Other Cerebellopontine Angle Tumors

Samii, Madjid; Gerganov, Venelin M.

doi:10.1007/978-3-642-35422-9_11

Cited by 2 publications

(4 citation statements)

References 240 publications

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“…Cerebellopontine angle (CPA) tumors constitute a significant proportion of intracranial neoplasms, representing up to 10% of tumors within the brain. 1 Located anterior to the cerebellum, lateral to the pons, and posteromedial to the petrous temporal bone, the CPA is traversed by several cranial nerves and important neurovascular structures. 2 As a result, lesions in this region can impart various clinical effects, including hearing loss, tinnitus, vertigo, and facial pain, among others.…”

Section: Introductionmentioning

confidence: 99%

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Hearing Improvement after Radiation Therapy for a Facial Nerve Schwannoma: Report of a Case and Review of Literature

Pecorari,

Ghosh,

Moskowitz

et al. 2024

J Neurol Surg Rep

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Introduction While facial nerve schwannomas are considered benign, they can impart various significant clinical effects due to pressure on nearby cerebrovascular structures within the cerebellopontine angle (CPA). Although surgical resection and/or radiation therapy often provide definitive treatment of such tumors, posttreatment hearing loss is a common finding. In this report, we present the case of a patient with a facial nerve schwannoma successfully treated with radiotherapy with resultant hearing improvement, an extremely rare clinical finding. Case Presentation A 63-year-old woman presented with a 1-year history of progressively worsening hearing loss and tinnitus. Brain imaging demonstrated an enhancing lesion of the right CPA measuring 2.7 × 2.1 × 3.1 cm. Pretreatment audiometry evaluation revealed sensorineural hearing loss in the right ear with a pure-tone average (PTA) of 74 dB, speech threshold (ST) of 75 dB, and speech discrimination (SD) of 0%. The patient proceeded with attempted surgical resection, aborted due to significant facial nerve stimulation, and ultimately underwent radiation therapy (50.4 Gy, 28 fractions). At the 1-year follow-up visit, the patient reports subjective hearing loss resolution with PTA of 34 dB, 30 dB ST, and 88% SD on audiological evaluation. Conclusion Although radiation therapy for schwannomas within the CPA has historically been associated with hearing loss, fractionated stereotactic radiotherapy (FSRT) may provide improved clinical outcomes compared with high-dose radiosurgery. Given the effectiveness of this treatment modality and improved quality of life offered to patients over surgery, FSRT may be considered an initial management option for patients with facial nerve schwannomas.

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Section: Introductionmentioning

confidence: 99%

“…3 Out of the tumors that arise within the CPA region, schwannomas account for the majority of lesions. 1 4…”

Section: Introductionmentioning

confidence: 99%

Hearing Improvement after Radiation Therapy for a Facial Nerve Schwannoma: Report of a Case and Review of Literature

Pecorari,

Ghosh,

Moskowitz

et al. 2024

J Neurol Surg Rep

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“…4 5 6 They may be confined within the internal auditory canal or extend into the CPA, resulting in symptoms related to the compression of adjacent CNs, brain stem, or posterior fossa (PF) structures. 5 7 8 Most VSs exhibit an intracanalicular component, characterized by the widening of the porus acusticus internus, observed in approximately 90% of cases. As these tumors grow, they extend beyond the canal.…”

Section: Introductionmentioning

confidence: 99%

“…They can cause hearing loss, tinnitus, balance issues, facial paralysis, and facial paresthesia, and in cases of large VS, may exert a mass effect on the brain stem and cerebellar peduncle, leading to other serious neurological manifestations. 7 8 9 Asymmetrical sensorineural hearing loss, confirmed by audiometry, or other CN deficits typically raises suspicion of VS. These symptoms often prompt further investigation using contrast-enhanced computed tomography (CECT) or magnetic resonance imaging (MRI).…”

Section: Introductionmentioning

confidence: 99%

Patient-Centered Neurosurgery: Improved Outcomes after Subtotal Surgical Resection and Nonframe-Based Fractionated Stereotactic Radiotherapy for Large Cerebellopontine Angle Vestibular Schwannoma

Hazra,

Chandy,

Roy

et al. 2024

Indian Journal of Neurosurgery

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Background The novel paradigm in neurosurgery for large vestibular schwannomas (VSs) involves a combination of planned subtotal resection (STR) and scheduled postoperative fractionated stereotactic radiotherapy (FSRT). Methods This retrospective observational study aimed to evaluate and compare the outcomes of patients who underwent either near-total resection (NTR) or were treated with STR and scheduled FSRT over 6 years. We systematically coded and analyzed the data to obtain comprehensive insights into the results. Results Our study included 65 patients diagnosed with large VS, who underwent retrosigmoid craniotomy and NTR or STR for tumor removal. The mean age of the cohort was 42.6 (standard deviation: 16.2) years, with 40 (61.5%) female patients. All patients presented with asymmetrical sensory neural hearing loss and other prevalent symptoms such as headache (58) and tinnitus (58). Cerebellar signs, speech abnormalities, and pyramidal signs were also observed. Ten patients underwent NTR, and 55 underwent STR followed by an FSRT at 3 months or later based on the physical and radiological findings. Facial nerve palsy was noted in all cases of those who underwent NTR, while no instances of facial nerve palsy, lower cranial nerve palsy, posterior fossa, or brain stem injury were noted in the STR group. One patient undergoing STR experienced meningitis and died despite best possible medical management. The majority of patients showed symptom improvement, and none of the patients reported recurrence at 3-year follow-up. Conclusion The combined approach of STR and FSRT ensures safety, high tumor control rates, and favorable outcomes. It provides a sensible alternative to NTR for managing large tumors, emphasizing tumor debulking while preserving neurological function for overall benefit.

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Other Cerebellopontine Angle Tumors

Cited by 2 publications

References 240 publications

Hearing Improvement after Radiation Therapy for a Facial Nerve Schwannoma: Report of a Case and Review of Literature

Hearing Improvement after Radiation Therapy for a Facial Nerve Schwannoma: Report of a Case and Review of Literature

Patient-Centered Neurosurgery: Improved Outcomes after Subtotal Surgical Resection and Nonframe-Based Fractionated Stereotactic Radiotherapy for Large Cerebellopontine Angle Vestibular Schwannoma

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