scholarly journals Cerebellopontine Angle Epidermoid Cysts: Surgical Treatment Outcome

2020 ◽  
Vol 9 (03) ◽  
pp. 175-178
Author(s):  
Mohamed I. Refaat ◽  
Omar Y. Abdallah
Keyword(s):  
Clinical Outcome ◽  
Surgical Management ◽  
Cerebellopontine Angle ◽  
Cranial Nerves ◽  
Radiological Outcome ◽  
Epidermoid Cysts ◽  
Presenting Symptoms ◽  
Clinical And Radiological Outcome ◽  
Postoperative Symptoms

Abstract Background  Epidermoid cysts (ECs)are an uncommon slowly growing congenital lesions. The cerebellopontine angle (CPA) is the most common site. Surgical management for these lesions remains challenging due to the high-adherence of the cyst capsule to the surrounding structures and its tendency to present with invasion of multiple cisterns. Objective The aim of this study was to evaluate the clinical and radiological outcome of surgically treated ECs in the CPA region. Materials and Methods This is a retrospective study conducted on patients presenting with symptomatic CPA ECs. Clinical outcome was assessed in terms of improving or worsening of the presenting symptoms. Radiological outcome was assessed by comparing the tumor size, brainstem, and cerebellar compression in the preoperative and postoperative images. Results In this study, 18 patients were included. All cases were operated upon by microsurgical evacuation of the cyst contents and excision of the nonadherent parts of the capsule. On admission, cranial nerve symptoms predominated. Improvement or resolution of preoperative deficits was seen in 15 patients. Preoperative symptoms worsened in two and new postoperative symptoms occurred in one patient. Seven patients needed additional ventriculoperitoneal (VP) shunt in the same setting due to the presence of hydrocephalus. During the follow-up period, symptomatic recurrence occurred in one patient, while asymptomatic recurrence occurred in one patient. Conclusion Surgical management of CPA ECs, leaving remnants of the capsule on cranial nerves and brain stem can be considered as a relatively safe surgical procedure with a good clinical outcome and low-recurrence risks.

scholarly journals Surgical Resection of Cerebellopontine Epidermoid Cysts: Limitations and Outcome

2017 ◽  
Vol 79 (02) ◽  
pp. 167-172 ◽  
Author(s):  
Ahmed Farhoud ◽  
Wael Khedr ◽  
Hisham Aboul-Enein
Keyword(s):  
Cranial Nerves ◽  
Postoperative Mortality ◽  
Residual Tumor ◽  
Retrosigmoid Approach ◽  
Subtotal Resection ◽  
Total Resection ◽  
Surgical Strategies ◽  
Epidermoid Cysts ◽  
Presenting Symptoms

Objective Epidermoid cysts are benign slowly growing tumors commonly involving the cerebellopontine angle (CPA). The aim of this study was to analyze the surgical limitations, surgical strategies, complications, and outcome of resection of these lesions. Material and Methods The clinical data and outcome of 32 cases operated for CPA epidermoid between 2007 and 2015 were retrospectively analyzed. The mean follow-up period was 42.6 months, and all patients were followed up at least for a whole year. Results There were 15 males and 17 females. The median age was 37.6 years. Headache and cranial nerves dysfunction were the most common presenting symptoms. Surgery was performed in all patients using the standard lateral suboccipital retrosigmoid approach. In three cases, microvascular decompression of an arterial loop was performed in addition to tumor excision. Total resection was accomplished in 19 out of 32 cases (59.4%), subtotal resection in 7 cases (21.9%), and only partial excision was achieved in 6 cases (18.7%). There was no recurrence or regrowth of residual tumor during the follow-up period. We had a single postoperative mortality due to postoperative pneumonia and septic shock. New cranial nerves deficits occurred in 15.6% of cases but were transient in most of them. Conclusion The favorable outcome of total resection of CPA epidermoids should always be weighed against the critical risks that accompany it especially in the presence of tight adhesions to vital neurovascular structures. The retrosigmoid approach is suitable for the resection of these tumors even if they were large in size.

Long-term follow-up of clinical and radiological outcome after cervical laminectomy

2013 ◽  
Vol 24 (S2) ◽  
pp. 229-235 ◽  
Author(s):  
Sarita van Geest ◽  
Anouk M. J. de Vormer ◽  
Mark P. Arts ◽  
Wilco C. Peul ◽  
Carmen L. A. Vleggeert-Lankamp
Keyword(s):  
Radiological Outcome ◽  
Cervical Laminectomy ◽  
Long Term Follow Up ◽  
Clinical And Radiological Outcome

scholarly journals Clinical and radiological outcome at 10 years of follow-up after total cervical disc replacement

