This study reports late surgical results obtained in 9 patients operated on for an epidermoid cyst of the fourth ventricle. They represent 19/9% of all cases of epidermoids treated at our Department over a period of 25 years (1975-2000). 7 cases were diagnosed with CT and 2 cases with MR. Duration of clinical history ranged from 2 months to 6 years (mean: 2,2 years). Preoperatively, 2 cases presented spontaneous remission of neurological symptoms and signs lasting about 1 year. 7 (77,8%) patients underwent subtotal removal of the cyst whereas in 2 patients the lesion was totally excised. 3 patients (33,3%) underwent a second operation for symptomatic recurrence diagnosed between 10 and 17 years from the first operation. At present, 7 (77,8%) patients are alive (mean follow up of 14,5 years, ranging from 5 to 23 years) without neuroradiological and clinical evidence of tumour recurrence. In this group, 6 have no neurological problems and 1 suffers from a light vestibulo-cerebellar syndrome. Fourth ventricle epidermoids have a good long-term prognosis even in the case of only subtotal removal. Follow-up clinical and MR controls allow an earlier diagnosis of recurrence. Surgery of recurrent cysts can be more demanding; nonetheless, long term prognosis can be quite good for patients in well preserved neurological condition.

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Surgery continues to play the leading role in the treatment of intracranial HE. However, adjuvant therapy with IFN represents a new and well-tolerated therapeutic method for residual intracranial lesions as well as multicentric extracranial disease.

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One-hundred thirty-six patients operated on for extra-axial tumors of the posterior and middle cranial fossae were retrospectively evaluated to define the relevance of trigeminal nerve dysfunction and to correlate clinical and surgical observations. The following data are reported: tumor types, presence of specific trigeminal symptoms and signs, mean duration of symptomatology, anatomical relation between tumor and fifth nerve. Trigeminal symptoms were present in 45 subjects (33.08%) with a mean duration of 23.56 months. Frequency of symptoms was different in various oncotypes. Fifth nerve disturbances were the symptom of onset in 18 subjects (13.23%). A tumoral involvement of the nerve was reported at surgery in 73 patients (53.67%) and was defined as contact, compression or infiltration. Postoperatively, 12 patients showed an improvement of fifth nerve disturbances. A statistically significant difference (p < 0.05) was found in: (1) the incidence of symptoms in patients with and in those without anatomical trigeminal involvement: (2) the incidence of signs in the same groups; (3) the incidence of postoperative relief in patients with fifth nerve compression compared to patients with different surgical findings; (4) the incidence of postoperative relief in patients with typical trigeminal neuralgia compared to those with other symptoms.