Primary glioblastoma of the cerebellopontine angle in adults

Abstract

Gliomas are rare entities in the cerebellopontine angle (CPA) in adults. The authors present clinical, neuroradiological, serological, and neuropathological findings in a 60-year-old man with an extraaxial CPA glioblastoma arising from the proximal portion of cranial nerve VIII. The patient presented with progressive left-sided deafness and left-sided facial palsy lasting less than 2 months and progressive dysarthria and dysphagia lasting 2 weeks. Preoperative neuroimaging suggested the diagnosis of CPA meningioma with "dural-tail" sign and involvement of the internal auditory canal. Serological examination showed an increase in the malignant markers of ferritin and neuron-specific enolase, which suggested underlying malignancy. The tumor was subtotally removed, and it was confirmed to be completely separated from the brainstem and cerebellum. Cranial nerves VII and VIII were destroyed and sacrificed. Transient severe bradycardia occurred during surgery due to entrapment of the caudal cranial nerve complex by the tumor in such an infiltrative way. The neuropathological examination revealed a glioblastoma. The patient underwent no further treatment and died of cachexia 2 months postoperatively. To the authors' knowledge, this represents the first case of a primary glioblastoma in the CPA in an adult. A high index of suspicion along with reliance on clinical assessment, radiological findings, and serum detection of specific malignant markers is essential to diagnose such uncommon CPA lesions.

Progressive multifocal exophytic pontine glioblastoma: a case report with literature review

“…According to the literature, CPA glioblastomas may have different origins [15]. Wu et al [16] reported a CPA glioblastoma that originated from the cranial VIII nerve and reviewed seven other similar cases. Cranial nerve glioblastomas are presumably originated from CNS tissue locating at the root entry zone of the cranial nerve or from heterotopic neuroglia cells in the leptomeninges.…”

Temporal Lobectomy for High Grade Gliomas: Impact on Outcomes and Implications for Postoperative Radiation Treatment Field Design

“…Such an operation essentially amounts to an amputation of the anterior temporal lobe, and will leave a large resection cavity on the floor of the middle fossa ( Figure 5). Gliomas would not be expected to recur in this resection cavity, as removal of the temporal lobe removes both the normal brain tissue and blood supply necessary to support tumor growth in this area, and leaves behind only dura and overlying calvarium, both very rare sites for glioma growth (Rainov et al, 1996;Gheyi et al, 2004;Wu et al, 2011;Arnautovic, Husain, & Linskey, 2000;Reifenberger et al, 1996;Hsieh et al, 2009;Brandes et al, 1998). The results of our study confirm this theory, as no recurrences involving the temporal lobectomy cavity have been documented after temporal lobectomy with follow up as long as 54 months.…”

Primary Glioblastoma of the Cerebellopontine Angle : Case Report and Review of the Literature

“…Glioblastoma multiforme (GBM) is the most common primary brain tumor in adults, comprising about 20% of all intra cranial tumors8,10). GBM usually arises in the supratentorial region, most commonly cerebral hemispheres8).…”

“…GBM usually arises in the supratentorial region, most commonly cerebral hemispheres8). Primary infratentorial GBM is an uncommon disease in adults and rarely found in cerebellopontine angle (CPA), especially8,10). A few cases of GBM arising in CPA have been reported in the literature1,2,5–7,9,11).…”

“…Most of cases reported are primary intraaxial GBM arising from cerebellar hemisphere or brainstem, with exophytic extension into CPA. One case of primary extraaxial GBM in the CPA has been reported, arising from the region of root entry zone of the eighth cranial nerve10).…”