Revuelta-Gutiérrez Rogelio, Díaz-Romero Paz Ricardo F, Vales-Hidalgo Lourdes Olivia, Hinojosa-González Ramón, Barges-Coll Juan
Servicio de Neurocirugía, Instituto Nacional de Neurología y Neurocirugía MVS, México, D.F., Mexico.
Cir Cir. 2009 Jul-Aug;77(4):257-65; 241-8.
Epidermoid tumors represent the third most common lesion of the cerebellopontine angle (CPA). Their evolution and clinical features are distinctively characteristic. We present a comprehensive review of the clinical, imaging and surgical aspects of epidermoid cysts of the CPA.
We conducted a case series of patients diagnosed with epidermoid cyst of the CPA who were operated on between 1998 and 2005. Lesions were classified according to their anatomic extent: grade I(-) within the boundaries of the CPA, grade II(-) extension to the suprasellar and perimesencephalic cisterns, and grade III(-) parasellar and temporomesial region involvement.
This study was comprised of 43 patients with a mean follow-up of 85 months. Mean age was 34 years, and 67% of the patients were female. The initial symptom was headache in 58.1% of the cases and trigeminal neuralgia in 41.8%. According to our classification, temporomesial involvement (25.6%) was significantly (p = 0.001) associated with a higher incidence of seizures, and trigeminal neuralgia was present in patients with lesions limited to the CPA (p = 0.006). The lesions were reached essentially through a retrosigmoidal approach (39.5%) and surgical excision was deemed to be complete in 65% of the cases.
Our grading classification according to the anatomic extension correlates well with clinical presentation, type of surgical approach and extent of surgical removal. It is desirable to reach a consensus on the classification of tumor extension.
表皮样肿瘤是桥小脑角（CPA）第三常见的病变。其演变过程和临床特征具有独特性。我们对CPA表皮样囊肿的临床、影像学及手术方面进行了全面综述。
我们对1998年至2005年间接受手术治疗的诊断为CPA表皮样囊肿的患者进行了病例系列研究。根据病变的解剖范围进行分类：I级（-）局限于CPA边界内，II级（-）延伸至鞍上池和中脑周围脑池，III级（-）累及鞍旁和颞叶内侧区域。
本研究包括43例患者，平均随访85个月。平均年龄为34岁，67%的患者为女性。58.1%的病例初始症状为头痛，41.8%为三叉神经痛。根据我们的分类，颞叶内侧受累（25.6%）与癫痫发作发生率较高显著相关（p = 0.001），而局限于CPA的病变患者出现三叉神经痛（p = 0.006）。病变主要通过乙状窦后入路到达（39.5%），65%的病例手术切除被认为是完整的。
我们根据解剖范围进行的分级分类与临床表现、手术入路类型及手术切除范围密切相关。希望就肿瘤扩展的分类达成共识。
