Intra-infundibular Epidermoid Cysts- A Distinct and Rare Entity

Chandrima Biswas; Moataz D Abouammo; Ludovica Pasquini; Guilherme Mansur; Mohammad Bilal Alsavaf; Kyle C Wu; Ricardo L Carrau; Daniel M Prevedello

doi:10.1016/j.wneu.2025.123682

Intra-infundibular Epidermoid Cysts- A Distinct and Rare Entity

World Neurosurg. 2025 Jan 20:123682. doi: 10.1016/j.wneu.2025.123682. Online ahead of print.

Authors

Chandrima Biswas¹, Moataz D Abouammo², Ludovica Pasquini¹, Guilherme Mansur¹, Mohammad Bilal Alsavaf², Kyle C Wu¹, Ricardo L Carrau², Daniel M Prevedello³

Affiliations

¹ Department of Neurosurgery, The Ohio State University and Wexner Medical Centre, Columbus, Ohio, USA.
² Department of Otorhinolaryngology, The Ohio State University and Wexner Medical Centre, Columbus, Ohio, USA.
³ Department of Neurosurgery, The Ohio State University and Wexner Medical Centre, Columbus, Ohio, USA. Electronic address: daniel.prevedello@osumc.edu.

PMID: 39842713
DOI: 10.1016/j.wneu.2025.123682

Abstract

Background: Epidermoid cyst (EC) located completely within the pituitary infundibulum is a rare entity with only seven reported cases. In this study, we have described our experience with resection of intra-infundibular epidermoid cysts (IECs) and reviewed the existing literature highlighting its distinguishing features and operative nuances.

Methods: Three consecutive cases of IEC operated at our institute was retrospectively studied. PubMed and EMBASE databases were searched, and seven case reports of IEC were found. Relevant clinical, radiological, operative data of ten cases were analyzed.

Results: The median age at diagnosis was 53.5 years and six cases were males. Preoperatively, although the average tumor size was only 1.62 cm³, 80% of patients had visual disturbance, and 78% of patients had deficiency in pituitary hormones. Five patients had preoperative diabetes insipidus. Mild diffusion restriction was noted in four out of five cases that mentioned it. The most common differential diagnosis considered was Rathke's cleft cyst and craniopharyngioma. Adhesion of the cyst wall to the stalk and/or the hypothalamus was a common occurrence resulting in residual wall being left behind in 50% cases. Expanded endoscopic endonasal approach was utilized in nine cases and one case underwent fronto-temporal craniotomy with resection via pretemporal approach. Postoperative chemical meningitis was demonstrated in two cases and sterile abscess was noted in another case.

Conclusion: IECs are rare tumors that are often misdiagnosed preoperatively. They have different postoperative morbidity profiles compared to other cystic lesions in the infundibulum. This makes it important to recognize this distinct entity.

Keywords: Endoscopic endonasal; Epidermoid cyst; Infundibulum; Pituitary stalk.