2017 ◽  
Vol 26 (9) ◽  
pp. 2441-2449 ◽  
Author(s):  
Christoph Mehren ◽  
Franziska Heider ◽  
Christoph J. Siepe ◽  
Bernhard Zillner ◽  
Ralph Kothe ◽  
...  
Keyword(s):  
Disc Replacement ◽  
Cervical Disc ◽  
Radiological Outcome ◽  
Cervical Disc Replacement ◽  
Clinical And Radiological Outcome

Endocrinopathy, Vision, Headache, and Recurrence After Transsphenoidal Surgery for Rathke Cleft Cysts

Neurosurgery ◽  
2010 ◽  
Vol 67 (3) ◽  
pp. 837-843 ◽  
Author(s):  
Scott D. Wait ◽  
Mark P. Garrett ◽  
Andrew S. Little ◽  
Brendan D. Killory ◽  
William L. White
Keyword(s):  
Rational Choice ◽  
Surgical Management ◽  
Transsphenoidal Surgery ◽  
Squamous Metaplasia ◽  
Senior Author ◽  
Visual Symptoms ◽  
Presenting Symptoms ◽  
Rathke Cleft Cyst ◽  
The Mean

Abstract BACKGROUND Rathke cleft cyst can enlarge and become symptomatic. OBJECTIVE To review the clinical data and results of all patients treated by the senior author for a Rathke cleft cyst. METHODS A prospectively maintained surgical database, supplemented with updates from telephone conversations, of all patients presenting to the Barrow Neurological Institute from 1992 to the present was reviewed. RESULTS Seventy-three patients (17 males, 56 females; mean age, 40 years; range, 5–80 years) underwent 77 resections. The mean length of follow-up was 27 months (range, 0–129 months). Presenting symptoms included headache (75%), followed by endocrinopathy (49%), and visual symptoms (39%). Preoperative chiasmopathy resolved in 75% and improved in 21% of the patients. Patients' preoperative endocrinopathy resolved at various rates, depending on the specific axis (29%–100%). Endocrinopathies were more likely to resolve in females than males. New postoperative endocrinopathies also occurred (0–8%). Headache resolved (68%) or improved (21%) in most patients. No patient had worsened headaches. Eight patients had a recurrence, 4 of whom underwent reoperation. The presence of squamous metaplasia was the only predictor of recurrence. CONCLUSION Surgical fenestration and/or resection of Rathke cleft cyst via the transsphenoidal approach are a rational choice for surgical management of these lesions when symptomatic. In most cases, visual symptoms and headache can be expected to improve. New persistent endocrine deficits can be expected in a small percentage of patients, but preexisting endocrinopathies resolve in many patients.

Craniocervical Instability in the Setting of Os Odontoideum

Neurosurgery ◽  
2015 ◽  
Vol 76 (5) ◽  
pp. 514-521 ◽  
Author(s):  
Deng Zhao ◽  
Shenglin Wang ◽  
Peter G. Passias ◽  
Chao Wang
Keyword(s):  
Surgical Management ◽  
Japanese Orthopaedic Association ◽  
Os Odontoideum ◽  
Complication Rates ◽  
Computed Tomographic ◽  
Presenting Symptoms ◽  
Functional Scores ◽  
Atlantoaxial Fixation ◽  
History Of

Abstract BACKGROUND: Our clinical understanding of os odontoideum (OO) remains incomplete. Congenital and traumatic causes have been proposed and advocated. Clinical presentations range from asymptomatic to axial pain to myelopathy or vertebral-basilar ischemia. A consensus for surgical management exists for those found to have an unstable atlantoaxial complex or symptomatic cranial-vertebral junction compression. OBJECTIVE: To evaluate the clinical presentation and surgical outcomes of patients with OO and an unstable atlantoaxial complex or symptomatic cranial-vertebral junction compression. METHODS: Patients with a diagnosis of OO who underwent surgical management were included. Patients were excluded on the basis of previous C2 fracture, Fielding diagnostic criteria, and inadequate follow-up. History of trauma and presenting symptoms were assessed. Clinical and neurological improvements were measured with the use of patient satisfaction scores and the Japanese Orthopaedic Association scores. Fusion status was documented with the use of radiographs and computed tomographic imaging. RESULTS: Of 279 patients, 112 reported a history of cranial-vertebral junction trauma, whereas 28 were diagnosed with congenital malformations. Clinically, 84.9% of patients presented with myelopathy, with pain presented in 42.6%. Atlantoaxial fixation was performed in 240 patients, occiput-to-C2 fixation in 35 patients, and extended occipito-cervical fixation in 4 patients. Mean follow-up was 40.3 months. Complications were reported in 2.4% of patients. Japanese Orthopaedic Association scores improved from a preoperative mean of 12.4 to 14.8. Two hundred thirty-five patients (77.7%) improved, with 30 patients experiencing no change in symptoms and 14 patients deteriorating. Fusion was achieved in 96.8% of patients. CONCLUSION: Our data reveal that surgical treatment for OO using the indications and techniques delineated is associated with high satisfaction rates, improved functional scores, and high fusion rates with low complication rates.

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