Cranial Nerve Preservation Following Surgical Treatment for Epidermoid Cysts of the Posterior and Middle Fossae

Kurt Grahnke; Daniel Burkett; Daphne Li; Caroline Szujewski; John P. Leonetti; Douglas E. Anderson

doi:10.1055/s-0037-1617431

Journal of Neurological Surgery Part B: Skull Base, Inhaltsverzeichnis

J Neurol Surg B Skull Base 2018; 79(05): 445-450
DOI: 10.1055/s-0037-1617431

Original Article

Georg Thieme Verlag KG Stuttgart · New York

Cranial Nerve Preservation Following Surgical Treatment for Epidermoid Cysts of the Posterior and Middle Fossae

Authors

Kurt Grahnke

¹Departments of Neurological Surgery and Otolaryngology, Head and Neck Surgery, and Stritch School of Medicine, Loyola University Chicago, Health Sciences Campus, Maywood, Illinois, United States
Daniel Burkett

²Department of Neurological Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, United States
Daphne Li

¹Departments of Neurological Surgery and Otolaryngology, Head and Neck Surgery, and Stritch School of Medicine, Loyola University Chicago, Health Sciences Campus, Maywood, Illinois, United States
Caroline Szujewski

¹Departments of Neurological Surgery and Otolaryngology, Head and Neck Surgery, and Stritch School of Medicine, Loyola University Chicago, Health Sciences Campus, Maywood, Illinois, United States
John P. Leonetti

¹Departments of Neurological Surgery and Otolaryngology, Head and Neck Surgery, and Stritch School of Medicine, Loyola University Chicago, Health Sciences Campus, Maywood, Illinois, United States
Douglas E. Anderson

¹Departments of Neurological Surgery and Otolaryngology, Head and Neck Surgery, and Stritch School of Medicine, Loyola University Chicago, Health Sciences Campus, Maywood, Illinois, United States

Abstract

Epidermoid cysts are rare lesions, accounting for 0.2 to 1.8% of all intracranial tumors. They most commonly occur in the cerebellopontine angle where they may cause a breadth of neurologic complications due to mass effect on the nearby cranial nerves (CN), vascular structures, and the brain stem. Treatment of epidermoid cysts is surgical, with the goal of complete resection using microsurgical technique and even more importantly preservation of the involved CNs, vasculature, and brain parenchyma. Successful surgery can result in total resolution of symptoms, but, in certain situations, may not be advisable due to adherence, scarring, or inflammation making dissection of CN fascicles difficult and possibly hazardous. We conducted a retrospective review from 1998 to 2016 and compiled a series of 28 skull base epidermoid cysts operated on at our institution. Cases were evaluated for presenting symptoms, history of prior resection, and postoperative results including CN function, extent of resection, residual tumor, and need for reoperations. The average tumor size (largest diameter) was 3.9 cm with a range of 1 to 7cm. Eighteen of twenty-eight (64%) patients underwent a gross total resection and ten underwent subtotal resection. No patients, whether presenting with CN deficits or not, experienced permanent worsening of CN function following surgery. Complete resection of epidermoid cysts should remain a high priority of therapy, but, in our opinion, preservation of CN function should be a primary goal, determining the extent of resection to provide patients with the highest quality of life possible following surgery.

Keywords

epidermoid cysts - cranial nerve preservation - skull base surgery - gross total resection - subtotal resection

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