title: Combined pre- and subtemporal transtentorial approach for epidermoid cysts of the cerebellopontine angle.
abstract: OBJECTIVE
  Epidermoid cysts of the cerebellopontine angle (CPA) can be a surgical challenge for the pediatric neurosurgeon. Ideally, total removal must be achieved; however, occasional adhesions of these tumors to vital neurovascular structures and extension far beyond the midline may preclude their total removal. The aims of this article are to present an alternative surgical approach to these lesions and to provide the rationale for this technique.
  
  
  METHODS
  A 16-year-old boy was admitted to our pediatric neurosurgery department with a 1-year history of nonspecific headaches. His neurological examination showed right-sided dysmetria and gait ataxia. Magnetic resonance scans showed a space-occupying lesion on the right CPA with low intensity on T(1)-weighted images and high intensity on T(2)-weighted images.
  
  
  RESULTS
  Craniotomy for tumor excision via pre- and subtemporal transtentorial approach was performed disclosing a 3.5 × 3 × 2.8-cm(3) well-encapsulated tumor, which was confirmed to be an epidermoid cyst. The postoperative course was uneventful.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Pediatric Neurosurgery, Department of Surgery and Anatomy, University Hospital of Ribeirão Preto Medical School, University of São Paulo, 14049-900, Ribeirão Preto, Brazil. rsoliveira30@gmail.com
authors.forename: Ricardo Santos
authors.initials: RS
authors.lastname: de Oliveira
authors.forename: Werllen Soares
authors.initials: WS
authors.lastname: Maia
authors.forename: Marcelo Volpon
authors.initials: MV
authors.lastname: Santos
authors.forename: Ródio Luis Brandão
authors.initials: RL
authors.lastname: Camara
mesh_terms: D000293:Adolescent; D001933:Brain Stem / Q000473:pathology / Q000601:surgery; D002530:Cerebellopontine Angle / Q000473:pathology / Q000601:surgery*; D003399:Craniotomy; D004814:Epidermal Cyst / Q000473:pathology / Q000601:surgery*; D020234:Gait Ataxia / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008866:Microsurgery; D019635:Neurosurgical Procedures / Q000379:methods*; D016683:Supine Position; D013701:Temporal Bone / Q000601:surgery*