{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T02:38:17Z","timestamp":1792809497545,"version":"4.5.0"},"reference-count":36,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:p>Intrinsic epidermoid tumors of the brainstem are rare, histologically benign lesions associated with high surgical morbidity and mortality due to their eloquent location. The authors report a child with progressive severe neurological deterioration from a large midline intrinsic brainstem epidermoid at the pontomedullary junction. The mass was removed through a posterior fossa craniotomy and midline endoscope-assisted microsurgical corridor through the floor of the fourth ventricle, using neurophysiological monitoring. Postoperatively, there was dramatic improvement in the patient\u2019s symptoms. Early recurrence of the mass necessitated reoperation with more aggressive resection of the cyst capsule, which led to complete radiographic reconstitution of the brainstem. The patient remains well with a durable recovery 7 years after presentation. The authors review the literature on brainstem epidermoids and discuss the differential diagnosis and management strategies for approaching these lesions, advocating for conservative surgery with resection of as much of the tumor capsule as is safely possible.<\/jats:p>","DOI":"10.3171\/2020.6.peds20482","type":"journal-article","created":{"date-parts":[[2020,10,2]],"date-time":"2020-10-02T03:16:19Z","timestamp":1601608579000},"page":"654-660","source":"Crossref","is-referenced-by-count":3,"title":["Endoscope-assisted microsurgical resection of intrinsic brainstem epidermoid: technical note and review of the literature"],"prefix":"10.3171","volume":"26","author":[{"given":"Alan R.","family":"Cohen","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scellig S. D.","family":"Stone","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Boston Children\u2019s Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"8","key":"b1","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"471","DOI":"10.1007\/BF00274412","article-title":"Recurrent intrinsic brain stem epidermoid cyst","volume":"8","author":"Fournier D","year":"1992","unstructured":"Fournier D, Mercier P, Menei P,  Recurrent intrinsic brain stem epidermoid cyst. Childs Nerv Syst. 1992;8(8):471\u2013474.10.1007\/BF002744121288859"},{"issue":"2","key":"b2","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"214","DOI":"10.3171\/jns.1985.62.2.0214","article-title":"Epidermoid cysts of the posterior fossa","volume":"62","author":"Berger MS","year":"1985","unstructured":"Berger MS, Wilson CB. Epidermoid cysts of the posterior fossa. J Neurosurg. 1985;62(2):214\u2013219.10.3171\/jns.1985.62.2.02143968559"},{"issue":"3","key":"b3","series-title":"Asian J Neurosurg","doi-asserted-by":"publisher","first-page":"194","DOI":"10.4103\/1793-5482.145163","article-title":"Brainstem epidermoid cyst: an update","volume":"11","author":"Patibandla MR","year":"2016","unstructured":"Patibandla MR, Yerramneni VK, Mudumba VS,  Brainstem epidermoid cyst: an update. Asian J Neurosurg. 2016;11(3):194\u2013200.10.4103\/1793-5482.14516327366244"},{"issue":"1","key":"b4","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1007\/s007010050013","article-title":"Epidermoid cyst involving the brain stem","volume":"142","author":"Kachhara R","year":"2000","unstructured":"Kachhara R, Bhattacharya RN, Radhakrishnan VV. Epidermoid cyst involving the brain stem. Acta Neurochir (Wien). 2000;142(1):97\u2013100.10.1007\/s007010050013"},{"issue":"6","key":"b5","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"537","DOI":"10.1016\/0090-3019(95)00470-X","article-title":"Intramedullary epidermoid cyst in the brain stem: case report","volume":"45","author":"Yoshizato K","year":"1996","unstructured":"Yoshizato K, Kai Y, Kuratsu J, Ushio Y. Intramedullary epidermoid cyst in the brain stem: case report. Surg Neurol. 1996;45(6):537\u2013540.10.1016\/0090-3019(95)00470-X8638239"},{"key":"b6","series-title":"Surgery of the Cerebellopontine Angle","author":"Bambakidis N","year":"2009","unstructured":"Bambakidis N, Megerian C, Spetzler R. Surgery of the Cerebellopontine Angle. People\u2019s Medical Publishing House; 2009."},{"issue":"2","key":"b7","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1016\/S0090-3019(01)00542-0","article-title":"Intra-axial dermoid\/epidermoid tumors of the brainstem in children","volume":"56","author":"Caldarelli M","year":"2001","unstructured":"Caldarelli M, Colosimo C, Di Rocco C. Intra-axial dermoid\/epidermoid tumors of the brainstem in children. Surg Neurol. 