Neurotologic management of intracranial epidermoid tumors

Objectives: Epidermoid cysts are the most common intracranial embryonal tumor, although they account for only 1% of all intracranial tumors. Epidermoids often spread into several intracranial compartments. Thorough preoperative surgical planning is imperative for safe epidermoid removal. This paper discusses the neurotologic management of intracranial epidermoid cysts Study Design: Retrospective chart review. Methods: A database search revealed 10 patients with diagnosis of intracranial epidermoid cysts between January 1,1971 and December 31, 2003 at our institution. Results: Six males and four females with ages ranging from 18 to 54 years of age underwent surgery between September 1,1971 and November 4, 2003. The average tumor size was 3.9 cm; six originated in the cerebellopontine angle and four in the petrous apex. Six patients had a translabyrinthine approach to the tumor, two with additional transcochlear exposure. Two patients had tumors removed by way of the middle fossa approach and one through the suboccipital approach. Multiple cranial nerves were involved by tumor in all patients, including nerves III through XI. The internal carotid artery was involved by tumor in four patients. Multiple cranial nerve deficits were seen preoperatively, and facial weakness was the most common new deficit post-operatively. Eight patients required intradural access for complete tumor removal. Seven had complete tumor removal. Headaches were the most common complication. One patient had seizures postoperatively, and another had a malignant epidermoid, which resulted in death. Conclusions: Intracranial epidermoid cysts require complex surgical planning. They involve multiple cranial nerves and vascular structures. Complete resection is frequently possible with minimal new cranial nerve deficits.