Mohanty A, Venkatrama S K, Rao B R, Chandramouli B A, Jayakumar P N, Das B S
Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India.
Neurosurgery. 1997 Jan;40(1):24-9; discussion 29-30. doi: 10.1097/00006123-199701000-00004.
Cerebellopontine angle (CPA) epidermoids, although of benign 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 outcomes with the extent of surgical removal.
Twenty-five consecutive patients with CPA epidermoids that were surgically treated were reviewed, and the final outcomes were assessed.
Thirteen patients had trigeminal neuralgia. In 7 of the 13 patients, trigeminal neuralgia was the only presenting feature. The epidermoid was confined to the CPA in each of 6 patients, and in each of 18, it had varying degrees of supratentorial extension. One patient had a predominant supratentorial epidermoid with extension to the CPA. The lesions were totally excised in 12 patients. Near-total removal was accomplished in eight patients, and in the remaining five, partial removal was accomplished. Transient worsening of the cranial nerve functions occurred in 11 patients, probably as a result of aggressive dissection of the capsule from the cranial nerves. In 9 of the 11 patients, the cranial nerve functions improved by the time of discharge. All of the patients who had trigeminal neuralgia were relieved of their symptoms. Eighteen patients were followed up for a mean period of 42 months, and none had symptoms of recurrence.
Aggressive surgical removal results in transient but significant cranial nerve dysfunction in the postoperative period. A conservative approach is indicated for patients in whom the capsule is adherent to the brain stem and the cranial nerves.
桥小脑角（CPA）表皮样囊肿虽然性质为良性，但因其与颅神经和脑干距离接近且粘连，具有相当大的神经外科手术意义。我们描述我们的经验，并试图将最终结果与手术切除范围相关联。
回顾了连续25例接受手术治疗的CPA表皮样囊肿患者，并评估最终结果。
13例患者患有三叉神经痛。在这13例患者中，7例患者三叉神经痛是唯一的表现特征。6例患者的表皮样囊肿局限于CPA，18例患者的表皮样囊肿有不同程度的幕上延伸。1例患者主要为幕上表皮样囊肿并延伸至CPA。12例患者病变被完全切除。8例患者实现了近全切除，其余5例实现了部分切除。11例患者出现颅神经功能短暂恶化，可能是由于从颅神经上积极剥离囊肿包膜所致。在这11例患者中，9例患者出院时颅神经功能有所改善。所有患有三叉神经痛的患者症状均得到缓解。18例患者平均随访42个月，均无复发症状。
积极的手术切除会导致术后出现短暂但明显的颅神经功能障碍。对于囊肿与脑干和颅神经粘连的患者，应采取保守方法。
