Name:
10.3171/2026.7.FOCVID2677_vid
Description:
10.3171/2026.7.FOCVID2677_vid
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/acecf251-8934-451f-8073-ec0185554de8/videoscrubberimages/Scrubber_190.jpg
Duration:
T00H06M30S
Embed URL:
https://stream.cadmore.media/player/acecf251-8934-451f-8073-ec0185554de8
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/acecf251-8934-451f-8073-ec0185554de8/18. 26-77.mp4?sv=2019-02-02&sr=c&sig=2Vvka7o5G8rbbwJRI1I9dxjVqW1Haqzk4SpK9w1bSjc%3D&st=2026-10-29T21%3A47%3A04Z&se=2026-10-29T23%3A52%3A04Z&sp=r
Upload Date:
2026-10-29T21:52:04.1776409Z
Transcript:
Language: EN.
Segment:0 .
[MUSIC PLAYING]
SPEAKER: This video demonstrates the diagnosis and retrosigmoid resection of a primary isolated ectopic cerebellopontine angle craniopharyngioma, causing progressive multiple cranial nerve deficit, highlighting monitoring-guided functional preservation and long-term tumor control. This lesion had been known for approximately 20 years, and had remained radiographically stable for several years before renewed enlargement.
SPEAKER: The patient, a woman in her 70s, presented with progressive left facial numbness and gait disturbance. She subsequently developed House-Brackmann grade V facial nerve palsy, dysphagia, and hoarseness. CT demonstrated an approximately isodense, mildly heterogeneous mass in the cerebellopontine angle, compressing the brainstem with focal peripheral punctate calcifications. Contrast-enhanced MRI showed a 44-millimeter lesion extending into the Meckel's cave, composed of a relatively homogeneous cystic component, and irregularly enhancing solid components.
SPEAKER: The cystic component was hyperintense on both T1- and T2-weighted images, and showed low signal on diffusion-weighted imaging. Schwannoma often contains cystic components, but the calcification is unusual. Meningioma can show calcifications and enhancing solid components, but a predominantly cystic architecture was atypical as cystic meningiomas are uncommon. Epidermoid cysts can appear predominantly cystic, but the low diffusion signal---rather than diffusion restriction---and the enhancing solid component were atypical.
SPEAKER: Overall, these findings prompted consideration of craniopharyngioma, despite the absence of sellar, suprasellar, or pituitary stalk involvement, based on our previous experience with two ectopic cerebellopontine angle craniopharyngiomas. Given the suggestive imaging findings and progressive cranial nerve deficit, we adopted a function-oriented strategy aimed at maximum safe resection and cranial nerve preservation.
SPEAKER: A retrosigmoid approach was selected because it avoids temporal lobe retraction, and allows early identification of the proximal facial nerve, enabling ball-type electrode placement and a continuous second-by-second monitoring from the early stage of dissection. In the park-bench position, we identified the lower cranial nerves and the facial-vestibulocochlear complex along the dorsocaudal surface of the tumor.
SPEAKER: After cyst puncture and evacuation of xanthochromic cyst fluid, we obtained a wide working space in the cerebellopontine angle and identify the trigeminal nerve on the cranial aspect of the lesion. After identifying proximal facial nerve, a ball-type electrode was then placed on the proximal facial nerve to begin serial stimulation monitoring at 1-second intervals. This real-time serial stimulation monitoring helped guide a capsule dissection around the facial-vestibulocochlear complex by allowing prompt recognition of amplitude changes.
SPEAKER: While monitoring real-time electromyographic responses, we remove the solid nodular component behind the facial-vestibulocochlear complex through the space between the facial and vestibulocochlear nerves, and the space above the vestibulocochlear nerve. Cranially, the trochlear nerve was also identified. And the solid component near the Meckel's cave was resected.
SPEAKER: The capsule was followed as far as safely possible, while preserving the anterior inferior cerebellar artery and abducens nerve. However, densely adherent portions on the facial-vestibulocochlear complex and brainstem were intentionally left to preserve function.
SPEAKER: The response amplitude on continuous facial nerve monitoring remained above 90% of baseline throughout the procedure. Postoperatively, no new neurological deficits developed. Hearing did not deteriorate, and facial nerve function improved from House-Brackmann grade V to grade II. Gait disturbance, hoarseness, and dysphagia resolved. Postoperative contrast-enhanced MRI confirmed near-total resection, with a small residual tumor intentionally left behind the facial-vestibulocochlear complex because of dense adhesion.
SPEAKER: Pathology confirmed adamantinomatous craniopharyngioma, characterized by a cyst wall lined by multilayered, keratinized squamous epithelium containing wet keratin, with granulation tissue rich in cholesterol clefts and multinucleated giant cells. No tumor regrowth has been observed, and no additional treatment has been required during 7 years of follow-up.
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