Sir, A 42-year-old man was admitted with insidious onset, progressive weakness of left upper and lower extremities of 6 months duration. Neurological examination revealed left spastic hemiparesis with grade 3 power with brisk deep tendon reflexes. Magnetic resonance imaging (MRI) brain revealed a lesion in right cerebellopontine angle, hypointense on T1-weighted images, hyperintense on T2-weighted images, not suppressed on FLAIR and showing restriction on diffusion-weighted imaging [Figure 1]. On administration of gadolinium, a thin rim of peripheral enhancement was evident. The tumor had multiple irregular, lobulated outpouchings into the brainstem. The imaging findings were consistent with the diagnosis of epidermoid cyst. A right retrosigmoid suboccipital craniectomy was performed in the lateral decubitus position. The tumor was pearly white in color, flaky in consistency and multilobulated with a poor plane from the brainstem. A near total excision of the tumor was done, as part of the capsule adherent to the brainstem could not be removed. Postoperative recovery was uneventful. Histological examination revealed the presence of keratin flakes with squamous epithelial lining consistent with the diagnosis of epidermoid cyst [Figure 2]. Follow-up at 3 months revealed minimal improvement in his left-sided weakness.
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