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Published on: August 15, 2025
Long term outcome in surgically treated posterior fossa epidermoids
Chittur Viswanathan Gopalakrishnan1, Khursheed A Ansari1, Suresh Nair1
1Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala 695011, India.
Objectives:
To study posterior fossa epidermoids treated surgically at our institute and to compare their long term outcome with respect to extent of surgical decompression.
Materials And Methods:
Retrospective analysis of 50 cases of posterior fossa epidermoid surgically treated at our institute between 1997 and 2007.
Results:
The mean duration from onset of symptoms to surgery was 2.5 years. Patients with cerebellopontine angle (CPA) epidermoids presented predominantly with trigeminal neuralgia (35%) and hearing loss (29%) while patients with fourth ventricle epidermoids had features of raised intracranial pressure (ICP) and gait ataxia (69.2% each). The rate of recurrence was 9% in tumors considered totally removed and 93% in those subtotally removed. Of the 17 patients with recurrences, 3 (7.9%) underwent a second operation. The mean duration of follow up at first recurrence was 9.3 years.
Conclusion:
Based on our experience, the rate of recurrence is significantly higher after subtotal removal as compared to total removal of epidermoids on long-term follow up. Symptomatic recurrence requiring re-exploration is evident only after a long duration (∼10.9 year) following primary surgery. Hence, total removal without producing new neurological deficits should be the standard goal when operating on posterior fossa epidermoid cysts.
