Fully endoscopic microvascular decompression for the treatment of hemifacial spasm, trigeminal neuralgia, and glossopharyngeal neuralgia: a retrospective study.

BACKGROUND: Microvascular decompression (MVD) is already the preferred surgical treatment for medically refractory neurovascular compression syndromes (NVC) such as hemifacial spasm (HFS), trigeminal neuralgia (TN), and glossopharyngeal neuralgia (GPN). Endoscopy has significantly advanced surgery and provides enhanced visualization of MVD. The aim of this study is to analyze the efficacy and safety of fully endoscopic microvascular decompression (E-MVD) for the treatment of HFS, TN, and GPN, as well as to present our initial experience. MATERIALS AND METHODS: This retrospective case series investigated fully E-MVD performed in 248 patients (123 patients with HFS, 115 patients with TN, and 10 patients with GPN ) from December 2008 to October 2021 at a single institution. The operation duration, clinical outcomes, responsible vessels, intra- and postoperative complications, and recurrences were recorded. Preoperative and immediate postoperative magnetic resonance imaging (MRI) and computerized tomography (CT) were performed for imageological evaluation. The Shorr grading and Barrow Neurological Institute (BNI) pain score were used to evaluate clinical outcomes. The efficacy, safety, and risk factors related to the recurrence of the operation were retrospectively analysed, and the surgical techniques of fully E-MVD were summarised. RESULTS: A total of 248 patients (103 males) met the inclusion criteria and underwent fully E-MVD were retrospectively studied. The effective rate of 123 patients with HFS was 99.1%, of which 113 cases were completely relieved and 9 cases were significantly relieved. The effective rate of 115 patients with TN was 98.9%, of which 105 cases had completely pain relieved after surgery, 5 cases had significant pain relieved, 4 cases had partial pain relieved but still needed to be controlled by medication. The effective rate of 10 patients with GPN was 100%, 10 cases of GPN were completely relieved after surgery. As for complications, temporary facial numbness occurred in 4 cases, temporary hearing loss in 5 cases, dizziness with frequent nausea and vomiting in 8 cases, headache in 12 cases, and no cerebral hemorrhage, intracranial infection, and other complications occurred. Follow-up ranged from 3 to 42 months, with a mean of 18.6 ± 3.3 months. There were 4 cases of recurrence of HFS and 11 cases of recurrence of TN. The other effective patients had no recurrence or worsening of postoperative symptoms. The cerebellopontine angle (CPA) area ratio (healthy/affected side), the length of disease duration, and the type of responsible vessels are the risk factors related to the recurrence of HFS, TN, and GPN treated by fully E-MVD. CONCLUSIONS: In this retrospective study, our results suggest that the fully E-MVD for the treatment of NVC such as HFS, TN, and GPN, is a safe and effective surgical method. Fully E-MVD for the treatment of NVC has advantages and techniques not available with microscopic MVD, which may reduce the incidence of surgical complications while improving the curative effect and reducing the recurrence rate.

Endoscopic third ventriculostomy for treatment of tonsillar descent with hydrocephalus: CSF flow dynamics and treatment strategies.

OBJECTIVE: To explore the role of cerebrospinal fluid (CSF) flow dynamics and develop treatment strategies involving endoscopic surgery for tonsillar descent with hydrocephalus. METHODS: This study included 15 patients with tonsillar descent with hydrocephalus. All patients underwent cine-magnetic resonance imaging (MRI) preoperatively to measure CSF flow at the entrance of the cerebral aqueduct and foramen of Magendie. Endoscopic third ventriculostomy (ETV) was performed. RESULTS: All patients exhibited abnormal CSF flow dynamics at Magendie's foramen prior to surgery. After surgery, cine-MRI showed CSF flow through the ventriculostomy. During the follow-up period of 8-72 months, the level of tonsillar descent reduced in 9 patients, and the spinal cord syrinx was reduced in 1 patient. Clinical symptoms were improved in 14 patients. Secondary endoscopically assisted posterior cranial fossa decompression was performed in one patient whose symptoms were not improved after ETV. In no case was secondary ventriculo-peritoneal shunting performed following primary ETV. CONCLUSION: ETV is a low-risk and effective method that can replace ventriculo-peritoneal shunt placement in the treatment of tonsillar descent with obstructive hydrocephalus. Preoperative cine-MRI of CSF flow dynamics in the aqueduct and Magendie's foramen provides valuable information for determining surgical timing and strategies.

