Has Management of Epidermoid Tumors of the Cerebellopontine Angle Improved? A Surgical Synopsis of the Past and Present

Abstract

We compared the surgical outcomes of recent patients with cerebellopontine angle (CPA) epidermoids treated with advanced surgical tools with those of patients treated in earlier series. From November 2000 to June 2004, we treated 12 patients with epidermoid tumors. One patient had a strict CPA lesion. Tumors extended into the prepontine region in seven cases and supratentorially in two. In two cases the CPA was involved bilaterally. All patients but one underwent a lateral suboccipital approach in a semi-sitting position with microsurgical technique. Endoscopic assistance was used in cases with extensions beyond the CPA. In one case, a subtemporal route was used. The mean follow-up was 27 months (range, 8 to 50 months). There were no deaths. Total removal was achieved in 7 of the 10 patients with unilateral CPA epidermoids. Preoperative status improved in eight (80%) patients, particularly the function of cranial nerves (CNs) V and VII. Only two patients had permanent CN deficits. Complete excision with preservation of CN function should be the goals of management of epidermoids of the CPA. In some cases, these goals can be difficult to achieve, even with contemporary surgical equipment. Bilateral and extensive tumors should be removed in staged procedures. The function of CN V and CN VII may recover after decompression, but the outcome of symptoms related to CN VIII is less certain. The endoscope is a reliable tool for assessing the extension of epidermoids, but it cannot be used for tumor removal.

Oral Rehabilitation of a Patient with Cerebellopontine Angle Epidermoid Cyst

“…Epidermoid cysts are benign tumors with slow growth that tend to envelop neurovascular structures without displacement (6,7). Symptoms depend on compression of these structures; often they cause trigeminal neuralgia or facial paresis if fifth or seventh cranial nerves are involved.…”

The combined microscopic-endoscopic technique for radical resection of cerebellopontine angle tumors

“…9,11,37,38,40,45,48 Tuchman et al 45 most recently reported on the specific use of the endoscope in the removal of 9 CPA epidermoid tumors, 7 of them through a retrosigmoid approach, and 2 with a subtemporal approach. These investigators used an endoscopic-assisted technique with initial resection performed with the microscope and importantly report that additional tumor was identified with the endoscope in 85% of cases.…”

“…Safavi-Abbasi et al 38 reported a series of 11 patients in which the endoscope was used for inspection following microscopic resection in epidermoid surgery. They advocated against the use of the endoscope for tumor dissection in epidermoids, recommending it to be used solely for inspection.…”

Cerebellopontine Angle Epidermoid Cyst. Case Report.

“…Rozwijają się między trzecim a piątym tygodniem życia płodowego [2,3]. Występują w każdym wieku, jednak najczęściej są rozpoznawane w trzeciej-piątej dekadzie życia [3,4]. Torbiel naskórkowa jest wolno rosnącym łagodnym guzem, a jej najczęstszym objawem jest neuralgia nerwu trójdzielnego.…”

“…Ściana torbieli jest zbudowana z prawidłowych komórek naskórka [3]. Najczęstsze lokalizacje torbieli to kąt mostowo-móżdżkowy, okolica nadsiodłowa oraz okolica trzeciej komory [3][4][5]7].…”