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.
KEYWORDS
Epidermoid - cerebellopontine angle - cranial nerve deficits - suboccipital - subtemporal
REFERENCES
neuropub@chw.edu