2001;56(2):97\u2013105.10.1016\/S0090-3019(01)00542-011580945"},{"issue":"1","key":"b8","series-title":"J Child Neurol","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1177\/0883073811414709","article-title":"Epidermoid cyst of the brainstem in children: case-based update","volume":"27","author":"Gopalakrishnan CV","year":"2012","unstructured":"Gopalakrishnan CV, Dhakoji A, Nair S. Epidermoid cyst of the brainstem in children: case-based update. J Child Neurol. 2012;27(1):105\u2013112.10.1177\/088307381141470921862831"},{"issue":"1","key":"b9","series-title":"J Pediatr Neurosci","doi-asserted-by":"publisher","first-page":"52","DOI":"10.4103\/1817-1745.131487","article-title":"Intrinsic brainstem white epidermoid cyst: an unusual case report","volume":"9","author":"Mishra SS","year":"2014","unstructured":"Mishra SS, Panigrahi S, Dhir MK, Pattajoshi AS. Intrinsic brainstem white epidermoid cyst: an unusual case report. J Pediatr Neurosci. 2014;9(1):52\u201354.2489190610.4103\/1817-1745.131487"},{"issue":"4","key":"b10","series-title":"J Neurosurg","first-page":"285","article-title":"Intrinsic brainstem epidermoid cyst. Case report and review of the literature","volume":"104","author":"Recinos PF","year":"2006","unstructured":"Recinos PF, Roonprapunt C, Jallo GI. Intrinsic brainstem epidermoid cyst. Case report and review of the literature. J Neurosurg. 2006;104(4)(suppl):285\u2013289.16619643"},{"issue":"8","key":"b11","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"1589","DOI":"10.1007\/s00381-018-3774-1","article-title":"Intrinsic epidermoid of the brain stem: case report and review of the literature","volume":"34","author":"Singh SK","year":"2018","unstructured":"Singh SK, Jain K, Jain VK. Intrinsic epidermoid of the brain stem: case report and review of the literature. Childs Nerv Syst. 2018;34(8):1589\u20131592.2955669610.1007\/s00381-018-3774-1"},{"issue":"3","key":"b12","series-title":"Neurol Med Chir (Tokyo)","doi-asserted-by":"publisher","first-page":"140","DOI":"10.2176\/nmc.47.140","article-title":"Brainstem epidermoid cyst in a child. Case report","volume":"47","author":"Takahashi M","year":"2007","unstructured":"Takahashi M, Paz Paredes A, Scavarda D, Lena G. Brainstem epidermoid cyst in a child. Case report. Neurol Med Chir (Tokyo). 2007;47(3):140\u2013144.10.2176\/nmc.47.140"},{"key":"b13","series-title":"World Neurosurg","doi-asserted-by":"publisher","first-page":"1046.e15","DOI":"10.1016\/j.wneu.2017.04.164","article-title":"Unusual intraparenchymal pontomedullary epidermoid cyst in a 2-year-old child: a case report and review of the literature","volume":"104","author":"Shtaya A","year":"2017","unstructured":"Shtaya A, Dabbous B, Fanou E,  Unusual intraparenchymal pontomedullary epidermoid cyst in a 2-year-old child: a case report and review of the literature. World Neurosurg. 2017;104:1046.e15\u20131046.e20.10.1016\/j.wneu.2017.04.164"},{"issue":"3","key":"b14","series-title":"J Pediatr Neurosci","doi-asserted-by":"publisher","first-page":"230","DOI":"10.4103\/1817-1745.193379","article-title":"A rare case of white pearls in brainstem","volume":"11","author":"Mankotia DS","year":"2016","unstructured":"Mankotia DS, Tandon V, Sardana H,  A rare case of white pearls in brainstem. J Pediatr Neurosci. 2016;11(3):230\u2013233.2785779410.4103\/1817-1745.193379"},{"key":"b15","series-title":"Surg Gynecol Obstet","first-page":"390","article-title":"Cruvelhier\u2019s tumeurs perlees","volume":"31","author":"Bailey P.","year":"1920","unstructured":"Bailey P. Cruvelhier\u2019s tumeurs perlees. Surg Gynecol Obstet. 1920;31:390\u2013401."},{"key":"b16","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"35","DOI":"10.3171\/jns.1960.17.1.0035","article-title":"Pearly tumor (epidermoid cholesteatoma) of the brain. Clinicopathologic study of two cases","volume":"17","author":"Rosenbluth PR","year":"1960","unstructured":"Rosenbluth PR, Lichtenstein BW. Pearly tumor (epidermoid cholesteatoma) of the brain. Clinicopathologic study of two cases. J Neurosurg. 1960;17:35\u201342.10.3171\/jns.1960.17.1.003514438982"},{"key":"b17","series-title":"The Brain","author":"Dandy W.","year":"1945","unstructured":"Dandy W. The Brain. W.F. Prior; 1945."},{"issue":"4","key":"b18","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"561","DOI":"10.1227\/00006123-198904000-00012","article-title":"Microneurosurgical treatment of intracranial dermoid and epidermoid tumors","volume":"24","author":"Ya\u015fargil MG","year":"1989","unstructured":"Ya\u015fargil MG, Abernathey CD, Sarioglu AC. Microneurosurgical treatment of intracranial dermoid and epidermoid tumors. Neurosurgery. 