J Neurol Surg B Skull Base 2018; 79(02): 167-172
DOI: 10.1055/s-0037-1606220
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Surgical Resection of Cerebellopontine Epidermoid Cysts: Limitations and Outcome

Ahmed Farhoud
1   Department of Neurosurgery, Alexandria University, Alexandria, Egypt
Wael Khedr
1   Department of Neurosurgery, Alexandria University, Alexandria, Egypt
Hisham Aboul-Enein
1   Department of Neurosurgery, Alexandria University, Alexandria, Egypt
› Author Affiliations
Further Information

Publication History

21 April 2017

15 July 2017

Publication Date:
23 August 2017 (online)


Objective Epidermoid cysts are benign slowly growing tumors commonly involving the cerebellopontine angle (CPA). The aim of this study was to analyze the surgical limitations, surgical strategies, complications, and outcome of resection of these lesions.

Material and Methods The clinical data and outcome of 32 cases operated for CPA epidermoid between 2007 and 2015 were retrospectively analyzed. The mean follow-up period was 42.6 months, and all patients were followed up at least for a whole year.

Results There were 15 males and 17 females. The median age was 37.6 years. Headache and cranial nerves dysfunction were the most common presenting symptoms. Surgery was performed in all patients using the standard lateral suboccipital retrosigmoid approach. In three cases, microvascular decompression of an arterial loop was performed in addition to tumor excision. Total resection was accomplished in 19 out of 32 cases (59.4%), subtotal resection in 7 cases (21.9%), and only partial excision was achieved in 6 cases (18.7%). There was no recurrence or regrowth of residual tumor during the follow-up period. We had a single postoperative mortality due to postoperative pneumonia and septic shock. New cranial nerves deficits occurred in 15.6% of cases but were transient in most of them.

Conclusion The favorable outcome of total resection of CPA epidermoids should always be weighed against the critical risks that accompany it especially in the presence of tight adhesions to vital neurovascular structures. The retrosigmoid approach is suitable for the resection of these tumors even if they were large in size.

