Whole Course Neuroendoscopic Resection of Cerebellopontine Angle Epidermoid Cysts.

Background  Epidermoid cysts are the third most common tumor of the cerebellopontine angle (CPA). Diagnosis often occurs after involvement of the sulci and cisterns that surround nerves and blood vessels, making complete resection highly challenging. Objective  To determine the efficacy of whole course neuroendoscopic surgery in the management of CPA epidermoid cysts. Methods  We performed a retrospective analysis of clinical data of 13 male and 17 female patients (mean age: 42.4 ± 11.4 years) who presented with a CPA epidermoid cyst and underwent whole course neuroendoscopy. Complications and tumor recurrence were assessed at follow-up. Results  Clinical manifestations included an initial symptom of headache ( n  = 21), gait instability ( n  = 6), intracranial hypertension ( n  = 13), posterior cranial nerve symptoms ( n  = 6), ataxia ( n  = 5), and hydrocephalus ( n  = 1). All patients tolerated tumor resection with subsequent symptomatic improvement, and the results of the postoperative magnetic resonance imaging scan did not show any remnants of tumor. Mean duration of surgery was 2.61 ± 0.47 hours, mean loss of blood was 96.8 ± 35.4 mL, and the mean duration of hospitalization was 7.5 ± 2.25 days. Postoperative complications (8 of 30 [26.7%]) included fever ( n  = 5), communicating hydrocephalus ( n  = 1), facial nerve paralysis ( n  = 1), and abducens nerve palsy ( n  = 1). Tumor recurrence was observed in two patients (6.7%). No deaths or intracranial hemorrhage was reported. Conclusions  The characteristics of epidermoid cysts make them amenable to whole course neuroendoscopic resection. Use of physiologic/pathologic interspaces and neuroendoscopic angulations decreases traction on the brain, improves complete resection rates, and decreases postoperative complications.