Endoscope-assisted microsurgical resection of intrinsic brainstem epidermoid: Technical note and review of the literature

Alan R. Cohen, Scellig S.D. Stone

Research output: Contribution to journalArticlepeer-review


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's 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.

Original languageEnglish (US)
Pages (from-to)654-660
Number of pages7
JournalJournal of Neurosurgery: Pediatrics
Issue number6
StatePublished - Dec 2020


  • Brain tumor
  • Brainstem
  • Diagnosis
  • Epidermoid
  • MRI
  • Microsurgery
  • Neuroendoscopy
  • Oncology
  • Surgical technique

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health
  • Clinical Neurology


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