1989;24(4):561\u2013567.10.1227\/00006123-198904000-000122710301"},{"issue":"1","key":"b19","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"123","DOI":"10.3171\/jns.1991.74.1.0123","article-title":"Epidermoid cysts of the brain stem. Report of three cases","volume":"74","author":"Obana WG","year":"1991","unstructured":"Obana WG, Wilson CB. Epidermoid cysts of the brain stem. Report of three cases. J Neurosurg. 1991;74(1):123\u2013128.10.3171\/jns.1991.74.1.01231984491"},{"key":"b20","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"1051","DOI":"10.3171\/jns.1964.21.12.1051","article-title":"Intracranial epidermoids. A study on their distribution and spread","volume":"21","author":"Ulrich J.","year":"1964","unstructured":"Ulrich J. Intracranial epidermoids. A study on their distribution and spread. J Neurosurg. 1964;21:1051\u20131058.10.3171\/jns.1964.21.12.1051"},{"key":"b21","series-title":"World Neurosurg","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1016\/j.wneu.2018.01.128","article-title":"Cerebellar vermian epidermoid tumor: a report of 2 cases","volume":"112","author":"Balogun JA","year":"2018","unstructured":"Balogun JA, Adeleke NA, Salami AO, Odebode TO. Cerebellar vermian epidermoid tumor: a report of 2 cases. World Neurosurg. 2018;112:153\u2013157.2941003510.1016\/j.wneu.2018.01.128"},{"issue":"5","key":"b22","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"1599","DOI":"10.3171\/2017.12.JNS172575","article-title":"Endoscopic endonasal resection of epidermoid cysts involving the ventral cranial base","volume":"130","author":"Forbes JA","year":"2019","unstructured":"Forbes JA, Banu M, Lehner K,  Endoscopic endonasal resection of epidermoid cysts involving the ventral cranial base. J Neurosurg. 2019;130(5):1599\u20131608.10.3171\/2017.12.JNS172575"},{"issue":"12","key":"b23","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"1025","DOI":"10.1007\/s00381-005-1172-y","article-title":"Epidermoid cyst of the brain stem symptomatic in childhood","volume":"21","author":"Ziyal IM","year":"2005","unstructured":"Ziyal IM, Bilginer B, Bozkurt G,  Epidermoid cyst of the brain stem symptomatic in childhood. Childs Nerv Syst. 2005;21(12):1025\u20131029.1604154810.1007\/s00381-005-1172-y"},{"issue":"2","key":"b24","series-title":"Neurology","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1212\/WNL.28.2.124","article-title":"Recurrent meningitis due to an intracranial epidermoid","volume":"28","author":"Schwartz JF","year":"1978","unstructured":"Schwartz JF, Balentine JD. Recurrent meningitis due to an intracranial epidermoid. Neurology. 1978;28(2):124\u2013129.10.1212\/WNL.28.2.124"},{"issue":"9","key":"b25","series-title":"Clin Neurol Neurosurg","doi-asserted-by":"publisher","first-page":"1888","DOI":"10.1016\/j.clineuro.2013.05.002","article-title":"Brainstem epidermoid cyst in an individual with two previous intracranial epidermoid cysts: a rare diagnosis in a rare individual","volume":"115","author":"Mask-Bull L","year":"2013","unstructured":"Mask-Bull L, Do B, Cattaneo JC. Brainstem epidermoid cyst in an individual with two previous intracranial epidermoid cysts: a rare diagnosis in a rare individual. Clin Neurol Neurosurg. 2013;115(9):1888\u20131890.10.1016\/j.clineuro.2013.05.002"},{"issue":"5","key":"b26","series-title":"AJR Am J Roentgenol","doi-asserted-by":"publisher","first-page":"1059","DOI":"10.2214\/ajr.155.5.2120936","article-title":"Diffusion-weighted MR imaging of the brain: value of differentiating between extraaxial cysts and epidermoid tumors","volume":"155","author":"Tsuruda JS","year":"1990","unstructured":"Tsuruda JS, Chew WM, Moseley ME, Norman D. Diffusion-weighted MR imaging of the brain: value of differentiating between extraaxial cysts and epidermoid tumors. AJR Am J Roentgenol. 1990;155(5):1059\u20131065, 1066\u20131068.10.2214\/ajr.155.5.21209362120936"},{"key":"b27","series-title":"World Neurosurg","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1016\/j.wneu.2019.07.072","article-title":"Split-pons syndrome by epidermoid cyst: a case report and review of the literature","volume":"131","author":"You E","year":"2019","unstructured":"You E, Bokhari R, Sirhan D. Split-pons syndrome by epidermoid cyst: a case report and review of the literature. World Neurosurg. 