Abstract
This case is a 20-year-old male, who presented with 1 month of right facial weakness
(HB4) and complaints of ipsilateral eye dryness. He was initially treated for Bell's
palsy with steroids and antiviral agents, but subsequently developed diplopia with
right lateral gaze and underwent an MRI (magnetic resonance imaging). MRI demonstrated
a 4.5 cm irregular lesion in the right cerebellopontine angle consistent with an epidermoid
cyst. Because the tumor had grown with the development of the central nervous system,
it has extended into different compartments, including the tentorial incisura and
pineal region. A predefined surgical corridor created by the tumor facilitated access
to the majority of the tumor through a retrosigmoid approach. Angled endoscopes (30-degree
up and down) provided further visualization of tumor away from the line of sight of
the microscope, thus allowing for gross total resection of the lesion. This video
also demonstrates a sharp dissection technique necessary for safe removal of adherent
tumor from critical neurovascular structures, including the basilar artery and several
cranial nerves. The ipsilateral auditory evoked responses (ABRs) showed slight improvement
from baseline toward the end of the case. A gross total resection was achieved, as
shown by the MRI. The patient remained at his baseline cranial nerve (CN) V, VII,
and VIII deficits during the immediate postoperative period.
The link to the video can be found at: https://youtu.be/vCq5juJh8hk.
Keywords
cerebellopontine angle - retrosigmoid - endoscopic assisted - epidermoid tumor
