BACKGROUND:

Different inflammatory diseases can manifest as intracranial lesions. They may be indistinguishable from intracranial neoplasms in the clinical setting, imaging studies or laboratory studies. The value of surgery in the diagnosis and the treatment of such lesions is still unclear.

MATERIALS AND METHODS:

3066 reports of histopathological examinations over a 10-year period were reviewed. Forty patients with an inflammatory intracranial lesion were identified. Clinical, radiological and follow-up data were analyzed and the diagnostic and therapeutic value of surgery was assessed.

RESULTS:

We identified 24 women and 16 men (mean age 47). The diameter of the lesion varied between 1 and 5.5 cm (mean 2.6 cm). The location of the inflammatory lesion was intracerebral supratentorial (n=18, 45%), intra-/suprasellar (n=5, 12.5%), cerebellar (n=5, 12.5%), in the brainstem (n=4, 10%), in the cerebellopontine angle (n=3, 7.5%), meningeal (n=3, 7.5%), and at other locations (n=6, 15%). Seventeen patients underwent surgical removal of the mass lesion, while in 23 patients a biopsy was taken. The lesions were classified into 7 groups: specific (infectious) granuloma (n=10, 25%), unspecific granuloma (n=7, 17.5%), idiopathic inflammatory pseudotumor (n=5, 12.5%), demyelinating lesions (n=5, 12.5%) encapsulated hematoma (n=4, 10%), organized cerebral infarction (n=3, 7.5%), and vasculitis (n=4, 10%). Surgery was judged as valuable in 35 patients (87.5%).

CONCLUSIONS:

The differential diagnosis of intracranial inflammatory lesions involves a wide spectrum. Surgery has a diagnostic and/or therapeutic value in most entities and clinical circumstances. However, attention must be taken to avoid surgery without a therapeutic or diagnostic value for the patient.

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