Czernicki Tomasz, Kunert Przemysław, Nowak Arkadiusz, Wojciechowski Jakub, Marchel Andrzej
Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland.
Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland.
Neurol Neurochir Pol. 2016;50(2):75-82. doi: 10.1016/j.pjnns.2015.11.008. Epub 2015 Dec 11.
To report clinical characteristics, treatment outcomes and risk of recurrence in patients with surgically treated cerebellopontine angle epidermoids.
In 1994-2013, we operated 17 patients, including 7 with tumor limited to the cerebellopontine angle, 7 with cerebellopontine angle tumor penetrating supratentorially, and 3 with cerebellopontine angle tumor extending along skull base to contralateral cerebellopontine angle. All patients were followed-up for the mean duration of 126 months.
On admission cranial nerve symptoms predominated. Total tumor removal was achieved in 5 patients, and incomplete removal (with small tumor remnants left on vessels, nerves, or brainstem) in 12 patients. Postoperatively, preoperative deficits worsened in 2 and new postoperative deficits occurred in 10 patients. The extent of tumor expansion had no effect on postoperative morbidity and risk of recurrence. During long-term follow-up, improvement or resolution of preoperative deficits was seen in 11 of 17 patients, and new postoperative deficits in 8 of 10 patients. Symptomatic recurrences after an average of more than 9 years were noted in 5 patients, 3 of whom were reoperated. Recurrences occurred in some younger patients and always in area of primary tumor. No effect of extent of tumor removal on risk of recurrence was found.
The extent of tumor removal had no effect on the risk of recurrence, and thus it may be acceptable to leave tumor capsule fragments adhering closely to nerves, vessels, or brainstem. During long-term follow-up, resolution or improvement of present preoperatively and new postoperative neurological deficits may be expected in most patients.
报告接受手术治疗的桥小脑角表皮样囊肿患者的临床特征、治疗结果及复发风险。
1994年至2013年，我们对17例患者进行了手术，其中7例肿瘤局限于桥小脑角，7例桥小脑角肿瘤向幕上穿破，3例桥小脑角肿瘤沿颅底延伸至对侧桥小脑角。所有患者平均随访126个月。
入院时以脑神经症状为主。5例患者实现了肿瘤全切除，12例患者为次全切除（血管、神经或脑干上残留小肿瘤）。术后，2例患者术前神经功能缺损加重，10例患者出现新的术后神经功能缺损。肿瘤扩展范围对术后发病率及复发风险无影响。在长期随访中，17例患者中有11例术前神经功能缺损得到改善或缓解，10例中有8例出现新的术后神经功能缺损。平均9年多后，5例患者出现症状性复发，其中3例再次手术。复发发生在部分年轻患者中，且总是发生在原发肿瘤部位。未发现肿瘤切除范围对复发风险有影响。
肿瘤切除范围对复发风险无影响，因此，对于紧密附着于神经、血管或脑干的肿瘤包膜碎片可不作处理。在长期随访中，大多数患者术前存在的及新出现的术后神经功能缺损有望得到缓解或改善。
