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Epidermoid Tumors in the Cerebellopontine Angle Presenting with Trigeminal Neuralgia

  • Son, Dong-Wuk (Department of Neurosurgery, Medical Research Institute, School of Medicine, Pusan National University) ;
  • Choi, Chang-Hwa (Department of Neurosurgery, Medical Research Institute, School of Medicine, Pusan National University) ;
  • Cha, Seung-Heon (Department of Neurosurgery, Medical Research Institute, School of Medicine, Pusan National University)
  • Received : 2008.08.25
  • Accepted : 2010.03.29
  • Published : 2010.04.28

Abstract

Objective : The purpose of this study is to evaluate the clinical characteristics and surgical outcome of cerebellopontine angle (CPA) epidermoids presenting with trigeminal neuralgia. Methods : Between 1996 and 2004, 10 patients with typical symptoms of trigeminal neuralgia were found to have cerebellopontine angle epidermoids and treated surgically at our hospital. We retrospectively analyzed the clinico-radiological records of the patients. Results : Total resection was done in 6 patients (60%). Surgical removal of tumor and microvascular decompression of the trigeminal nerve were performed simultaneously in one case. One patient died due to postoperative aseptic meningitis. The others showed total relief from pain. During follow-up, no patients experienced recurrence of their trigeminal neuralgia (TN). Conclusion : The clinical features of TN from CPA epidermoids are characterized by symptom onset at a younger age compared to TN from vascular causes. In addition to removal of the tumor, the possibility of vascular compression at the root entry zone of the trigeminal nerve should be kept in mind. If it exists, a microvascular decompression (MVD) should be performed. Recurrence of tumor is rare in both total and subtotal removal cases, but long-term follow-up is required.

Keywords

References

  1. Altschuler EM, Jungreis CA, Sekhar LN, Jannetta PJ, Sheptak PE : Operative treatment of intracranial epidermoid cysts and cholesterol granulomas : report of 21 cases. Neurosurgery 26 : 606-613; discussion 614, 1990
  2. Alvord EC Jr : Growth rates of epidermoid tumors. Ann Neurol 2 : 367-370, 1977 https://doi.org/10.1002/ana.410020504
  3. Apfelbaum MI : Epidermoid cysts and cholesterol granulomas centered on the posterior fossa : twenty years of diagnosis and management. Neurosurgery 21 : 805, 1987
  4. Barker FG 2nd, Jannetta PJ, Babu RP, Pomonis S, Bissonette DJ, Jho HD : Long-term outcome after operation for trigeminal neuralgia in patients with posterior fossa tumors. J Neurosurg 84 : 818- 825, 1996 https://doi.org/10.3171/jns.1996.84.5.0818
  5. Berger MS, Wilson CB : Epidermoid cysts of the posterior fossa. J Neurosurg 62 : 214-219, 1985 https://doi.org/10.3171/jns.1985.62.2.0214
  6. Dee RH, Kishore PR, Young HF : Radiological evaluation of cerebellopontine angle epidermoid tumor. Surg Neurol 13 : 293-296, 1980
  7. Headache Classification Subcommittee of the International Headache Society : The International Classification of Headache Disorders : 2nd edition. Cephalalgia 24 Suppl 1 : 9-160, 2004
  8. Ikushima I, Korogi Y, Hirai T, Sugahara T, Shigematsu Y, Komohara Y, et al. : MR of epidermoids with a variety of pulse sequences. AJNR Am J Neuroradiol 18 : 1359-1363, 1997
  9. Jannetta PJ : Treatment of trigeminal neuralgia by suboccipital and transtentorial cranial operations. Clin Neurosurg 24 : 538-549, 1977 https://doi.org/10.1093/neurosurgery/24.CN_suppl_1.538
  10. Kallmes DF, Provenzale JM, Cloft HJ, McClendon RE : Typical and atypical MR imaging features of intracranial epidermoid tumors. AJR Am J Roentgenol 169 : 883-887, 1997 https://doi.org/10.2214/ajr.169.3.9275916
  11. Kobata H, Kondo A, Iwasaki K : Cerebellopontine angle epidermoids presenting with cranial nerve hyperactive dysfunction : pathogenesis and long-term surgical results in 30 patients. Neurosurgery 50 : 276-285; discussion 285-286, 2002
  12. Kobata H, Kondo A, Iwasaki K, Nishioka T : Combined hyperactive dysfunction syndrome of the cranial nerves : trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia : 11-year experience and review. Neurosurgery 43 : 1351-1361; discussion 1361-1362, 1998
  13. Link MJ, Cohen PL, Breneman JC, Tew JM Jr : Malignant squamous degeneration of a cerebellopontine angle epidermoid tumor. Case report. J Neurosurg 97 : 1237-1243, 2002 https://doi.org/10.3171/jns.2002.97.5.1237
  14. Liu P, Saida Y, Yoshioka H, Itai Y : MR imaging of epidermoids at the cerebellopontine angle. Magn Reson Med Sci 2 : 109-115, 2003 https://doi.org/10.2463/mrms.2.109
  15. Meng L, Yuguang L, Feng L, Wandong S, Shugan Z, Chengyuan W : Cerebellopontine angle epidermoids presenting with trigeminal neuralgia. J Clin Neurosci 12 : 784-786, 2005 https://doi.org/10.1016/j.jocn.2004.09.023
  16. Mohanty A, Venkatrama SK, Rao BR, Chandramouli BA, Jayakumar PN, Das BS : Experience with cerebellopontine angle epidermoids. Neurosurgery 40 : 24-29; discussion 29-30, 1997
  17. Netsky MG : Epidermoid tumors. Review of the literature. Surg Neurol 29 : 477-483, 1988 https://doi.org/10.1016/0090-3019(88)90144-9
  18. Puca A, Meglio M, Tamburrini G, Vari R : Trigeminal involvement in intracranial tumours. Anatomical and clinical observations on 73 patients. Acta Neurochir (Wien) 125 : 47-51, 1993 https://doi.org/10.1007/BF01401827
  19. Rubin G, Scienza R, Pasqualin A, Rosta L, Da Pian R : Craniocerebral epidermoids and dermoids. A review of 44 cases. Acta Neurochir (Wien) 97 : 1-16, 1989 https://doi.org/10.1007/BF01577734
  20. Sabin HI, Bordi LT, Symon L : Epidermoid cysts and cholesterol granulomas centered on the posterior fossa : twenty years of diagnosis and management. Neurosurgery 21 : 798-805, 1987 https://doi.org/10.1227/00006123-198712000-00004
  21. Samii M, Tatagiba M, Piquer J, Carvalho GA : Surgical treatment of epidermoid cysts of the cerebellopontine angle. J Neurosurg 84 : 14-19, 1996 https://doi.org/10.3171/jns.1996.84.1.0014
  22. Vinchon M, Pertuzon B, Lejeune JP, Assaker R, Pruvo JP, Christiaens JL : Intradural epidermoid cysts of the cerebellopontine angle : diagnosis and surgery. Neurosurgery 36 : 52-56; discussion 56-57, 1995 https://doi.org/10.1227/00006123-199501000-00006
  23. Yamakawa K, Shitara N, Genka S, Manaka S, Takakura K : Clinical course and surgical prognosis of 33 cases of intracranial epidermoid tumors. Neurosurgery 24 : 568-573, 1989 https://doi.org/10.1227/00006123-198904000-00013
  24. Yasargil MG, Abernathey CD, Sarioglu AC : Microneurosurgical treatment of intracranial dermoid and epidermoid tumors. Neurosurgery 24 : 561-567, 1989 https://doi.org/10.1227/00006123-198904000-00012

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