EXPERIENCE WITH CEREBELLOPONTINE ANGLE EPIDERMOIDS

OBJECTIVE: Cerebellopontine angle (CPA) epidermoids, although of benig n nature, are of considerable neurosurgical interest because of their close proximity and adherence to the cranial nerves and the brain stem . We describe our experience and attempt to correlate the final outcom es with the extent of surgical removal. METHODS: Twenty-five consecuti ve patients with CPA epidermoids that were surgically treated were rev iewed, and the final outcomes were assessed. RESULTS: Thirteen patient s had trigeminal neuralgia. In 7 of the 13 patients, trigeminal neural gia was the only presenting feature. The epidermoid was confined to th e CPA in each of 6 patients, and in each of 18, it had varying degrees of supratentorial extension. One patient had a predominant supratento rial epidermoid with extension to the CPA. The lesions were totally ex cised in 12 patients. Near-total removal was accomplished in eight pat ients, and in the remaining five, partial removal was accomplished. Tr ansient worsening of the cranial nerve functions occurred in 11 patien ts, probably as a result of aggressive dissection of the capsule from the cranial nerves. In 9 of the 11 patients, the cranial nerve functio ns improved by the time of discharge. All of the patients who had trig eminal neuralgia were relieved of their symptoms. Eighteen patients we re followed up for a mean period of 42 months, and none had symptoms o f recurrence. CONCLUSION: Aggressive surgical removal results in trans ient but significant cranial nerve dysfunction in the postoperative pe riod. A conservative approach is indicated for patients in whom the ca psule is adherent to the brain stem and the cranial nerves.