小脳橋角部類上皮腫に対する手術戦略

Surgical Strategy for Cerebellopontine Angle Epidermoid Cysts

Point

・小脳橋角部類上皮腫手術の目標は，被膜の全摘と脳神経機能温存の両立にある．

・目標達成のためには，さまざまな頭蓋底アプローチを使い分ける高い技術と熟練した術中モニタリングが必須である．

・フォローは長期間行う必要があり，悪性転化の可能性も念頭に置くべきである．

＊本論文中、［Video］マークのある図につきましては、関連する動画を見ることができます（公開期間：2028年8月まで）。

　Intracranial epidermoid cysts are congenital benign tumors; however, there is a long-term risk of recurrence if the tumor capsule is left behind perioperatively. Additionally, in cerebellopontine angle surgery, in which cranial nerves and blood vessels are densely concentrated, cranial nerve functions must be preserved besides radical removal of the tumor capsule. Particularly, the optimal surgical field should be obtained under direct visualization to avoid cranial nerve damage due to manipulation over cranial nerves and leaving the tumor behind in the blind spot of the surgical field. Therefore, besides the use of intraoperative monitoring, high surgical skills are required to use four skull base surgical approaches, such as lateral suboccipital retrosigmoid approach (LSO), anterior transpetrosal approach (ATP), combined transpetrosal approach, and ATP and LSO, depending on the size and progression of the tumor. Moreover, this disease should be treated at a specialized facility for skull base surgery.