Endoscopic-Assisted Keyhole Resection of a Recurrent Epidermoid Tumor: 2-Dimensional Operative Video

Abstract

Epidermoid tumors are benign lesions. Surgical resection is the only treatment option available for these lesions.1 The surgical approach should be tailored to the clinical and anatomic findings to achieve radical resection, preferably total removal of the content and the capsule to prevent recurrences.2 Total resection is frequently possible in de novo lesions using tailored skull base approaches and their combination as well as modern microsurgical techniques, including the endoscope-assisted tools.2,3 Giant recurrent tumors, however, are not amenable for total resection. Hence, the severe adhesions will lead to a higher morbidity as the epidermoid capsule becomes thicker and more fibrous after prior resections attempts.2,4 The extent of the resection should still be safely extended as much as possible to delay the interval between surgeries. Endoscopic techniques are of great help in achieving such results through a keyhole approach when conservative surgery is decided.3 We present the case of a 69-yr-old male with a past medical history of coronary heart disease, hypertension, hypothyroidism, and recurrent giant epidermoid cyst in the left cerebellopontine angle, with significant compression of the brainstem and extended into Meckel's cave, internal auditory canal, and jugular fossa. He underwent resection in 1983, 2004, and 2012. He presented with worsening gait, and multiple cranial nerves deficits. A minimally invasive approach through a keyhole craniotomy was performed given the age, comorbidity, and multirecurrent nature of his lesion. The patient consented to the intervention and publication of his image. He had a satisfying evacuation of his cyst content with transient facial and lower cranial nerve postoperative worsening.