journal-title":"J Cereb Blood Flow Metab"},{"key":"10.25259\/SNI_578_2020\/ref-35","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1007\/s11670-005-0063-9","article-title":"Giant hyperdense intradiploic epidermoid cyst of the skull with extra and intracranial extension: Report of two cases and literatures review","volume":"17","author":"Xiao","year":"2005","journal-title":"Chin J Cancer Res"},{"key":"10.25259\/SNI_578_2020\/ref-36","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.wneu.2019.04.223","article-title":"Epidermoid cyst with torcular herophili obstruction and unusual venous drainage","volume":"128","author":"Yokota","year":"2019","journal-title":"World Neurosurg"}],"container-title":["Surgical Neurology International"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/surgicalneurologyint.com\/acute-onset-diplopia-from-intracranial-hypertension-due-to-torcular-herophili-obstruction-by-an-hemorrhagic-intradiploic-epidermoid-cyst\/","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/acute-onset-diplopia-from-intracranial-hypertension-due-to-torcular-herophili-obstruction-by-an-hemorrhagic-intradiploic-epidermoid-cyst\/","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,3,16]],"date-time":"2021-03-16T19:45:48Z","timestamp":1615923948000},"score":1,"resource":{"primary":{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/acute-onset-diplopia-from-intracranial-hypertension-due-to-torcular-herophili-obstruction-by-an-hemorrhagic-intradiploic-epidermoid-cyst\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,17]]},"references-count":35,"alternative-id":["10.25259\/SNI_578_2020"],"URL":"https:\/\/doi.org\/10.25259\/sni_578_2020","relation":{},"ISSN":["2152-7806"],"issn-type":[{"value":"2152-7806","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,17]]},"article-number":"100"}}