Surgical treatment of parapontine epidermoid cysts presenting with trigeminal neuralgia

J Clin Neurosci. 2011 Mar;18(3):344-6. doi: 10.1016/j.jocn.2010.07.110. Epub 2011 Jan 17.


We retrospectively reviewed the management of 49 patients with parapontine epidermoid cyst presenting with trigeminal neuralgia, emphasizing the importance of fully removing the tumor to relieve the trigeminal neuralgia. Clinical symptoms, MRI, the operative approach, and post-operative results were examined. Trigeminal neuralgia was noted in all patients. The mean duration from onset of symptoms to surgery was 18 months. Total removal was achieved in 23 patients, near-total removal in 21, and subtotal removal in five patients. However, all tumor capsule that adhered to the trigeminal nerve was completely removed. After the operation, 33 patients developed facial hypoesthesia, three complained of double vision, and two developed acute hydrocephalus. At six months of follow-up, all patients had recovered and returned to their normal lives. At 2 years of follow-up, one patient experienced pain recurrence and underwent another operation. Parapontine epidermoid cysts either encase cranial nerve (CN) V but with intact arachnoid between the capsule and the nerve, or compress and distort the nerve with tumor capsule adherent or attached to the nerve surface. Resecting the tumor capsule's attachment to CN V is critical in relieving pain, even though this method may damage the nerve.

MeSH terms

  • Adult
  • Brain Diseases / surgery*
  • Diplopia / etiology
  • Epidermal Cyst / complications*
  • Epidermal Cyst / pathology
  • Epidermal Cyst / surgery*
  • Female
  • Humans
  • Hydrocephalus / etiology
  • Hypesthesia / etiology
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Neurosurgical Procedures / adverse effects
  • Postoperative Complications / etiology
  • Retrospective Studies
  • Trigeminal Nerve / pathology
  • Trigeminal Nerve / surgery
  • Trigeminal Neuralgia / etiology*
  • Trigeminal Neuralgia / surgery