Auditory and facial nerve function following surgery for. Schwannomas affect mainly head and neck peripheral nerves, are benign tumors and derive from schwann cells. Tumors of the cerebellopontine angle request pdf researchgate. All had histologically verified cpacmf tumors and underwent radical. Cerebellopontine angle cpa meningiomas account for 1.
Read more about symptoms, diagnosis, treatment, complications, causes and prognosis. The results obtained by using the mf approach were superior for intracanalicular tumors p0. Cerebellopontine angle ependymoma in a young adult. Cureus surgical management and outcome experience of 53. Surgical outcomes of cerebellopontine angle tumors in 50 cases. We present a case of a 28yearold male who was involved in road traffic accident with suspected mild head injury. An endoscopic assisted retrosigmoid approach to the cerebellopontine angle for resection of an epidermoid cyst mina g. Background synchronous tumors of the cerebellopontine angle cpa are very rare and inconsistently described.
These features were studied in patients presenting to the regional neurootological unit. Cerebellopontine angle cpa ependymomas are atypical kind of ependymomas that characteristically occur in the pediatric age group. We calculated the actuarial progressionfree survival pfs. Focal hyperintensity fhi in the dorsal brain stem on t2weighted images of patients with cerebellopontine angle cpa tumor was thought to. Although an acoustic neurinoma vestibular schwannoma, acoustic neuroma, acoustic neurilemoma is the most common lesion found. The cerebellopontine angle is the site of the cerebellopontine angle cistern one of the subarachnoid cisterns that contains cerebrospinal fluid, arachnoid tissue. The incidence in adults is not uncommon and when present in this age group, they are more likely to occur laterally in the cerebellar hemispheres or other rare sites like cerebellopontine angle cpa. The combined microscopicendoscopic technique for radical resection of cerebellopontine angle tumors. Cerebellopontine angle cpa tumors are masses located in the region between the cerebellum and pons. Schwannoma of right cerebellopontine angle is extremely rare to diagnose by cytology. Much rarer primary tumors are schwannomas of other cranial nerves.
These usually present with a viith cranial nerve palsy either late in their course as the facial nerve is displaced and compressed by an expanding cerebellopontine tumor or as a postoperative complication after neurosurgical resection. Tumors of the cerebellopontine angle jama otolaryngology. Neuroradiology of the lesions of the petrous bone apex, internal auditory canal and cerebellopontine angle. Acoustic neuromas, which are also called vestibular schwannomas, 3, and meningiomas are the two most frequent lesions and account for approximately 85%90% of all cpa tumors, 1. Focal hyperintensity in the dorsal brain stem of patients with. Cerebellopontine angle and fourth ventricle part 1 of 2. Cerebellopontine angle syndrome is usually due to an acoustic schwannoma arising from the vestibular nerve. The angle is bordered laterally and anteriorly by the posterior face of the petrous temporal bone. To report our experience with a large series of surgical procedures for removal of cerebellopontine angle cpa tumors using different approaches. Discuss the epidemiology and pathophysiology of cerebellopontine angle cpa epidermoid tumors.
To our knowledge, the current study is the largest case series to report on radiosurgery for cerebellopontine angle epidermoid tumors. Other tumors presenting in this area are meningioma, epidermoid, pontine glioma, and. Pdf nonacoustic tumors of the cerebellopontine angle. Cerebellopontine angle an overview sciencedirect topics.
Surgery of the cerebellopontine angle 1st edition pdf download now surgery of the cerebellopontine angle is a single volume text which meshes the information available in surgical atlases with clinical disease entities. The inclusion of an interactive atlas adds to the importance of the text and complements it, and also obviates the need to. Cerebellopontine angle tumor neoplasm of cerebellopontine angle. This is a prospective study of 30 patients at the neurosurgical department medical city, with mean age of 36 years with cpa tumors predominantly acoustic neuroma that underwent surgical removal using a suboccipital retrosigmoid approach over a 1year. Cerebellopontine angle tumors otolaryngologists perspective. Previously named as aggressive papillary middle ear tumors, they have recently been shown to arise from the endolymphatic sac. Endoscopic techniques for cerebellopontine angle cpa surgery have been well studied and applied to tumor resection, vascular. Therefore, finding a case of cpa ependymoma in a young male adult is not a common occurrence patient concerns. They constitute the most frequently diagnosed tumors of the posterior fossa and account for up to 10% of all intracranial neoplasms. Cerebellopontine angle tumor neoplasm of cerebellopontine.
A detailed account of the management of these lesions is. Approximately 10% of all intracranial tumors originate in the cerebellopontine angle cpa, with vestibular schwannomas comprising the majority of tumors in this location. Lesions of the cerebellopontine angle cpa are frequent and represent 6%10% of all intracranial tumors, 1, 2. Epidermoid cysts do not enhance on magnetic resonance imaging. He underwent a ventriculoperitoneal shunt initially. This group of tumors account for nearly 10% of all intracranial tumors. The cerebellopontine angle syndrome is a distinct neurological syndrome of deficits that can arise due to the closeness of the cerebellopontine angle to specific cranial nerves. Medulloblastomas are commonly occurring tumors in the posterior fossa in children.
