Resection of a quadrigeminal cistern epidermoid cyst through a sitting paramedian supracerebellar transtentorial approach

Abstract A 32-year old man presented with blurry vision, headache and vertigo. MRI revealed obstructive hydrocephalus from a hypointense lesion spanning the quadrigeminal cistern to the mesial temporal lobe, with restriction on DWI imaging suggesting an epidermoid cyst. The paramedian supracerebellar transtentorial approach was selected, and the procedure was performed in the sitting position. Gross total resection was achieved with punctate residual left on the posterior cerebral artery due to significant adherence. The patient remained neurologically stable postoperatively with a brief course of Parinaud’s syndrome. Two years post-operatively, imaging revealed significant tumor regrowth and he underwent reoperation through the same approach.