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Surgical management is challenging due to their adhesion to critical neurovascular structures and tendency for recurrence. The current study examines surgical outcomes, extent of resection, and recurrence rates during long-term follow-up. A retrospective analysis was conducted on patients treated for epidermoid lesions between 2000 and 2021, focusing on clinical and radiological outcome and long-term symptom development. Among 55 patients (56.4% male), the majority harbored lesions in the cerebellopontine angle (75.3%). The mean age at surgery was 41.3 years, with an average follow-up of 82 months. Total removal was achieved in 61% of cases, with 75% of them remaining recurrence-free. In comparison, 35% of near-total removal and 25% of subtotal removal remained recurrence-free. Immediate symptom improvement was similar after total and non-total removal (12.6% vs. 10.5%), but long-term improvement was higher after total removal (43% vs. 27%). Transient cranial nerve deficits occurred in 25% of total and in 32% of non-total removal cases, with similar rates of minor complications. Total removal provided better long-term symptom control and lower recurrence rates without significantly increasing neurological deficits, supporting it as the preferred surgical strategy while maintaining functional preservation.<\/jats:p>","DOI":"10.1038\/s41598-025-90333-4","type":"journal-article","created":{"date-parts":[[2025,2,17]],"date-time":"2025-02-17T19:14:42Z","timestamp":1739819682000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Long term management of intracranial epidermoids balancing extent of resection and functional preservation in a 20 year institutional experience"],"prefix":"10.1038","volume":"15","author":[{"given":"Mazin","family":"Omer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia M.","family":"Nakagawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arthur H. 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