Overexpressed KDM5B is associated with the progression of glioma and promotes glioma cell growth via downregulating p21.

Epigenetic alterations such as aberrant expression of histone-modifying enzymes have been implicated in tumorigenesis. Upregulation of lysine (K)-specific demethylase 5B (KDM5B) has been reported in a variety of malignant tumors. However, the impact of KDM5B in glioma remains unclear. The objective of this study was to investigate the expression and prognostic value of KDM5B in glioma. In clinical glioma samples, we found that KDM5B expression was significantly upregulated in cancer lesions compared with normal brain tissues. Kaplan-Meier analysis showed that patients with glioma and higher KDM5B expression tend to have shorter overall survival time. By silencing or overexpressing KDM5B in glioma cells, we found that KDM5B could promote cell growth both in vitro and in vivo. Moreover, we demonstrated that KDM5B promoted glioma proliferation partly via regulation of the expression of p21. Our study provided evidence that KDM5B functions as a novel tumor oncogene in glioma and may be a potential therapeutic target for glioma management.

[Therapeutic effect of endoscopic third ventriculostomy for pediatric hydrocephalus].

OBJECTIVE: To validate the proposed endoscopic third ventriculostomy success score (ETVSS) for predicting successful ETV outcomes for pediatric hydrocephalus on the basis of individual characteristics. METHODS: For 121 cases at our department from June 2007 to June 2010 at both 6 and 24 months, Actual successful rates were compared with Chi-square test and 95% confidence interval for low, moderate and high chance of success strata based on the ETVSS. Long-term successful probability was calculated with Kaplan-Meier methods. RESULTS: The 6-month ETV successful rate was higher than the mean predicted probabilities of success for both moderate and low success strata, but slightly lower for the high chance of success strata. The ETVSS accurately predicted the outcomes at 24 months; the low, medium and high chance of success strata had actual success rates of 74% (37/50), 62% (28/45) and 41% (11/26) and mean predicted successful probabilities of 81.3%, 61.4% and 34.4% respectively. CONCLUSION: ETVSS may accurately predict the overall long-term successful rates in high, moderate and low-risk groups. Thus it will aid clinical decision-making through predicting the therapeutic effect of ETV.

Endoscopic Fenestration for Treating Galassi Type III Middle Cranial Fossa Arachnoid Cysts: Single- and Multiple-stoma have the Same Curative Effect.

BACKGROUND: For endoscopic fenestration of middle cranial fossa arachnoid cysts (MCFACs), the decisions on the location and number of stomas are key issues. However, research on this particular topic has been limited. Thus, this study aimed to compare single- versus multiple-stoma endoscopic fenestration for treating Galassi type III MCFACs. METHODS: This retrospective study included 86 patients with Galassi type III MCFACs treated with endoscopic fenestration. Single-stoma fenestration to the basal cistern was performed in 37 cases, whereas multiple-stoma fenestration to the basal cistern and the carotid cistern was performed in 49 cases. Clinicoradiologic profiles and follow-up data were analyzed. RESULTS: The rate of symptom relief was 83.7% (72/86), and the rate of cyst shrinkage was 96.5% (83/86). Postoperative ipsilateral subdural effusion, which was significant (p = 0.042), and noninfectious fever were the two most common complications in the single- and multiple-stoma groups. No significant differences in intraoperative nerve injury, vascular injury, proportion of cases with cyst reduction, and symptom remission rate were observed between the two groups. The rates of cyst recurrence and secondary surgery in the single-stoma group were higher than those in the multiple-stoma group, although the difference was not significant. CONCLUSION: Endoscopic fenestration is an effective and minimally invasive approach for treating Galassi type III MCFACs. Single- and multiple-stoma endoscopic fenestrations have the same curative effect.

[Trans-sylvian-insular approach endoscopic surgery for basal ganglia hypertensive hemorrhage].

OBJECTIVE: To explore the operative techniques and efficacy of trans-sylvian-insular approach endoscopic surgery for hypertensive basal ganglia hemorrhage. METHODS: A retrospective analysis was conducted in 54 patients with hypertensive basal ganglia hemorrhage from December 2009 to December 2011. All of them underwent neuroendoscopic surgery via a trans-sylvian-insular approach. The hematoma volume was 30 - 40 ml (n = 8), 40 - 50 ml (n = 42) and > 50 ml (n = 4). And the Glasgow Coma Scale (GCS) was 8 - 12 (n = 48) and 13 - 15 (n = 6). RESULTS: The clearance rate of hematoma was > 90% (n = 44) and 80% - 90% (n = 10). None suffered re-hemorrhage or death. CONCLUSION: As a mini-invasive and efficacious approach for hypertensive basal ganglia hemorrhage, trans-sylvian-insular approach endoscopic surgery has a high clearance rate of hematoma is high and causes minimal damage to normal brain tissue. It is worth of clinical promotion.

