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Combined pre- and subtemporal transtentorial approach for epidermoid cysts of the cerebellopontine angle

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Abstract

Objective

Epidermoid cysts of the cerebellopontine angle (CPA) can be a surgical challenge for the pediatric neurosurgeon. Ideally, total removal must be achieved; however, occasional adhesions of these tumors to vital neurovascular structures and extension far beyond the midline may preclude their total removal. The aims of this article are to present an alternative surgical approach to these lesions and to provide the rationale for this technique.

Material and methods

A 16-year-old boy was admitted to our pediatric neurosurgery department with a 1-year history of nonspecific headaches. His neurological examination showed right-sided dysmetria and gait ataxia. Magnetic resonance scans showed a space-occupying lesion on the right CPA with low intensity on T1-weighted images and high intensity on T2-weighted images.

Results

Craniotomy for tumor excision via pre- and subtemporal transtentorial approach was performed disclosing a 3.5 × 3 × 2.8-cm3 well-encapsulated tumor, which was confirmed to be an epidermoid cyst. The postoperative course was uneventful.

Conclusions

A combined pre- and subtemporal approach utilizes a wide opening of the tentorium and the option of supratentorial retraction of the cerebellum to provide an excellent angle of approach to CPA lesions involving the anterolateral aspect of the brain stem in children.

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Authors and Affiliations

  1. Division of Pediatric Neurosurgery, Department of Surgery and Anatomy, University Hospital of Ribeirão Preto Medical School, University of São Paulo, 14049-900, Ribeirão Preto, Brazil

    Ricardo Santos de Oliveira, Werllen Soares Maia & Marcelo Volpon Santos

  2. Division of Neurosurgery, Rio Grande do Norte Federal University, Natal, Brazil

    Ródio Luis Brandão Camara

Authors
  1. Ricardo Santos de Oliveira
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  2. Werllen Soares Maia
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  3. Marcelo Volpon Santos
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  4. Ródio Luis Brandão Camara
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Correspondence to Ricardo Santos de Oliveira.

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de Oliveira, R.S., Maia, W.S., Santos, M.V. et al. Combined pre- and subtemporal transtentorial approach for epidermoid cysts of the cerebellopontine angle. Childs Nerv Syst 28, 2137–2142 (2012). https://doi.org/10.1007/s00381-012-1904-8

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  • DOI: https://doi.org/10.1007/s00381-012-1904-8

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