2019;131:275\u2013280.e10.3130684610.1016\/j.wneu.2019.07.072"},{"issue":"5","key":"b28","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1016\/0090-3019(89)90143-2","article-title":"Epidermoid cyst traversing the pons into the fourth ventricle. Case report","volume":"32","author":"Iihara K","year":"1989","unstructured":"Iihara K, Kikuchi H, Ishikawa M, Nagasawa S. Epidermoid cyst traversing the pons into the fourth ventricle. Case report. Surg Neurol. 1989;32(5):377\u2013381.10.1016\/0090-3019(89)90143-22814791"},{"issue":"8","key":"b29","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1007\/BF00335076","article-title":"Brain stem dermoid cyst","volume":"10","author":"Dunn LT","year":"1994","unstructured":"Dunn LT, May PL, MacKenzie JM. Brain stem dermoid cyst. Childs Nerv Syst. 1994;10(8):529\u2013532.10.1007\/BF003350767882376"},{"issue":"2","key":"b30","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"254","DOI":"10.3171\/jns.1979.51.2.0254","article-title":"Excision of a brain-stem epidermoid cyst. Case report","volume":"51","author":"Weaver EN Jr","year":"1979","unstructured":"Weaver EN Jr, Coulon RA Jr. Excision of a brain-stem epidermoid cyst. Case report. J Neurosurg. 1979;51(2):254\u2013257.10.3171\/jns.1979.51.2.0254448436"},{"issue":"6","key":"b31","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"1197","DOI":"10.1007\/s00701-016-2813-5","article-title":"Cyst-cisternal shunting for cystic multirecurrent brainstem epidermoid: case report and literature review","volume":"158","author":"Mortini P","year":"2016","unstructured":"Mortini P, Bailo M, Spina A,  Cyst-cisternal shunting for cystic multirecurrent brainstem epidermoid: case report and literature review. Acta Neurochir (Wien). 2016;158(6):1197\u20131201.10.1007\/s00701-016-2813-5"},{"issue":"2","key":"b32","series-title":"Skull Base Surg","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1055\/s-2008-1058152","article-title":"Anterior transpetrosal approach to the prepontine epidermoids","volume":"9","author":"Shimamoto Y","year":"1999","unstructured":"Shimamoto Y, Kawase T, Sasaki H,  Anterior transpetrosal approach to the prepontine epidermoids. Skull Base Surg. 1999;9(2):75\u201380.10.1055\/s-2008-1058152"},{"issue":"4","key":"b33","series-title":"Turk Neurosurg","first-page":"452","article-title":"Giant intramedullary epidermoid extending from the brain stem to the upper thoracic spinal cord","volume":"22","author":"Kansal R","year":"2012","unstructured":"Kansal R, Mahore A, Dange N. Giant intramedullary epidermoid extending from the brain stem to the upper thoracic spinal cord. Turk Neurosurg. 2012;22(4):452\u2013453."},{"issue":"3","key":"b34","series-title":"Neurosurgery","first-page":"579","article-title":"Microsurgical excision of a pontomedullary epidermoid cyst with prepontine extension: case report","volume":"38","author":"Malcolm GP","year":"1996","unstructured":"Malcolm GP, Gibson R, Ironside JW, Whittle IR. Microsurgical excision of a pontomedullary epidermoid cyst with prepontine extension: case report. Neurosurgery. 1996;38(3):579\u2013583.8837813"},{"issue":"1","key":"b35","series-title":"J Neurooncol","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1007\/s11060-019-03202-2","article-title":"Radiotherapy for recurrent intracranial epidermoid cysts without malignant transformation: a single-institution case series","volume":"144","author":"Morshed RA","year":"2019","unstructured":"Morshed RA, Wu SY, Sneed PK, McDermott MW. Radiotherapy for recurrent intracranial epidermoid cysts without malignant transformation: a single-institution case series. J Neurooncol. 2019;144(1):89\u201396.10.1007\/s11060-019-03202-231168670"},{"issue":"5","key":"b36","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"811","DOI":"10.3171\/jns.1978.48.5.0811","article-title":"Epidermoid cyst in the brain stem. Case report","volume":"48","author":"Leal O","year":"1978","unstructured":"Leal O, Miles J. Epidermoid cyst in the brain stem. Case report. J Neurosurg. 1978;48(5):811\u2013813.10.3171\/jns.1978.48.5.0811641558"}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/26\/6\/article-p654.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/26\/6\/article-p654.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/26\/6\/article-p654.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T01:54:42Z","timestamp":1792806882000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/26\/6\/article-p654.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,12]]},"references-count":36,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/2020.6.peds20482","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,12]]}}}