[Endoscopic treatment for fourth ventricular outlet obstruction].

OBJECTIVE: To explore the therapeutic efficacies of endoscope for fourth ventricular outlet obstruction (FVOO). METHODS: Endoscopic third ventriculostomy (ETV) was performed for 30 cases. The circumstances of third ventricular floor and basal cistern were observed and recorded intra-operatively. Meanwhile the fourth ventricular exploration and fistulation were performed across enlarged aqueduct. And the velocity and flow rate of aqueduct, fourth ventricular outlet and stoma were evaluated post-operatively with Cine-MR (magnetic resonance). RESULTS: Standard ETV was performed successfully in 28 patients. Fourth ventricular exploration (n = 6) and outlet membrane fistulation (n = 2) were carried out. The mean follow-up period was 2.3 years (range: 0.5 - 4.0). The overall success rate was 78.6%. CONCLUSION: ETV is a viable therapeutic option for FVOO patients. The therapeutic effects of outlet membrane fistulation require further observations.

[Neuroendoscopic treatment of different types of quadrigeminal cistern arachnoid cysts].

OBJECTIVE: To evaluate the method, strategy and efficacy of treating different types of quadrigeminal cistern arachnoid cysts (QCAC) with neuroendoscope. METHODS: A retrospective analysis was conducted for 12 QCAC patients with obstructive hydrocephalus. They were classified into 3 types and underwent neuroendoscopic operation at our hospital between November 2005 and November 2009. Their surgical approaches, complications and efficacy were analyzed. The mean age of first diagnosis was 3.7 years old. There were 7 type II cases and 5 type III cases with a varying level of symptoms. The follow-up period was 6 - 24 months. Cine-MRI (magnetic resonance imaging) examination was performed both preoperatively and post-operatively. RESULTS: Among them, 12 patients recovered well without any occurrence of hemorrhage, paralysis, lower cranial nerve injury, cerebrospinal fluid leakage, infection or death. Subdural effusion occurred in 3 cases, but disappeared within 6 months. Seven feverish cases recovered after a symptomatic treatment. The shapes of cysts and ventricles almost returned to a normal level in 8 cases. Three cases of arachnoid cyst had a slight change. CONCLUSION: In accordance with the QCAC patient types, different neuroendoscopic approaches can fully reconstruct the cerebrospinal fluid circulation. And the use of frameless navigation makes it more precise and safe.

[Endoscopic microvacular decompression for trigeminal neuralgia].

OBJECTIVE: To explore the feasibility, operating technique and precautions of endoscopic microvascular decompression for trigeminal neuralgia. METHODS: A retrospective analysis was conducted for 21 patients with primary trigeminal neuralgia. All underwent neuroendoscopic microvascular decompression for trigeminal nerves. RESULTS: The pains disappeared upon awaking post-anesthesia in 19 patients. In 2 patients, pains became significantly alleviated and disappeared after taking carbamazepine for 1 - 3 months. No patient suffered the injuries of trigeminal nerve and other cranial nerves. None had cerebellum edema or death. During the follow-up period, there was no recurrence of pains. CONCLUSION: Neuroendoscopic surgery may accomplish microvascular decompression for trigeminal nerve independently. As a minimally invasive and effective technique, it offers a clearer vision of local anatomy and decreases the probability of damaging nerves and vessels. There is no need for pulling cerebellum. It brings minimal damage to normal brain tissue compared with microsurgery. Further popularization is warranted.

[Operative approach for hydrocephalus associated with cerebellar tonsillar hernia].

