Abstract
Epidermoids, or congenital cholesteatomas, constitute about 0.2% to 1.5% of intracranial
tumors, and 3% to 5% of tumors of the cerebellopontine angle (CPA). We review the
surgical management of CPA epidermoids in 13 patients at the House Ear Clinic for
the years 1978 to 1993. There were seven male and six female patients, ranging in
age from 27 to 59 years (average, 40 years). Tumors ranged in size from 3.5 cm to
7.0 cm, and the surgical approach was tailored to the tumor extent and location. All
patients complained at presentation of unilateral hearing loss, and nine had poor
speech discrimination (less than 50%) preoperatively. Serviceable hearing was preserved
in two patients. Two patients presented with facial nerve symptoms, and four cases
had postoperative permanent facial nerve paralysis (House-Brackmann Grade V or VI).
There were no surgical deaths. Four patients required second surgeries to remove residual
cholesteatoma. Compared with prior series, we describe a higher rate of total tumor
removed, as well as a higher rate of second operations, indicating a more aggressive
approach to these lesions.
