{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T02:10:54Z","timestamp":1791598254592,"version":"4.3.4"},"reference-count":44,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,1]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Complete removal of an epidermoid cyst (EC) is considered to prevent recurrence. In the cerebellopontine angle (CPA), ECs form adhesions to the surrounding neural and vascular structures, which makes complete removal challenging. At times, this achievement comes with neurological sequelae but can be justified by the promise of long-term disease control. The aim of this study was to investigate when recurrence occurs and whether the extent of resection affects recurrence over long-term follow-up.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n This retrospective cohort study included 30 consecutive patients (20 male, mean age 36 years) who underwent surgery for CPA EC from 1975 to 2022 at a single neurosurgical center with a catchment population of 2.2 million. Clinical and imaging data were collected from patient medical records. The extent of tumor resection was evaluated using MRI and compared with surgical reports. Kaplan-Meier survival analysis was performed to estimate reoperation-free survival.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Eleven patients (37%) required reoperation due to recurrence, 8 (27%) more than once. A total of 24 reoperations were performed. The estimated median reoperation-free survival was 20 years (95% CI 4\u201336) from the primary surgery and 11 years (95% CI 8\u201314) from reoperation. The incidence of recurrence followed a linear trend; the longer the follow-up, the higher the chance of recurrence. Neither the postoperative imaging\u2013based or surgeon-assessed extent of tumor removal predicted recurrence. New postoperative symptoms were observed in 50% of patients. Although many of the new symptoms resolved during the first 3 months, only 16% (3\/19) of patients with follow-up > 1 year remained asymptomatic at the end of follow-up.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n During long-term follow-up, recurrence of CPA EC was frequent and occured with all grades of resection. Given the relatively high risk of neurological sequelae associated with surgery, the surgical strategy should prioritize safe resection over aggressive attempts at total removal. Even in cases of complete resection, routine imaging follow-up at intervals of 5 to 10 years, with the possibility of extending surveillance up to 20 years, is recommended.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2025.6.jns243041","type":"journal-article","created":{"date-parts":[[2025,10,25]],"date-time":"2025-10-25T01:40:45Z","timestamp":1761356445000},"page":"361-368","source":"Crossref","is-referenced-by-count":2,"title":["Cerebellopontine epidermoid cysts: is the pursuit of complete resection justifiable despite high recurrence rates?"],"prefix":"10.3171","volume":"144","author":[{"given":"Anselmi","family":"Kovalainen","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Uusimaa, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justiina","family":"Huhtakangas","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Uusimaa, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Lehecka","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Uusimaa, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"4","key":"b1","series-title":"J Neurosurg","first-page":"743","article-title":"Giant intracranial epidermoids: is total removal feasible?","volume":"122","author":"Aboud E","year":"2015","unstructured":"Aboud E, Abolfotoh M, Pravdenkova S, Gokoglu A, Gokden M, Al-Mefty O. Giant intracranial epidermoids: is total removal feasible?. J Neurosurg. 2015;122(4):743\u2013756."},{"issue":"4","key":"b2","series-title":"Neurosurgery","first-page":"561","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."},{"issue":"1","key":"b3","series-title":"Z f d g Neur u Psych","first-page":"416","article-title":"Die Epidermoide des Zentralnervensystems","volume":"155","author":"Mahoney W","year":"1936","unstructured":"Mahoney W. Die Epidermoide des Zentralnervensystems. Z f d g Neur u Psych. 