  • References

  • 1 Gopalakrishnan CV, Ansari KA, Nair S, Menon G. Long term outcome in surgically treated posterior fossa epidermoids. Clin Neurol Neurosurg 2014; 117: 93-99
  • 2 Nagasawa D, Yew A, Safaee M. , et al. Clinical characteristics and diagnostic imaging of epidermoid tumors. J Clin Neurosci 2011; 18 (09) 1158-1162
  • 3 Mohanty A, Venkatrama SK, Rao BR, Chandramouli BA, Jayakumar PN, Das BS. Experience with cerebellopontine angle epidermoids. Neurosurgery 1997; 40 (01) 24-29 , discussion 29–30
  • 4 Kobata H, Kondo A, Iwasaki K. Cerebellopontine angle epidermoids presenting with cranial nerve hyperactive dysfunction: pathogenesis and long-term surgical results in 30 patients. Neurosurgery 2002; 50 (02) 276-285 , discussion 285–286
  • 5 Schiefer TK, Link MJ. Epidermoids of the cerebellopontine angle: a 20-year experience. Surg Neurol 2008; 70 (06) 584-590 , discussion 590
  • 6 Samii M, Tatagiba M, Piquer J, Carvalho GA. Surgical treatment of epidermoid cysts of the cerebellopontine angle. J Neurosurg 1996; 84 (01) 14-19
  • 7 Toglia JU, Netsky MG, Alexander Jr E. Epithelial (epidermoid) tumors of the cranium. Their common nature and pathogenesis. J Neurosurg 1965; 23 (04) 384-393
  • 8 Pikis S, Margolin E. Malignant transformation of a residual cerebellopontine angle epidermoid cyst. J Clin Neurosci 2016; 33: 59-62
  • 9 Asahi T, Kurimoto M, Endo S, Monma F, Ohi M, Takami M. Malignant transformation of cerebello-pontine angle epidermoid. J Clin Neurosci 2001; 8 (06) 572-574
  • 10 Czernicki T, Kunert P, Nowak A, Wojciechowski J, Marchel A. Epidermoid cysts of the cerebellopontine angle: Clinical features and treatment outcomes. Neurol Neurochir Pol 2016; 50 (02) 75-82
  • 11 de Oliveira RS, Maia WS, Santos MV, Camara RL. Combined pre- and subtemporal transtentorial approach for epidermoid cysts of the cerebellopontine angle. Childs Nerv Syst 2012; 28 (12) 2137-2142
  • 12 Aboud E, Abolfotoh M, Pravdenkova S, Gokoglu A, Gokden M, Al-Mefty O. Giant intracranial epidermoids: is total removal feasible?. J Neurosurg 2015; 122 (04) 743-756
  • 13 Hasegawa M, Nouri M, Nagahisa S. , et al. Cerebellopontine angle epidermoid cysts: clinical presentations and surgical outcome. Neurosurg Rev 2016; 39 (02) 259-266 , discussion 266–267
  • 14 Schroeder HW, Oertel J, Gaab MR. Endoscope-assisted microsurgical resection of epidermoid tumors of the cerebellopontine angle. J Neurosurg 2004; 101 (02) 227-232
  • 15 Akhavan-Sigari R, Bellinzona M, Becker H, Samii M. Epidermoid cysts of the cerebellopontine angle with extension into the middle and anterior cranial fossae: surgical strategy and review of the literature. Acta Neurochir (Wien) 2007; 149 (04) 429-432
  • 16 Yaşargil MG, Abernathey CD, Sarioglu AÇ. Microneurosurgical treatment of intracranial dermoid and epidermoid tumors. Neurosurgery 1989; 24 (04) 561-567
  • 17 Samii M, Tatagiba M, Carvalho GA. Retrosigmoid intradural suprameatal approach to Meckel's cave and the middle fossa: surgical technique and outcome. J Neurosurg 2000; 92 (02) 235-241
  • 18 Samii M, Alimohamadi M, Gerganov V. Endoscope-assisted retrosigmoid intradural suprameatal approach for surgical treatment of trigeminal schwannomas. Neurosurgery 2014; 10 (Suppl. 04) 565-575 , discussion 575
  • 19 Tuchman A, Platt A, Winer J, Pham M, Giannotta S, Zada G. Endoscopic-assisted resection of intracranial epidermoid tumors. World Neurosurg 2014; 82 (3-4): 450-454
  • 20 Altschuler EM, Jungreis CA, Sekhar LN, Jannetta PJ, Sheptak PE. Operative treatment of intracranial epidermoid cysts and cholesterol granulomas: report of 21 cases. Neurosurgery 1990; 26 (04) 606-613 , discussion 614
  • 21 Salazar J, Vaquero J, Saucedo G, Bravo G. Posterior fossa epidermoid cysts. Acta Neurochir (Wien) 1987; 85 (1-2): 34-39
  • 22 Barker II FG, Jannetta PJ, Babu RP, Pomonis S, Bissonette DJ, Jho HD. Long-term outcome after operation for trigeminal neuralgia in patients with posterior fossa tumors. J Neurosurg 1996; 84 (05) 818-825
  • 23 Obrador S, Lopez-Zafra JJ. Clinical features of the epidermoids of the basal cisterns of the brain. J Neurol Neurosurg Psychiatry 1969; 32 (05) 450-454
  • 24 Meng L, Yuguang L, Feng L, Wandong S, Shugan Z, Chengyuan W. Cerebellopontine angle epidermoids presenting with trigeminal neuralgia. J Clin Neurosci 2005; 12 (07) 784-786
  • 25 Nomura T, Ikezaki K, Matsushima T, Fukui M. Trigeminal neuralgia: differentiation between intracranial mass lesions and ordinary vascular compression as causative lesions. Neurosurg Rev 1994; 17 (01) 51-57
  • 26 Nagata S, Matsushima T, Fujii K, Fukui M, Kuromatsu C. Hemifacial spasm due to tumor, aneurysm, or arteriovenous malformation. Surg Neurol 1992; 38 (03) 204-209
  • 27 Singh AK, Jain VK, Chhabra DK, Hongo K, Kobayashi S. Hemifacial spasm and cerebellopontine angle epidermoid: case report and review. Neurol Res 1994; 16 (04) 321-323
  • 28 Safavi-Abbasi S, Di Rocco F, Bambakidis N. , et al. Has management of epidermoid tumors of the cerebellopontine angle improved? A surgical synopsis of the past and present. Skull Base 2008; 18 (02) 85-98
  • 29 deSouza CE, deSouza R, da Costa S. , et al. Cerebellopontine angle epidermoid cysts: a report on 30 cases. J Neurol Neurosurg Psychiatry 1989; 52 (08) 986-990