Abstract
Infratentorial ependymomas that arise in the fourth ventricle and extend into the
cerebellopontine angle (CPA) through the foramina of Luschka are well described. However,
a primary CPA location of an ependymoma is distinctly uncommon. In this video, we
present a 46-year-old man with episodes of dizziness, left-sided tinnitus, imbalance,
double vision, and nausea. An magnetic resonance imaging (MRI) scan of the head showed
a large mass lesion centered in the CPA with heterogenous enhancement. Differential
diagnosis included ependymoma, meningioma, schwannoma of the vestibular nerve, or
lower cranial nerves, and choroid plexus papilloma. He underwent microsurgical gross
total resection of the tumor via a retrosigmoid approach. Direct stimulation of the
cranial nerves was performed throughout the case and there was no attachment of the
tumor to any cranial nerve to suggest that this might be a schwannoma. The tumor encased
important vasculature, including the posterior-inferior cerebellar artery. The histopathology
was a grade II ependymoma. The patient tolerated the surgery well and his postoperative
course was uneventful. He remained neurologically intact. He received radiation therapy
and there was no recurrent or residual disease on follow-up studies. This video demonstrates
important steps of the surgical approach and microsurgical resection techniques for
this type of challenging tumor.
The link to the video can be found at: https://youtu.be/KK-y6EYh888.
Keywords
cerebellopontine angle - ependymoma - surgical resection - adult
