CP Angle Epidermoid
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Let's review another video to describe and illustrate, the techniques for resection of CP angle epidermoid tumors. This is a 26-year-old female who presented with intractable right-sided trigeminal neuralgia, and was diagnosed with a small epidermoid tumor in the area of the fifth cranial nerve near the brain stem. The character of the tumor was confirmed on diffusion weighted images. The hyper intensity of the mass on these sequences confirms the diagnosis of a CP angle epidermoid cyst. Patient was placed in that lateral position and lumbar puncture was performed and 30 cc of CSF was removed. Curvilinear incision exposes retromastoid area. Boney removal, on roof, the edges of the transverse and sigmoid sinuses, the tumor can be found along the CP angle. All the arachnoid bands were widely dissected and the pearly tumor was removed piecemeal. Here's the fourth cranial nerve, at the edge of the tentorium. Branch of the superior cerebellar artery. Here's the root entry zone of the trigeminal nerve right underneath these tumor fragments. The nerve is being generously decompressed and all the tumor fragments are being removed. Here's again the nerve, the tumor interior to the nerve is also being dissected. Here is the seventh and eighth cranial nerves. The anatomy of the posterior fossa has demonstrated additional pieces of the tumor also removed again along the ventral aspect of the brain stem. No obvious tumor is apparent except the small piece that was dislodged about the time when irrigation was used. Upon removal of the last pieces of the tumor closure was completed. Three months postoperative MRI demonstrates complete excision of the mass. The patient has not had any recurrence of her pain since her surgery. Thank you.
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