Cerebellopontine angle epidermoids: results of surgical treatment.

Epidermoids, or congenital cholesteatomas, constitute about 0.2% to 1.5% of intracranial tumors, and 3% to 5% of tumors of the cerebellopontine angle (CPA). We review the surgical management of CPA epidermoids in 13 patients at the House Ear Clinic for the years 1978 to 1993. There were seven male and six female patients, ranging in age from 27 to 59 years (average, 40 years). Tumors ranged in size from 3.5 cm to 7.0 cm, and the surgical approach was tailored to the tumor extent and location. All patients complained at presentation of unilateral hearing loss, and nine had poor speech discrimination (less than 50%) preoperatively. Serviceable hearing was preserved in two patients. Two patients presented with facial nerve symptoms, and four cases had postoperative permanent facial nerve paralysis (House-Brackmann Grade V or VI). There were no surgical deaths. Four patients required second surgeries to remove residual cholesteatoma. Compared with prior series, we describe a higher rate of total tumor removed, as well as a higher rate of second operations, indicating a more aggressive approach to these lesions.