• Chandrima Biswas, Moataz D Abouammo, Ludovica Pasquini, Guilherme Mansur, Mohammad Bilal Alsavaf, Kyle C Wu, Ricardo L Carrau, and Daniel M Prevedello.
• Department of Neurosurgery, The Ohio State University and Wexner Medical Centre, Columbus, Ohio, USA.
• World Neurosurg. 2025 Jan 20: 123682123682.

BackgroundEpidermoid 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.MethodsThree 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.ResultsThe 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.ConclusionIECs 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.Copyright © 2025. Published by Elsevier Inc.

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