Nonschwannoma Tumors of the Cerebellopontine Angle

Friedmann, David R.; Grobelny, Bartosz T.; Golfinos, John G.; Roland, J. Thomas

doi:10.1016/j.otc.2015.02.006

Cited by 48 publications

(65 citation statements)

References 46 publications

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“…6,20 While aggressive and complete resection of meningiomas is curative, tumors arising within the CPA present unique surgical challenges com- pared with supratentorial lesions, given their close association with critical neurological and vascular structures.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy and outcomes of facial nerve–sparing treatment approach to cerebellopontine angle meningiomas

D’Amico¹,

Banu²,

Petridis³

et al. 2017

Journal of Neurosurgery

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ABBREVIATIONS CN = cranial nerve; CPA = cerebellopontine angle; EMG = electromyography; EOR = extent of resection; GKRS = Gamma Knife radiosurgery; GTR = gross-total resection; IAC = internal auditory canal; STR = subtotal resection; TTP = time to progression. SUBMITTED August 3, 2016 OBJECTIVE Advanced microsurgical techniques contribute to reduced morbidity and improved surgical management of meningiomas arising within the cerebellopontine angle (CPA). However, the goal of surgery has evolved to preserve the quality of the patient's life, even if it means leaving residual tumor. Concurrently, Gamma Knife radiosurgery (GKRS) has become an acceptable and effective treatment modality for newly diagnosed, recurrent, or progressive meningiomas of the CPA. The authors review their institutional experience with CPA meningiomas treated with GKRS, surgery, or a combination of surgery and GKRS. They specifically focus on rates of facial nerve preservation and characterize specific anatomical features of tumor location with respect to the internal auditory canal (IAC). METHODS Medical records of 76 patients with radiographic evidence or a postoperative diagnosis of CPA meningioma, treated by a single surgeon between 1992 and 2016, were retrospectively reviewed. Patients with CPA meningiomas smaller than 2.5 cm in greatest dimension were treated with GKRS, while patients with tumors 2.5 cm or larger underwent facial nerve-sparing microsurgical resection where appropriate. Various patient, clinical, and tumor data were gathered. Anatomical features of the tumor origin as seen on preoperative imaging confirmed by intraoperative investigation were evaluated for prognostic significance. Facial nerve preservation rates were evaluated. RESULTS According to our treatment paradigm, 51 (67.1%) patients underwent microsurgical resection and 25 (32.9%) patients underwent GKRS. Gross-total resection (GTR) was achieved in 34 (66.7%) patients, and subtotal resection (STR) in 17 (33.3%) patients. Tumors recurred in 12 (23.5%) patients initially treated surgically, requiring additional surgery and/or GKRS. Facial nerve function was unchanged or improved in 68 (89.5%) patients. Worsening facial nerve function occurred in 8 (10.5%) patients, all of whom had undergone microsurgical resection. Upfront treatment with GKRS for CPA meningiomas smaller than 2.5 cm was associated with preservation of facial nerve function in all patients over a median follow-up of 46 months, regardless of IAC invasion and tumor origin. Anatomical origin was associated with extent of resection but did not correlate with postoperative facial nerve function. Tumor size, extent of resection, and the presence of an arachnoid plane separating the tumor and the contents of the IAC were associated with postoperative facial nerve outcomes. CONCLUSIONS CPA meningiomas remain challenging lesions to treat, given their proximity to critical neurovascular structures. GKRS is a safe and effective option for managing CPA meningiomas smaller than 2.5 cm without associated mass ef...

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Section: Discussionmentioning

confidence: 99%

“…6 Meningiomas, the second most common tumor of the CPA after vestibular schwannomas, are slow-growing, benign lesions that account for 5%-15% of tumors in this region. Fortunately, meningiomas can often be cured by complete removal.…”

mentioning

confidence: 99%

Efficacy and outcomes of facial nerve–sparing treatment approach to cerebellopontine angle meningiomas

D’Amico¹,

Banu²,

Petridis³

et al. 2017

Journal of Neurosurgery

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“…Approximately, 70 to 90% of these tumors are vestibular schwannomas (VS) (1). Other less common lesions include meningiomas, hemangiopericytomas, epidermoids, lipomas, paragangliomas, and arachnoid cysts (2).…”

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confidence: 99%

Postoperative Complications and Readmission Rates Following Surgery for Cerebellopontine Angle Schwannomas

Mahboubi

Haidar

Moshtaghi

et al. 2016

Otology &Amp; Neurotology

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Objective To investigate the 30-day postoperative complication, readmission, and reoperation rates following surgery for cerebellopontine angle (CPA) schwannomas. Study Design Cross-sectional analysis. Setting National surgical quality improvement program dataset (NSQIP) 2009 through 2013. Patients All surgical cases with an International Classification of Diseases, 9th edition, Clinical Modification (ICD-9-CM) diagnosis code of 225.1, benign neoplasms of cranial nerves, and one of the following current procedural terminology (CPT) codes, were included: 61616, 61526, 61530, and 61520. Intervention(s) Surgical resection as indicated by the CPT codes above. Main Outcome Measure(s) Demographics, comorbidities, 30-day postoperative complications, readmission rate, and reoperation rate. Results Overall, 404 cases were identified, of which 42.6% were men. The average age was 51 years. Comorbidities were present in 45.3%. NSQIP-tracked complications occurred in 9.7% of patients. Most common complications were wound infections including surgical-site infection and wound dehiscence (11 patients, 2.7%), sepsis (10 patients, 2.5%), blood loss (nine patients, 2.2%), and deep vein thrombosis (DVT; seven patients, 1.7%). Mortality occurred in four patients (1.0%). The complication rate was statistically higher in patients with comorbidities versus those without (10.2% versus 4.1%, p = 0.04). Patients with complications were more likely to undergo reoperation (2.5% with versus 4.1% without, p = 0.001). Unplanned readmissions occurred in 41 cases (10.1%) and reoperations occurred in 23 patients (5.7%). Conclusions Most common NSQIP-tracked complications in excision of CPA neoplasms are infections, sepsis, blood loss, and deep vein thrombosis (DVT). Further, investigation of patients with unplanned readmission and reoperation are warranted. Neurotologists need to take an active role in the data to be gathered in the NSQIP database as it relates to vestibular schwannomas.

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“…Both observers misclassified one lesion for VS instead of meningioma (Figure ). Consequences of such misdiagnoses are limited, as management strategies are usually identical . Third, GdT1w is often considered gold standard to diagnose CPA lesions .…”

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of high‐resolution T2‐weighted MRI vs contrast‐enhanced T1‐weighted MRI to screen for cerebellopontine angle lesions in symptomatic patients

Hentschel¹,

Kunst²,

Rovers³

et al. 2018

Clinical Otolaryngology

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Nonschwannoma Tumors of the Cerebellopontine Angle

Cited by 48 publications

References 46 publications

Efficacy and outcomes of facial nerve–sparing treatment approach to cerebellopontine angle meningiomas

Efficacy and outcomes of facial nerve–sparing treatment approach to cerebellopontine angle meningiomas

Postoperative Complications and Readmission Rates Following Surgery for Cerebellopontine Angle Schwannomas

Diagnostic accuracy of high‐resolution T2‐weighted MRI vs contrast‐enhanced T1‐weighted MRI to screen for cerebellopontine angle lesions in symptomatic patients

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