Surgical Outcomes of Cerebellopontine Angle Tumors in 34 Cases

Abstract

Introduction: Cerebellopontine angle tumors are a surgical challenge to many neurosurgeons who want to operate in this space. Although most of these tumors are benign, they are a challenge because of the complex anatomy and important neurovascular structures that traverse this space. Most common cerebellopontine angle tumor is vestibular schwannoma. The management of these cases is essentially surgical. There has been a change in the surgical strategy over the years from simple intratumoral decompression to complete microsurgical excision, to radical excision with facial nerve and hearing preservation. Objectives: To study the clinical and radiological characteristics, know the pathological types and determine the surgical resectability and outcome of cerebellopontine angle tumor. Materials and Methods: It is a retrospective study done in the department of Neurosurgery, Apollo Hospitals Dhaka. 34 patients diagnosed with cerebellopontine angle tumor were recruited into the study. Results: Among 34 cases of cerebellopontine angle tumors vestibular schwannoma alone constituted 79%. Most of the tumors were large or giant tumors. Total resection was done in 25% of vestibular schwannoma and 50% of meningiomas. Anatomical preservation of facial nerve was achieved in 73% of patients. Facial nerve function as measured by the House Brackmann system. Postoperatively 61% had a score of 1 or 2; 29% had a score of 3 or 4; and 8% had a score of 5 or 6. Other complications included 2 cases of CSF leak, 3 cases of meningitis, 2 cases of lower cranial nerve palsy and 1 patient died. Conclusion: Cerebellopontine angle tumors show high incidence from 3rd to 5th decade with common symptoms being hearing loss and ataxia. Most of the patients presented at a delayed stage with large to giant tumors with no useful hearing. Sub total excision with keeping anterior part of tumor for preserving facial nerve function is the goal.

Giant cerebellopontine Angle Tumor Surgery: Experience of a Tertiary Care Center in Lahore, Pakistan

“…However, in a study by Joarder et al facial nerve preservation was 74% for the large size tumors and 62% for giant tumors, which is comparable to our results. 16 In our case series, 16% of patients had a physiological injury to caudal cranial nerves (9,10,11,12) for which post-operative tracheostomy and PEG were done for 4 -6 weeks. This again emphasizes the fact that large and giant tumors have greater involvement of the nerves as compared to small tumors.…”

Treated large posterior fossa vestibular schwannoma and meningioma: Hearing outcome and willingness‐to‐accept brain implant for unilateral deafness

“…Tumor size was not controlled for tumor type comparisons. Joarder et al reported on hearing outcome for 34 CPA tumors (27 VSs, 6 meningiomas, and 1 epidermoid) 6 . Hearing preservation was attempted in three VS and two meningioma cases.…”

“…While both tumor types share common presentation symptoms and intervention approaches, there are few studies that have directly compared hearing outcome after surgical resection for similarly sized tumors. 5,6 From a pathogenesis standpoint, the tumor originating cell-type differs between VS and meningioma suggesting that hearing outcomes may be different between the two. Schwann cells that envelope audiovestibular nerve fibers give rise to VS, 7,8 whereas arachnoid cap cells that surround the brain and spinal cord give rise to meningioma.…”

“…Key decision‐making factors for tumor management include tumor size, audiovestibular deficits, brainstem compression, patient age, treatment preference, and co‐morbidities. While both tumor types share common presentation symptoms and intervention approaches, there are few studies that have directly compared hearing outcome after surgical resection for similarly sized tumors 5,6 …”

“…While both tumor types share common presentation symptoms and intervention approaches, there are few studies that have directly compared hearing outcome after surgical resection for similarly sized tumors. 5 , 6 …”