OBJECTIVE: To assess the pre-operative examination and operative approach for hydrocephalus associated with cerebellar tonsillar hernia. METHODS: A retrospective analysis was conducted for 24 patients of hydrocephalus associated with cerebellar tonsillar hernia. All subjects received both pre-operative and post-operative Cine MRI examinations to detect the velocity and quantity of cerebrospinal fluid (CSF) at the important sites in ventricular system. A majority of cases had endoscopic third ventriculostomy (ETV) while others underwent both ETV and endoscopic posterior cranial fossa decompression. RESULTS: The pre-operative CSF hydrodynamics of all cases were abnormal at foramen magnum. A post-operative CSF flow through stoma might be detected by Cine MRI in all cases. The clinical symptoms improved to different extents in 21 cases while another two cases showed no improvement. Later these two patients underwent endoscopic posterior cranial fossa decompression. Cerebellar tonsillar hernia improved in 14 cases. CONCLUSION: Cine MRI can detect the CSF hydrodynamics at craniocervical junction so as to help a surgeon determine the time and the plan of operation. Most cases of hydrocephalus associated with cerebral tonsillar hernia are of obstructive hydrocephalus. The efficacy of ETV for hydrocephalus has been confirmed. Also ETV has a therapeutic effect for cerebellar tonsillar hernia and syringomyelia.

WD Repeat Domain 5 Promotes Invasion, Metastasis and Tumor Growth in Glioma Through Up-Regulated Zinc Finger E-Box Binding Homeobox 1 Expression.

BACKGROUND: Glioma is one of the important diseases that threaten human survival in today's society. WD repeat domain 5 (WDR5) belongs to the components of the lysine methyltransferase complex. WDR5 is involved in gene transcription regulation, cell senescence, cancer and other biological events through methylation modification. However, its expression and function in glioma are still unclear. MATERIALS AND METHODS: The expression of WDR5 was observed in glioma cells, and then a glioma cell line SW1783 knocked down WDR5 was established. The effects of the decrease of WDR5 expression on proliferation, migration, invasion and EMT of glioma cells were detected, respectively. The downstream regulators of WDR5 were identified by gene expression profiling technology, and the possible molecular mechanisms were identified. RESULTS: In this study, we found that WDR5 could promote glioma cell's proliferation, migration, invasion and tumor metastasis. In glioma, especially in metastatic glioma tissues, WDR5 levels were significantly increased, the higher expression level could also cause a significant reduction in overall survival of glioma patients. Second, the ability of cells' proliferation, migration, invasion and tumor metastasis was significantly reduced in WDR5 knockdown cell lines. We also found a significant change in the expression level of epithelial and mesenchymal markers in WDR5 knockdown cell lines. Furthermore, we found that knockdown of WDR5 could inhibit the expression of zinc finger E-box binding homeobox 1 (ZEB1), and knockdown of ZEB1 could inhibit invasion, migration and epithelial-mesenchymal transformation (EMT) in WDR5 over-expression cell line. We also found that WDR5 may regulate ZEB1's expression through H3K4me3. CONCLUSION: In summary, in this study, we have studied the relationship between WDR5 and glioma, and found that WDR5's expression is positively correlated with the proliferation, migration, and invasion of glioma cells, which will help find the potential therapeutic target for glioma patients.

[Endoscopic therapy for obstructive hydrocephalus caused by cysts in the pathway of CSF circulation].

OBJECTIVE: To explore the process and technique of neuroendoscopic operation to treat obstructive hydrocephalus caused by cysts located in the pathway of CSF circulation. METHODS: The cine MRI examinations and endoscopic operations were taken to treat 30 cases with obstructive hydrocephalus. Among all the cases, there are 11 intraventricular cysts (8 lateral ventricular cysts, 4 fourth ventricular cysts), 4 suprasellar arachnoid cysts, 1 quadrigeminal cistern arachnoid cyst, 6 Dandy-Walker malformations and 8 posterior fossa arachnoid cysts. RESULTS: CSF dynamic of all patients improved to different extents post-operation. It was observed that CSF passed through the stoma after ETV in all patients. The volume of 9 intraventricular cysts, 4 suprasellar arachnoid cysts, 1 quadrigeminal cistern arachnoid cyst and 4 posterior fossa arachnoid cysts diminished for different degrees. There were no surgery-related serious complications or deaths. There were not cyst enlarged and stoma obstructed cases. CONCLUSIONS: Obstructive hydrocephalus caused by cysts in the pathway of CSF circulation is the optimal indication for neuro-endoscopic surgery. After resecting cyst partially, we should take the endoscopic third ventriculostomy to rebuild the passway of CSF and elevate the cranial compliance. Cine MRI and radionuclide cisternography are helpful to understand the CSF dynamic and absorption.

MiR-205 suppresses epithelial-mesenchymal transition and inhibits tumor growth of human glioma through down-regulation of HOXD9.

Epithelial-mesenchymal transition (EMT) plays a pivotal role in cancer progression. Hsa-miR-205 is considered one of the fundamental regulators of EMT. In the present study, we found that miR-205 was down-regulated in glioma tissues and human glioma cells U87 and U251. Meanwhile, miR-205 overexpression enhanced E-cadherin, reduced mesenchymal markers, and decreased cell proliferation, migration, and invasion in vitro. In vivo, miR-205 suppressed tumor growth. Additionally, HOXD9 was confirmed as a direct target of miR-205. Suppression of HOXD9 by miR-205 was demonstrated by luciferase reporter assay, quantitative real time-PCR analysis, and western blot. Moreover, we observed a negative correlation between miR-205 and HOXD9 in human glioma tissues. In summary, our findings demonstrated that miR-205 suppresses glioma tumor growth, invasion, and reverses EMT through down-regulating its target HOXD9.

lncRNA AWPPH promotes the migration and invasion of glioma cells by activating the TGF-ß pathway.

The long noncoding RNA (lncRNA) AWPPH, also termed microRNA-4435-2HG, has been associated with the poor prognosis of patients with hepatocellular carcinoma (HCC), and has been demonstrated to promote the progression of HCC and bladder cancer. The present study aimed to investigate the role of lncRNA AWPPH in glioma. The expression levels of AWPPH in tumor tissues obtained from patients with glioma and in plasma samples obtained from patients with glioma and healthy controls were detected by reverse transcription-quantitative polymerase chain reaction. The plasma levels of transforming growth factor (TGF)-ß1 were measured by an enzyme-linked immunosorbent assay. An AWPPH expression vector was transfected into human glioma cell lines. Subsequently, cancer cell migration and invasion were assessed by Transwell migration and invasion assays, respectively. The expression of TGF-ß1 in the transfected-glioma cells was detected by western blot analysis. It was identified that AWPPH expression levels in tumor tissues were higher in patients with metastatic glioma; however, no significant differences in AWPPH expression were revealed between patients with different tumor sizes. The plasma levels of AWPPH were positively correlated with the plasma levels of TGF-ß1 in patients with glioma but not in healthy controls. In addition, AWPPH overexpression enhanced cancer cell migration and invasion, and upregulated TGF-ß1 expression. Treatment with TGF-ß1 demonstrated no significant effect on AWPPH expression; however, a TGF-ß inhibitor attenuated the effects of AWPPH overexpression on cell migration and invasion. Therefore, the present study proposed that AWPPH may promote the migration and invasion of glioma cells by activating the TGF-ß pathway.

Application of neuroendoscopic surgical techniques in the assessment and treatment of cerebral ventricular infection.

Cerebral ventricular infection (CVI) is one of the most dangerous complications in neurosurgery because of its high mortality and disability rates. Few studies have examined the application of neuroendoscopic surgical techniques (NESTs) to assess and treat CVI. This multicenter, retrospective study was conducted using clinical data of 32 patients with CVI who were assessed and treated by NESTs in China. The patients included 20 men and 12 women with a mean age of 42.97 years. NESTs were used to obliterate intraventricular debris and pus, fenestrate or incise the intraventricular compartment and reconstruct cerebrospinal fluid circulation, and remove artificial material. Intraventricular irrigation with antibiotic saline was applied after neuroendoscopic surgery (NES). Secondary hydrocephalus was treated by endoscopic third ventriculostomy or a ventriculoperitoneal shunt. Neuroendoscopic findings of CVI were used to classify patients into Grade I (n = 3), Grade II (n = 13), Grade III (n = 10), and Grade IV (n = 6) CVI. The three patients with grade I CVI underwent one NES, the 23 patients with grade II/III CVI underwent two NESs, and patients with grade IV CVI underwent two (n = 3) or three (n = 3) NESs. The imaging features and grades of neuroendoscopy results were positively related to the number of neurosurgical endoscopic procedures. Two patients died of multiple organ failure and the other 30 patients fully recovered. Among the 26 patients with secondary hydrocephalus, 18 received ventriculoperitoneal shunt and 8 underwent endoscopic third ventriculostomy. There were no recurrences of CVI during the 6- to 76-month follow-up after NES. Application of NESTs is an innovative method to assess and treat CVI, and its neuroendoscopic classification provides an objective, comprehensive assessment of CVI. The study trial was approved by the Institutional Review Board of Beijing Shijitan Hospital, Capital Medical University, China.

