Epidermoids of the cerebellopontine angle: a 20-year experience.
BACKGROUND
There is considerable debate within the current literature whether total or subtotal removal of CPA epidermoids yields better long-term outcomes. The aim of this study was to review our experience with cerebellopontine-angle epidermoid tumors, as well as the current literature, focusing on the correlation between long-term outcome and the extent of surgical removal.


METHODS
We performed a retrospective review of 24 patients with epidermoid tumors of the CPA surgically treated at our institution between 1985 and 2005.


RESULTS
The mean duration from onset of symptoms to surgery was 3.1 years. Cranial nerve dysfunction was noted in 83% of patients preoperatively. Total removal was achieved in 13 patients, near total removal in 6 patients, and subtotal removal in 5 patients. Patients who underwent total removal had a median MRS score of 0, whereas those who underwent near/subtotal removal had a median MRS score of 1. The rate of recurrence was 23% in tumors considered totally removed and 27% in those near/subtotally removed. Of the 6 patients with recurrences, 5 underwent a second operation. The mean duration of follow-up was 4.2 years.


CONCLUSIONS
Total removal of CPA epidermoids does not result in significantly increased morbidity and mortality and should be the goal of surgical treatment. However, near/subtotal resection of lesions that extend far beyond the CPA or are densely adherent to neurovascular structures is justified, as there is no significant difference in the rate of recurrence.
Schiefer
Terry K
TK
Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
Link
Michael J
MJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D002526:Cerebellar Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D002530:Cerebellopontine Angle; D002648:Child; D002781:Cholesteatoma / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D015331:Cohort Studies; D018572:Disease-Free Survival; D004814:Epidermal Cyst / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult