Abstract
Background: Intracranial cholesteatomas are rare, non-neoplastic lesions that typically originate in the temporal bone but can extend into the posterior fossa. Their occurrence in the posterior fossa is extremely rare and presents significant surgical challenges due to their potential to compress vital structures such as cranial nerves and vascular components. These lesions can lead to neurological deficits, and their management re quires careful preoperative planning and precise surgical techniques.
Case Summary: A 39-year-old male presented with progressive left-sided hearing loss, headaches, fever, and neck rigidity. MRI imaging revealed a large cholesteatoma compressing the cerebellum and several cranial nerves. The patient underwent a retrosigmoid approach for tumor resection. Intraoperative findings includ ed involvement of cranial nerves V, VII, VIII, X, XI, and XII, as well as significant compression of the AICA, PICA, and basilar artery. The tumor was friable and easily dissected, allowing for complete resection without complications such as bleeding or cerebrospinal fluid leaks.
Conclusion: This case highlights the importance of early diagnosis, careful preoperative imaging, and me ticulous surgical planning in the management of intracranial cholesteatomas. The retrosigmoid approach provided optimal access for complete tumor removal while preserving critical neural and vascular structures. Key clinical takeaways include the necessity of a multidisciplinary approach and the careful preservation of function in complex posterior fossa surgeries.
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