Minimally Invasive Posterolateral Transcavernous Transtentorial Approach for Giant Epidermoid Cysts: Case Series

Giant epidermoid cysts involving the middle cranial and posterior fossae can adhere to neurovascular structures and are challenging to manage. The minimally invasive posterolateral transcavernous transtentorial approach (MIPLATTA) offers an alternative route for resection while minimizing surgical morbidity.

A retrospective analysis was conducted on a consecutive series of patients with histopathologically confirmed giant epidermoid cysts who underwent resection using the MIPLATTA between 2019 and 2023. Patients with lesions extending supra- and infratentorially who had pre- and postoperative imaging for volumetric analysis and a minimum follow-up of 6 months were included. Surgical outcomes were assessed based on the extent of resection, complications, and functional recovery using the modified Rankin Scale.

Ten patients were included (mean age, 42 years). All 10 cysts were located in the prepontine region and cerebellopontine angle, and 5 extended into the middle fossa. Six patients had gross total resection, and 4 had subtotal resection because of adherence of the cyst to critical structures. The mean (range) operative time was 10.8 (6-13) hours. At the 6-month follow-up, 3 patients had cranial nerve deficits, 3 had hydrocephalus, 1 had a cerebrospinal fluid fistula, and 2 had chemical meningitis. Functional outcome assessments showed modified Rankin Scale score ≤2 in all patients.

The MIPLATTA provided a versatile surgical corridor for resecting giant transtentorial epidermoid cysts. It enabled extensive lesion exposure while preserving neurovascular structures and offered favorable surgical outcomes with acceptable morbidity. Further studies are warranted to compare MIPLATTA efficacy with that of conventional approaches.