1936;155(1):416\u2013471."},{"issue":"2","key":"b4","series-title":"J Neurosurg","first-page":"214","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."},{"issue":"4","key":"b5","series-title":"J Neurosurg","first-page":"384","article-title":"Epithelial (epidermoid) tumors of the cranium. Their common nature and pathogenesis","volume":"23","author":"Toglia JU","year":"1965","unstructured":"Toglia JU, Netsky MG, Alexander E Jr. Epithelial (epidermoid) tumors of the cranium. Their common nature and pathogenesis. J Neurosurg. 1965;23(4):384\u2013393."},{"issue":"9","key":"b6","series-title":"Acta Neurochir (Wien)","first-page":"2465","article-title":"Importance of appropriate surgical approach selection for radical resection of cerebellopontine angle epidermoid cysts with preservation of cranial nerve functions: our experience of 54 cases","volume":"163","author":"Sakamoto H","year":"2021","unstructured":"Sakamoto H, Kohno M, Matsushima K, Ichimasu N, Nakajima N, Yoshino M. Importance of appropriate surgical approach selection for radical resection of cerebellopontine angle epidermoid cysts with preservation of cranial nerve functions: our experience of 54 cases. Acta Neurochir (Wien). 2021;163(9):2465\u20132474."},{"issue":"3","key":"b7","series-title":"Neurosurg Rev","first-page":"2499","article-title":"Long-term surgical oncological and functional outcome of large spetroclival and cerebellopontine angle epidermoid cysts: a multicenter study","volume":"45","author":"Sellier A","year":"2022","unstructured":"Sellier A, Troude L, Baumgarten C, Long-term surgical oncological and functional outcome of large spetroclival and cerebellopontine angle epidermoid cysts: a multicenter study. Neurosurg Rev. 2022;45(3):2499."},{"issue":"2","key":"b8","series-title":"Neurosurg Rev","first-page":"259","article-title":"Cerebellopontine angle epidermoid cysts: clinical presentations and surgical outcome","volume":"39","author":"Hasegawa M","year":"2016","unstructured":"Hasegawa M, Nouri M, Nagahisa S, Cerebellopontine angle epidermoid cysts: clinical presentations and surgical outcome. 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Neurosurgery. 1989;24(4):561\u2013567."},{"issue":"1","key":"b3","series-title":"Z f d g Neur u Psych","first-page":"416","article-title":"Die Epidermoide des Zentralnervensystems","volume":"155","author":"Mahoney W","year":"1936","unstructured":"Mahoney W. Die Epidermoide des Zentralnervensystems. Z f d g Neur u Psych. 1936;155(1):416\u2013471."},{"issue":"2","key":"b4","series-title":"J Neurosurg","first-page":"214","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."},{"issue":"4","key":"b5","series-title":"J Neurosurg","first-page":"384","article-title":"Epithelial (epidermoid) tumors of the cranium. Their common nature and pathogenesis","volume":"23","author":"Toglia JU","year":"1965","unstructured":"Toglia JU, Netsky MG, Alexander E Jr. Epithelial (epidermoid) tumors of the cranium. Their common nature and pathogenesis. J Neurosurg. 1965;23(4):384\u2013393."},{"issue":"9","key":"b6","series-title":"Acta Neurochir (Wien)","first-page":"2465","article-title":"Importance of appropriate surgical approach selection for radical resection of cerebellopontine angle epidermoid cysts with preservation of cranial nerve functions: our experience of 54 cases","volume":"163","author":"Sakamoto H","year":"2021","unstructured":"Sakamoto H, Kohno M, Matsushima K, Ichimasu N, Nakajima N, Yoshino M. Importance of appropriate surgical approach selection for radical resection of cerebellopontine angle epidermoid cysts with preservation of cranial nerve functions: our experience of 54 cases. Acta Neurochir (Wien). 2021;163(9):2465\u20132474."},{"issue":"3","key":"b7","series-title":"Neurosurg Rev","first-page":"2499","article-title":"Long-term surgical oncological and functional outcome of large spetroclival and cerebellopontine angle epidermoid cysts: a multicenter study","volume":"45","author":"Sellier A","year":"2022","unstructured":"Sellier A, Troude L, Baumgarten C, Long-term surgical oncological and functional outcome of large spetroclival and cerebellopontine angle epidermoid cysts: a multicenter study. Neurosurg Rev. 2022;45(3):2499."