Intracranial epidermoid cyst
Headache, right sided facial numbness and facial palsy
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There is a large lobulated extra-axial lesion located in the right cerebellopontine angle, suprasellar cistern, right medial temporal region, right Meckel's cave and prepontine cistern. It appears isointense to CSF on T1 and T2 with heterogenous signal on FLAIR images and restricted diffusion in DWI/ADC map.
It is encasing basilar, right posterior cerebral, superior cerebellar and right posterior communicating arteries with compression of brain stem (mainly midbrain), right medial temporal lobe, right optic tract and mamillary bodies. It is also encasing right 3rd, 4th, 5th, 6th, 7th, 8th and 9th cranial nerves. It is indenting pituitary stalk, but not invading the sella turcica.
No hydrocephalus or intraventricular extension.
Appearances in this case are compatible with intracranial epidermoid cyst causing mass effect, vascular structures and cranial nerves encasement.
Epidermoid cysts (also called epidermoid tumors) are benign lesions of ectodermal origin. They account for about 1% of all intracranial tumors.
Cerebellopontine angle and suprasellar cistern are the most common locations.
Epidermoid cysts are slowly growing tumors, and because of this, they are typically moderately large when discovered.
Isointense to CSF on T1 and T2 with heterogenous signal on FLAIR images and diffusion restriction on DWI/ADC map is the typical MR appearance of epidermoid cysts.