Long term outcome in surgically treated posterior fossa epidermoids.
OBJECTIVE
To study posterior fossa epidermoids treated surgically at our institute and to compare their long term outcome with respect to extent of surgical decompression.


METHODS
Retrospective analysis of 50 cases of posterior fossa epidermoid surgically treated at our institute between 1997 and 2007.


RESULTS
The mean duration from onset of symptoms to surgery was 2.5 years. Patients with cerebellopontine angle (CPA) epidermoids presented predominantly with trigeminal neuralgia (35%) and hearing loss (29%) while patients with fourth ventricle epidermoids had features of raised intracranial pressure (ICP) and gait ataxia (69.2% each). The rate of recurrence was 9% in tumors considered totally removed and 93% in those subtotally removed. Of the 17 patients with recurrences, 3 (7.9%) underwent a second operation. The mean duration of follow up at first recurrence was 9.3 years.


CONCLUSIONS
Based on our experience, the rate of recurrence is significantly higher after subtotal removal as compared to total removal of epidermoids on long-term follow up. Symptomatic recurrence requiring re-exploration is evident only after a long duration (∼10.9 year) following primary surgery. Hence, total removal without producing new neurological deficits should be the standard goal when operating on posterior fossa epidermoid cysts.
Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala 695011, India. Electronic address: doc_gopal@yahoo.com.
Chittur Viswanathan
CV
Gopalakrishnan
Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala 695011, India. Electronic address: drkhursheed@rediffmail.com.
Khursheed A
KA
Ansari
Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala 695011, India. Electronic address: snair@sctimst.ac.in.
Suresh
S
Nair
Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala 695011, India. Electronic address: neuron1967@gmail.com.
Girish
G
Menon
D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D002528:Cerebellar Neoplasms / Q000473:pathology / Q000601:surgery; D002530:Cerebellopontine Angle; D002551:Cerebral Ventricle Neoplasms / Q000473:pathology / Q000601:surgery; D003388:Cranial Fossa, Posterior / Q000601:surgery*; D003399:Craniotomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D019635:Neurosurgical Procedures / Q000379:methods; D012189:Retrospective Studies; D019292:Skull Base Neoplasms / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
Cerebellopontine angle; Cholesteatoma; Epidermoid cyst; Fourth ventricle