Methods a retrospective analysis of clinical notes identified 42 patients with nonacoustic tumours of the. Martuza because lesions of the cerebellopontine angle most commonly cause hearing loss and vestibular disturbance as their earliest symptoms, the otologist is often consulted for diagnosis and treatment. Patients with cerebellopontine angle tumors, including acoustic neuromas, usually have a unilaterally reduced vestibular response on caloric testing on the side of the lesion. Management of cerebellopontine angle epidermoid tumors. The most common cause of trigeminal neuralgia is compression of the trigeminal nerve by blood vessels approximately 90% of cases, followed by compression by tumors, such as epidermoid tumors, neurilemmomas or meningiomas 8%, and malformations, such as arteriovenous malformation 0. Although a diverse range of pathologies may be seen in this region, the most common by far is a vestibular schwannoma. Pdf cerebellopontine angle cpa tumors are uncommon in children, and the pathological. Large meningiomas of the cerebellopontine angle present a formidable surgical challenge due to tumor vascularity, neural attachment, and brain stem compression. The crucial neurovascular structures should be identified as early as possible during surgery, which enables their preservation and guides subsequent operative steps. The characteristic morphological features of these depend on the tissue from which the tumors arise.
Superior anatomical view of the left cerebellopontine angle cpa. Cerebellopontine angle tumor symptoms, causes, diagnosis, and treatment information for cerebellopontine angle tumor acoustic neuroma with alternative diagnoses, fulltext book chapters, misdiagnosis, research treatments, prevention, and prognosis. Posterior fossa and cerebellopontine angle cistern. Gerganov clinical pearls comprehensive knowledge of the complex anatomy of the cerebellopontine cp angle is a prerequisite for achieving good surgical results. Chapter 38 cerebellopontine angle tumors madjid samii, venelin m.
Gamma knife radiosurgery for cerebellopontine angle. All aspects are considered, including biological and radiological characteristics, neurological presentation, diagnosis, treatment options and followup care. Synchronous tumors of the cerebellopontine angle mayo clinic. An endoscopic assisted retrosigmoid approach to the. If the inline pdf is not rendering correctly, you can download the pdf file. Cerebellopontine angle cpa masses are relatively common. Department of neurosurgery, tufts medical center and tufts university school of medicine, boston, massachusetts epidermoid cysts are rare lesions accounting for 1%. Studies reveal that acoustic neuromas vestibular schwannomas constitute nearly 80% of all cerebellopontine angle tumors. Nonvestibular schwannoma tumors in the cerebellopontine angle.
Pdf tumors in the cerebellopontine angle in children. Objectives nonacoustic tumours of the cerebellopontine angle differ from vestibular schwannomas in their prevalence, clinical features, operative management, and surgical outcome. Ionm for cerebellopontine angle tumor surgery free running emgs can be monitored while surgery around the vicinity of the facial nerve takes place stimulation with a monopolar electrode can also be used to localize the facial nerve within a tumor or identify various branches of the facial nerve by noting the muscles that are activated facial. Health, general accountants blood glucose blood sugar cancer metastasis care and treatment development and progression prognosis cerebrospinal fluid proteins certified public accountants medical research medicine, experimental.
Cerebellopontine angle tumors in infants and children ncbi. Of all cpa tumors, meningiomas are the secondmost frequent tumor in this area. Surgery of cerebellopontine lesions madjid samii springer. Cerebellopontine angle tumors are encountered rather more commonly than anticipated by otolaryngologist. Cerebellopontine angle cpa tumors are the most common neoplasms in the posterior fossa, accounting for 510% of intracranial tumors. We present a case of an elst who presented as a cpa tumor with hydrocephalus. Most are located in midline of cerebellum, and are commonly seen in pediatric age group. This was a retrospective analysis of 50 patients mean age, 49 years with cpa tumors predominantly acoustic neuroma who underwent surgical removal. Pediatric cerebellopontine angle medulloblastomas kumar r.
This book covers the entire spectrum of cerebellopontine angle lesions, from the most common to the rarest. Although a diverse range of pathologies may be seen in this region, the most common by far is a vestibular schwannoma pathology. Cerebellopontine angle article about cerebellopontine. Endolymphatic sac tumors elst are rare papillary tumors of the temporal bone. List the treatment options, including the surgical goals and results, for cpa epidermoid tumors.
First published over 100 years ago, logan turners diseases of the nose, throat and ear. The educational objectives for this selfassessment module are for the participant to exercise, selfassess, and improve his or her understanding of the imaging features of cerebellopontine angle cpa masses and the role of advanced mri in the differential diagnosis of cpa masses. Clinical features and outcomes in patients with non. Many different types of tumor may arise in the cerebellopontine angle. Diseasedisorder overview by ear, nose and throat journal. Tumors of the cp angle account for 5% to 10% of all intracranial neoplasms. The cpa is defined as the angle formed in the horizontal section by the pons and the cerebellum in which the trigeminal v and acousticofacial nerve bundle viii are located.
A technical note on endonasal combined microscopic endoscopic with free head navigation technique of removal of. Tc99m mibi brain spect of cerebellopontine angle tumors. Cerebellopontine definition of cerebellopontine by. Gamma knife radiosurgery for cerebellopontine angle epidermoid tumors has rarely been reported. Surgery of the cerebellopontine angle 1st edition pdf.
They are benign tumors commonly seen in adults, which usually present after a long asymptomatic period. We report one such rare case presenting the cytological features in material obtained during the resection of the tumor. Cerebellopontine angle mass radiology reference article. The combined microscopicendoscopic technique for radical. Most cpa tumors are benign, with over 85% being vestibular schwannomas acoustic neuromas, lipomas, vascular malformations, and hemangiomas. Cerebellopontine angle meningioma diagnosed based on.
Cerebellopontine angle masses can be divided into four groups, based on imaging characteristics. Describe the clinical presentations and radiologic features of cpa epidermoid tumors as well as their differential diagnosis. The most common cerebellopontine angle cpa tumor is a vestibular schwannoma, but one in five cpa tumors are not vestibular schwannomas. This chapter describes the clinical and radiological features of cerebellopontine angle cpa tumors. Logan turners diseases of the nose throat and ear pdf. The purpose of this paper is to present our use of the combined transtemporal approach in the surgical treatment of.