},{"issue":"2","key":"b8","series-title":"Neurosurg Rev","first-page":"259","article-title":"Cerebellopontine angle epidermoid cysts: clinical presentations and surgical outcome","volume":"39","author":"Hasegawa M","year":"2016","unstructured":"Hasegawa M, Nouri M, Nagahisa S, Cerebellopontine angle epidermoid cysts: clinical presentations and surgical outcome. Neurosurg Rev. 2016;39(2):259\u2013267."},{"issue":"7","key":"b9","series-title":"Acta Neurochir (Wien)","first-page":"1791","article-title":"Microsurgical anatomy and pathoanatomy of the outer arachnoid membranes in the cerebellopontine angle: cadaveric and intraoperative observations","volume":"165","author":"Kurucz P","year":"2023","unstructured":"Kurucz P, Ganslandt O, Buchfelder M, Barany L. Microsurgical anatomy and pathoanatomy of the outer arachnoid membranes in the cerebellopontine angle: cadaveric and intraoperative observations. Acta Neurochir (Wien). 2023;165(7):1791\u20131805."},{"issue":"6","key":"b10","series-title":"Surg Neurol","first-page":"584","article-title":"Epidermoids of the cerebellopontine angle: a 20-year experience","volume":"70","author":"Schiefer TK","year":"2008","unstructured":"Schiefer TK, Link MJ. Epidermoids of the cerebellopontine angle: a 20-year experience. Surg Neurol. 2008;70(6):584\u2013590."},{"issue":"6","key":"b11","series-title":"J Neurosurg","first-page":"1592","article-title":"Long-term surgical outcomes of intracranial epidermoid tumors: impact of extent of resection on recurrence and functional outcomes in 63 patients","volume":"136","author":"Hasegawa H","year":"2022","unstructured":"Hasegawa H, Vakharia K, Carlstrom LP, Long-term surgical outcomes of intracranial epidermoid tumors: impact of extent of resection on recurrence and functional outcomes in 63 patients. J Neurosurg. 2022;136(6):1592\u20131600."},{"issue":"2","key":"b12","series-title":"J Neurosurg","first-page":"291","article-title":"Extent of resection of epidermoid tumors and risk of recurrence: case report and meta-analysis","volume":"133","author":"Shear BM","year":"2020","unstructured":"Shear BM, Jin L, Zhang Y, Extent of resection of epidermoid tumors and risk of recurrence: case report and meta-analysis. 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Cerebellopontine angle epidermoids presenting with cranial nerve hyperactive dysfunction: pathogenesis and long-term surgical results in 30 patients. Neurosurgery. 2002;50(2):276\u2013286."},{"issue":"1","key":"b15","series-title":"J Neurosurg","first-page":"14","article-title":"Surgical treatment of epidermoid cysts of the cerebellopontine angle","volume":"84","author":"Samii M","year":"1996","unstructured":"Samii M, Tatagiba M, Piquer J, Carvalho GA. Surgical treatment of epidermoid cysts of the cerebellopontine angle. J Neurosurg. 1996;84(1):14\u201319."},{"issue":"9","key":"b16","series-title":"J Clin Neurosci","first-page":"1158","article-title":"Clinical characteristics and diagnostic imaging of epidermoid tumors","volume":"18","author":"Nagasawa D","year":"2011","unstructured":"Nagasawa D, Yew A, Safaee M, Clinical characteristics and diagnostic imaging of epidermoid tumors. 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J Clin Neurosci. 2016;33:59\u201362."},{"key":"b19","series-title":"Front Oncol","first-page":"750899","article-title":"Primary squamous cell carcinomas arising in intracranial epidermoid cysts: a series of nine cases and systematic review","volume":"11","author":"Zuo P","year":"2021","unstructured":"Zuo P, Sun T, Wang Y, Primary squamous cell carcinomas arising in intracranial epidermoid cysts: a series of nine cases and systematic review. Front Oncol. 2021;11:750899."},{"issue":"7","key":"b20","series-title":"Clin Neurol Neurosurg","first-page":"1071","article-title":"An analysis of intracranial epidermoid tumors with malignant transformation: treatment and outcomes","volume":"115","author":"Nagasawa DT","year":"2013","unstructured":"Nagasawa DT, Choy W, Spasic M, An analysis of intracranial epidermoid tumors with malignant transformation: treatment and outcomes. 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