{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T02:27:26Z","timestamp":1792290446624,"version":"4.4.0"},"reference-count":57,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2015,4]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECT<\/jats:title>\n                    <jats:p>Epidermoid tumors arise from misplaced squamous epithelium and enlarge through the accumulation of desquamated cell debris. Optimal treatment consists of total removal of the capsule; therefore, giant and multicompartmental tumors are particularly challenging. A conservative attitude in handling the tumor capsule is common given concerns about capsule adherence to neurovascular structures, and thus the possibility of recurrence is accepted with the intent of minimizing complications. This study focuses on the outcome of surgery in patients with giant epidermoid tumors for which total capsule removal was the aim.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>The authors conducted a retrospective analysis of all patients with giant epidermoid tumors treated by the senior author (O.A.), who pursued total removal of the capsule through skull base approaches. Patients were divided into 2 groups: one including patients with de novo tumors and the other consisting of patients who presented with recurrent tumors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Thirty-four patients had undergone 46 operations, and the senior author performed 38 of these operations in the study period. The average tumor dimensions were 55 \u00d7 36 mm, and 25 tumors had multicompartmental extensions. Total removal of the tumor and capsule was achieved with the aid of the microscope in 73% of the 26 de novo cases but in only 17% of the 12 recurrent tumor cases. The average follow-up among all patients was 111 months (range 10\u2013480 months), and the average postsurgical follow-up was 56.8 months (range 6\u2013137 months). There were 4 recurrences in the de novo group, and every case had had a small piece of tumor capsule left behind. One patient died after delayed rupture of a pseudoaneurysm. In the de novo group, the average preoperative Karnofsky Performance Scale (KPS) score was 71.42%, which improved to 87.14% on long-term follow-up. In the group with recurrences, the KPS score also improved on long-term follow-up, from 64.54% to 84.54%. In the de novo group, 3 cases (11.5%) had permanent cranial nerve deficits, and 4 cases (15.4%) had a CSF leak. In the recurrence group, 3 cases (25%) had new, permanent cranial nerve deficits, and 1 (8.3%) had a CSF leak. Two patients in this group developed hydrocephalus and required a shunt.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Total removal of the capsule of giant epidermoid tumors was achieved in 73% of patients with de novo tumors and was associated with improved function, low morbidity and mortality, and a lower risk of recurrence. Surgery in patients with recurrent tumors was associated with higher morbidity and persistence of the disease.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2014.11.jns1481","type":"journal-article","created":{"date-parts":[[2015,1,16]],"date-time":"2015-01-16T10:02:24Z","timestamp":1421402544000},"page":"743-756","source":"Crossref","is-referenced-by-count":56,"title":["Giant intracranial epidermoids: is total removal feasible?"],"prefix":"10.3171","volume":"122","author":[{"given":"Emad","family":"Aboud","sequence":"first","affiliation":[{"name":"Arkansas Neuroscience Institute;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Abolfotoh","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brigham and Women's Hospital, Harvard University, School of Medicine, Boston, Massachusetts; and"},{"name":"Department of Neurosurgery, Ain Shams University, Cairo, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Svetlana","family":"Pravdenkova","sequence":"additional","affiliation":[{"name":"Arkansas Neuroscience Institute;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulkerim","family":"Gokoglu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brigham and Women's Hospital, Harvard University, School of Medicine, Boston, Massachusetts; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Murat","family":"Gokden","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ossama","family":"Al-Mefty","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brigham and Women's Hospital, Harvard University, School of Medicine, Boston, Massachusetts; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns1481","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"574","DOI":"10.1227\/00006123-198904000-00014","article-title":"Multiple complications from an intracranial epidermoid cyst: case report and literature review","volume":"24","author":"Abramson","year":"1989"},{"key":"b2-jns1481","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"91","DOI":"10.3171\/2009.4.PEDS08489","article-title":"Neurosurgical management of intracranial epidermoid tumors in children. 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