Histone demethylase KDM5A inhibits glioma cells migration and invasion by down regulating ZEB1.

Malignant gliomas are highly lethal cancers worldwide as tumor cells infiltrate to healthy brain tissue invariably. Histone demethylase KDM5A as an oncogene or tumor suppressor in cancer still has been controversial. KDM5A may have a different function in different type cancer cells. However, the specific roles of KDM5A in the progression of glioma remain undiscovered. In this study, we found that compared with primary glioma, metastasis glioma had low KDM5A levels. Besides, lower KDM5A levels were linked to poor survival in glioma cancer patients, indicating that KDM5A is a new prognostic marker for glioma cancer. KDM5A knockdown increases the invasive abilities of glioma cancer cells and changes the EMT markers. A mechanism, KDM5A suppressing the expression of ZEB1, and its catalytic activity is indispensable for anti-invasive function. Our study revealed that histone demethylase KDM5A exerts anti-invasiveness function partly through repressing oncogenic ZEB1 expression by mediating H3K4 demethylation. We also demonstrate that ZEB1 play a crucial role in KDM5A induced function. In summary, in this study, we showed that KDM5A has a crucial role in glioma and therefore may serve as a novel therapeutic target and prognostic marker in glioma.

Experience with Lumbar Puncture Following Endoscopic Third Ventriculostomy for Obstructive Hydrocephalus.

Background and Objective The increase in intracranial pressure (ICP) in some patients in the immediate postoperative period following endoscopic third ventriculostomy (ETV) is not well understood. This study explored the effect of lumbar puncture following ETV for obstructive hydrocephalus on outcome. Materials and Methods A total of 145 patients with obstructive hydrocephalus underwent ETV between 2009 and 2014. Following ETV, all patients underwent lumbar puncture on postoperative days 1 and 3. Results In 106 patients, ICP returned to normal levels accompanied by symptom relief. In 39 patients, ICP remained high on postoperative days 3, and lumbar puncture was continued every alternate postoperative day for 11 days. ICP always returned to normal. These 39 patients were divided into two groups for analysis: group A (age < 18 years) and group B (age ≥ 18 years). Peak values of ICP for groups A and B were recorded on days 3 and 5, respectively. Conclusions Our study suggests an important role for postoperative lumbar puncture in ensuring successful treatment results after ETV. In most of the symptomatic patients with obstructive hydrocephalus, lumbar puncture appears to contribute to rapid ICP normalization, to alleviation of symptoms, and prevention of complications.

Whole Course Neuroendoscopic Resection of Cerebellopontine Angle Epidermoid Cysts.

Background Epidermoid cysts are the third most common tumor of the cerebellopontine angle (CPA). Diagnosis often occurs after involvement of the sulci and cisterns that surround nerves and blood vessels, making complete resection highly challenging. Objective To determine the efficacy of whole course neuroendoscopic surgery in the management of CPA epidermoid cysts. Methods We performed a retrospective analysis of clinical data of 13 male and 17 female patients (mean age: 42.4 ± 11.4 years) who presented with a CPA epidermoid cyst and underwent whole course neuroendoscopy. Complications and tumor recurrence were assessed at follow-up. Results Clinical manifestations included an initial symptom of headache (n = 21), gait instability (n = 6), intracranial hypertension (n = 13), posterior cranial nerve symptoms (n = 6), ataxia (n = 5), and hydrocephalus (n = 1). All patients tolerated tumor resection with subsequent symptomatic improvement, and the results of the postoperative magnetic resonance imaging scan did not show any remnants of tumor. Mean duration of surgery was 2.61 ± 0.47 hours, mean loss of blood was 96.8 ± 35.4 mL, and the mean duration of hospitalization was 7.5 ± 2.25 days. Postoperative complications (8 of 30 [26.7%]) included fever (n = 5), communicating hydrocephalus (n = 1), facial nerve paralysis (n = 1), and abducens nerve palsy (n = 1). Tumor recurrence was observed in two patients (6.7%). No deaths or intracranial hemorrhage was reported. Conclusions The characteristics of epidermoid cysts make them amenable to whole course neuroendoscopic resection. Use of physiologic/pathologic interspaces and neuroendoscopic angulations decreases traction on the brain, improves complete resection rates, and decreases postoperative complications.