Preoperative and postoperative facial nerve and auditory function were reviewed retrospectively in 13 cases of cerebellopontine angle meningiomas. According to their location within the posterior fossa and with special reference to the internal auditory canal, they were classified into a premeatal and a retromeatal group. All the tumors were removed by an otoneurosurgical team by use of a retrosigmoid approach. Postoperative results (1 year after operation) were compared within the two groups with respect to preservation of hearing (normal hearing in 31% and preservation of preoperative hearing in 69% of the cases) and facial nerve function (no or mild postoperative impairment in 69% of the cases). Both preoperative and postoperative impairment of facial nerve and auditory function prevailed in the premeatal group. For preservation of vital vascular and central nervous structures, subtotal resection with consecutive fractionated radiation therapy had to be performed in 30% of the cases. Our results provide substantial evidence that in cerebellopontine angle meningiomas a precise preoperative study of tumor location will assist in improving individual operative strategy and thus postoperative functional results.

To our knowledge, this represents the first case of the syndrome of the trephined in which the neurological deficits map primarily to the brainstem and show rapid improvement following cranioplasty. We show that cranioplasty in patients with large skull defects is indicated for more then cosmetic reasons and should be considered even after longer periods following a trauma.

The authors report an unusual manifestation of extracranial vertebral artery dissection (VAD), presenting with a predominantly motor radicular manifestation. Cervical magnetic resonance imaging (MRI) revealed the intramural hematoma in the dissected vessel wall, compressing mainly the segmental motor root and, to a lesser degree, the sensory ganglion. In the digital subtraction angiography (DSA), a circumscribed narrowing of the incriminated vessel was demonstrated. Color-coded Duplex imaging (CDDI) revealed complete recanalization after a few days of anticoagulation treatment. Complete neurologic recovery was seen after 3 months. Considering the MRI data, the likely pathogenetic mechanism was compression of the nerve root by the intramural hematoma. The synopsis with similar cases in the literature points to the characteristic features, i.e., the association of neck pain with radicular motor deficit and the absence of degenerative disk disease. The respective syndrome should raise the suspicion of vertebral artery dissection, especially in young individuals.

Es werden die Resultate und Komplikationen einer retrospektiven Studie von 92 Patienten vorgestellt, die innerhalb von 1981–1991 eines KleinhirnbrÜkkenwinkeltumors wegen Über einen retrosigmoidalen Zugang von einem neurochirurgischotologischen Team operiert wurden. Das Kollektiv setzte sich aus 73 vestibulÄren Schwannomen, 9 Meningeomen, 3 Neurofibromatosen vom Typ 2, 3 Epidermoidzysten und jeweils 1 Lipom, Tuberkulom, HÄmangioblastom und Gliom zusammen. Die LetalitÄt war insgesamt null. Die Fazialisfunktion ein Jahr postoperativ zeigte sich bei den vestibulÄren Schwannomen in 66% als gut (House-Grad I–II) und in 26% als mÄssig (House-Grad III–IV), sowie bei den Meningeomen in 76% als gut. Bei den Schwannomen steht die Fazialisfunktion in signifikanter Korrelation zur TumorgrÖsse (p = 0,0002). Bei 28% der vestibulÄren Schwannome und 100% der Meningeome mit prÄoperativ normalem GehÖr (Gardner-Klasse I) konnte postoperativ unabhÄngig von der TumorgrÖsse die HÖrfunktion vollstÄndig erhalten werden (Gardner-Klasse I). Die weitere postoperative MorbiditÄt wird unter Einbeziehung der aktuellen Literatur abgehandelt.

Cordectomy can be a useful instrument to preserve functions of the upper extremities and to improve spasticity and pain in patients with severe myelopathy and tethered cord, syringomyelia, or arachnopathy of various etiologies.