Combined pre- and subtemporal transtentorial approach for epidermoid cysts of the cerebellopontine angle

Oliveira, Ricardo Santos de; Maia, Werllen Soares; Santos, Marcelo Volpon; Câmara, Ródio Luís Brandão

doi:10.1007/s00381-012-1904-8

Cited by 8 publications

(7 citation statements)

References 19 publications

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“…Although several authors recommended the use of more intricate approaches or staged surgery in large CPA epidermoids, [10][11][12] most series including the present one relied mainly on the lateral suboccipital (retrosigmoid) approach even with extensive tumors. 1,[4][5][6][13][14][15] In our experience, the retrosigmoid approach allows adequate exposure even without having to retract the cerebellum with a rigid retractor, as these lesions expand the subarachnoid spaces significantly and create a wide surgical corridor which is usually sufficient.…”

Section: Approachmentioning

confidence: 98%

Surgical Resection of Cerebellopontine Epidermoid Cysts: Limitations and Outcome

2017

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Epidermoid cysts are benign slowly growing tumors commonly involving the cerebellopontine angle (CPA). The aim of this study was to analyze the surgical limitations, surgical strategies, complications, and outcome of resection of these lesions. The clinical data and outcome of 32 cases operated for CPA epidermoid between 2007 and 2015 were retrospectively analyzed. The mean follow-up period was 42.6 months, and all patients were followed up at least for a whole year. There were 15 males and 17 females. The median age was 37.6 years. Headache and cranial nerves dysfunction were the most common presenting symptoms. Surgery was performed in all patients using the standard lateral suboccipital retrosigmoid approach. In three cases, microvascular decompression of an arterial loop was performed in addition to tumor excision. Total resection was accomplished in 19 out of 32 cases (59.4%), subtotal resection in 7 cases (21.9%), and only partial excision was achieved in 6 cases (18.7%). There was no recurrence or regrowth of residual tumor during the follow-up period. We had a single postoperative mortality due to postoperative pneumonia and septic shock. New cranial nerves deficits occurred in 15.6% of cases but were transient in most of them. The favorable outcome of total resection of CPA epidermoids should always be weighed against the critical risks that accompany it especially in the presence of tight adhesions to vital neurovascular structures. The retrosigmoid approach is suitable for the resection of these tumors even if they were large in size.

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Section: Approachmentioning

confidence: 98%

Surgical Resection of Cerebellopontine Epidermoid Cysts: Limitations and Outcome

2017

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“…Complex skull base tumors may need complex approaches, combining surgical approaches such as the pre- and subtemporal transtentorial approach to access the cerebellopontine angle. [ 9 ] Figure 4 illustrates some possible surgical approaches to access skull base tumors.…”

Section: Discussionmentioning

confidence: 99%

Pediatric skull base tumors: A management challenge

et al. 2021

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A BSTRACT Context: Skull base tumors are varied in children and are particularly challenging to pediatric neurosurgeons, with few papers in the literature describing the evolution, complications, and outcome. The authors evaluated long-term outcomes in children submitted to skull base tumor surgery and performed a literature review. Aims: The aim of this study was to analyze surgical results, complications, and outcomes, on comparison with previous publications. Materials and Methods: A retrospective analysis of children undergoing surgery at a single institution between 2000 and 2018 for lesions of the cranial base was carried out. In addition, a literature review was carried out describing a total of 115 children operated on for skull base tumors. Statistical Analysis: Chi-squared and Fisher’s exact tests were performed to compare the distribution of categorical variables and a nonparametric Mann–Whitney U test was used to perform intergroup comparisons of continuous variables. Results: Seventeen children ranging in age from 8 months to 17 years (mean, 10.9 years) underwent skull base approaches. Tumor types included schwannoma, meningioma, chondroid chordoma, mature teratoma, epidermoid cyst, hemangiopericytoma, rhabdomyosarcoma, myofibroblastic inflammatory tumor, fibromyxoid sarcoma, Crooke’s cell adenoma, ossifying fibroma, osteoblastoma, nasopharyngeal angiofibroma and Ewing’s sarcoma. Gross total resection was achieved in 6 patients (35.3%), 12 patients (70.6%) had benign histology, and 5 patients (29.4%) had a malignant tumor. Transient postoperative cerebrospinal fluid leak affected only one patient. Thirteen children (76.4%) had a residual neurological deficit at last follow-up evaluation. Three (17.6%) surviving patients received adjuvant therapy. The rate of recurrence or lesion progression was 17.6%. Conclusions: Skull base tumors in children present a therapeutic challenge because of their unique pathological composition and can lead to considerable morbidity and mortality in pediatric age.

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“…7,18 However, epidermoids tend to grow without causing much symptoms until they reach a significant size, favoring the conventional large size craniotomy for their complete excision by single or staged surgery. [19][20][21] However, with the evolution of preoperative diagnostic imaging, intraoperative illumination, and special microneurosurgical instruments, there has been tremendous development in understanding the nature of pathology, their accurate site, topographical relationship, and advanced neurosurgical techniques. The same has resulted into selection of safest and optimal corridor for the lesions using the smallest possible surgical exposure, that is, the keyhole craniotomy.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Keyhole Approach for Intracranial Epidermoid

Verma

Singh

Dikshit

et al. 2021

JNRP

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Objective In contemporary neurosurgical practice, keyhole endoscopic approach has established its role in various neurosurgical pathologies. Intracranial epidermoid is an ideal pathology for endoscopic keyhole approach as epidermoid is well encapsulated, extra-axial, avascular, and easily suckable. The objective of this study is to share our experience of endoscopic keyhole approach for intracranial epidermoids at various locations as a new minimally invasive neurosurgical approach to deal with these lesions. Materials and Methods We conducted a retrospective study on 26 patients who underwent keyhole pure endoscopic excision of intracranial epidermoid between July 2015 and December 2019. Patient's demographics, clinical features, radiological imaging, and postoperative complications were noted. Follow-up outcome of preoperative symptoms and postoperative complications were also analyzed. Results The mean age of the study population was 30.5 years with a mean follow-up of 30 months. The common presenting features were headache, hearing loss, and trigeminal neuralgic pain. Gross total resection was achieved in 73.1% cases, while near total resection and subtotal resection were achieved in 19.2 and 7.7% cases, respectively. In the follow-up, maximal improvement was seen in trigeminal neuralgic pain (83%) and headache (66.7%). Major postoperative complications were facial nerve paresis, lower cranial nerve paresis, and transient facial hypoesthesia, most of which improved over time. None of the patients required resurgery till date. Statistical Analysis Patients' data were analyzed using SPSS software version 23 (Statistical Package for Social Sciences, IBM, Chicago, United States). Conclusion This study demonstrates that with careful patient selection, endoscopic keyhole excision of epidermoid is a good alternative to conventional microsurgical excision with comparable surgical and functional outcomes.

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Combined pre- and subtemporal transtentorial approach for epidermoid cysts of the cerebellopontine angle

Abstract: A combined pre- and subtemporal approach utilizes a wide opening of the tentorium and the option of supratentorial retraction of the cerebellum to provide an excellent angle of approach to CPA lesions involving the anterolateral aspect of the brain stem in children.

Cited by 8 publications

References 19 publications

Surgical Resection of Cerebellopontine Epidermoid Cysts: Limitations and Outcome

Surgical Resection of Cerebellopontine Epidermoid Cysts: Limitations and Outcome

Pediatric skull base tumors: A management challenge

Endoscopic Keyhole Approach for Intracranial Epidermoid

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