Importance of appropriate surgical approach selection for radical resection of cerebellopontine angle epidermoid cysts with preservation of cranial nerve functions: our experience of 54 cases

• Published in: Acta neurochirurgica Vol. 163; no. 9; pp. 2465 - 2474
• Main Authors: Sakamoto, Hiroki, Kohno, Michihiro, Matsushima, Ken, Ichimasu, Norio, Nakajima, Nobuyuki, Yoshino, Masanori
• Format: Journal Article
• Language: English
• Published: Vienna Springer Vienna 01.09.2021; Springer Nature B.V
• Subjects: Cerebellopontine Angle - surgery; Cranial Nerves; Cysts; Elbow; Epidermal Cyst - surgery; Facial nerve; Humans; Interventional Radiology; Medicine; Medicine & Public Health; Minimally Invasive Surgery; Neurology; Neuroradiology; Neurosurgery; Original Article - Tumor - Other; Patients; Preservation; Retrospective Studies; Skull; Surgery; Surgical Orthopedics; Treatment Outcome; Tumor – Other; Epidermoid cyst; Recurrence; Surgical approaches; Surgery; Cerebellopontine angle; Cranial nerve preservation
• ISSN: 0001-6268; 0942-0940
• DOI: 10.1007/s00701-021-04840-0

Background Although many reports state that only the lateral suboccipital retrosigmoid approach (LSO) should be used for removal of cerebellopontine angle (CPA) epidermoid cysts, it is preferable to use various surgical approaches as appropriate for each patient, for radical resection with an optimal operative field under direct visualization, and for the preservation of cranial nerve (CN) functions. In the present study, we hence focused on the importance of surgical approach selection for removal of CPA epidermoid cysts and analyzed the results of CPA epidermoid cysts after surgery in our series. Methods Fifty-four patients who underwent surgery for CPA epidermoid cysts were retrospectively analyzed, regarding their surgical approaches, removal rates, preservation rates of CN function 1 year after surgery, and recurrence. Surgical approaches were selected for patients according to the size and extension of the tumor. Results Surgical approaches consisted of LSO (20 cases), anterior transpetrosal approach (ATP; 3 cases), combined transpetrosal approach (27 cases), and ATP + LSO (4 cases). Mean tumor content removal and capsule removal rates were 97.4% and 78.3%, respectively. Preservation rates of facial nerve function and useful hearing were 94.4% and 90.7%, respectively. The mean postoperative follow-up time was 62.8 months, and there were two cases of recurrence requiring reoperation about 10 years after surgery. Conclusions For CPA epidermoid cyst surgeries, selection of the appropriate surgical approach for each patient and radical resection with an optimal operative field under direct visualization enable tumor removal without the need for reoperation for a long time, with preservation of CN functions.