Whole Course Neuroendoscopic Resection of Cerebellopontine Angle Epidermoid Cysts

Abstract

Background Epidermoid cysts are the third most common tumor of the cerebellopontine angle (CPA). Diagnosis often occurs after involvement of the sulci and cisterns that surround nerves and blood vessels, making complete resection highly challenging. Objective To determine the efficacy of whole course neuroendoscopic surgery in the management of CPA epidermoid cysts. Methods We performed a retrospective analysis of clinical data of 13 male and 17 female patients (mean age: 42.4 ± 11.4 years) who presented with a CPA epidermoid cyst and underwent whole course neuroendoscopy. Complications and tumor recurrence were assessed at follow-up. Results Clinical manifestations included an initial symptom of headache (n = 21), gait instability (n = 6), intracranial hypertension (n = 13), posterior cranial nerve symptoms (n = 6), ataxia (n = 5), and hydrocephalus (n = 1). All patients tolerated tumor resection with subsequent symptomatic improvement, and the results of the postoperative magnetic resonance imaging scan did not show any remnants of tumor. Mean duration of surgery was 2.61 ± 0.47 hours, mean loss of blood was 96.8 ± 35.4 mL, and the mean duration of hospitalization was 7.5 ± 2.25 days. Postoperative complications (8 of 30 [26.7%]) included fever (n = 5), communicating hydrocephalus (n = 1), facial nerve paralysis (n = 1), and abducens nerve palsy (n = 1). Tumor recurrence was observed in two patients (6.7%). No deaths or intracranial hemorrhage was reported. Conclusions The characteristics of epidermoid cysts make them amenable to whole course neuroendoscopic resection. Use of physiologic/pathologic interspaces and neuroendoscopic angulations decreases traction on the brain, improves complete resection rates, and decreases postoperative complications.

Long Term Surgical Oncological and Functional Outcome of Large Petroclival and Cerebellopontine Angle Epidermoid Cysts: A Multicenter Study.

“…EC grow linearly, not exponentially, [2] and the overlooked micro-fragments of cyst walls have the propensity to regrowth which is empirically known. [4,5,9,12,14,20,21] Our results (see Kaplan Meier plot, Figure 5A) underline that recurrence or regrowth might be expected in the ultra-late period, regardless the EOR of the cyst. Patients should be aware and a clinic-radiological sequential follow-up must be planned in long term.…”

“…The literature dealing with the same topic is scarce and only a few retrospective cohort studies include more than 30 patients. [5,7,12,13,19,23,24] CN preoperative de cit…”

“…The high rate of postoperative CN injury, resulting from the adhesion of the tumor capsule to the nerve, is a well-known complication of this surgery. [12] Very few studies have detailed the evolution of CN de cit over time. [4,5,7,12,13,20,23].…”

“…[7] Two series have reported a lower rate of postoperative de cit. [5,12] The cohort of 30 patients undergoing retrosigmoid surgery associated with whole course neuroendoscopy of Hu et al experienced only 7% of new de cits. [12] Finally, two papers have reported a higher rate of new postoperative de cit, but with a very good improvement over time.…”

Combined microsurgical and endoscopic technique for removal of extensive intracranial epidermoids

“…Hu et al . [ 10 ] retrospectively analyzed the result of only endoscopically treated CPA epidermoids in 30 patients with recurrence of 6.5%, but did not include other patients of epidermoids which were not treated by pure endoscopic approach.…”