Patients with cerebellopontine angle tumors, including acoustic neuromas, usually have a. In a series of 1,354 cerebellopontine angle tumors treated at the otologic medical croup, approximately 10% were lesions other than acoustic neurinomas. As the tumor was symptomatic, we discussed the potential treatment options with the patient, who decided to undergo gamma knife treatment at her local hospital. This was a retrospective analysis of 50 patients mean age, 49 years with cpa tumors predominantly acoustic neuroma who underwent surgical removal. Cerebellopontine angle cpa meningiomas account for 1. Ebook download surgery of the cerebellopontine angle, by nicholas c. Both of these congenital lesions can be found in the cerebellopontine angle cpa, and symptomatic clinical presentation is dictated by the location of the lesion. Methodstwenty five cases of cpa surgeries performed between november 2002 and december 2008 in which mi. Disease involving the cerebellopontine angle cpa may arise from structures located within the cistern or from extension of lesions located primarily outside the cisternfrom the brainstem, fourth ventricle, choroid plexus and bony skull base. The adobe flash plugin is needed to view this content. Calcifying pseudoneoplasm of the cerebellopontine angle.
These features were studied in patients presenting to the regional neurootological unit. Temporal resolution in patients with cerebellopontine. Gerganov clinical pearls comprehensive knowledge of the complex anatomy of the cerebellopontine cp angle is a prerequisite for achieving good surgical results. Calcifying pseudoneoplasms of the neuraxis are rare tumors. Synchronous tumors of the cerebellopontine angle mayo clinic. Studies reveal that acoustic neuromas vestibular schwannomas constitute nearly 80% of all cerebellopontine angle tumors. They are benign tumors commonly seen in adults, which usually present after a long asymptomatic period. Pdf tumors in the cerebellopontine angle in children. Although several mechanisms for cranial nerve dysfunction due to these tumors have been proposed, no direct evaluation for hyper or hypoactive dysfunction has been done. Many different types of tumor may arise in the cerebellopontine angle.
Objectives nonacoustic tumours of the cerebellopontine angle differ from vestibular schwannomas in their prevalence, clinical features, operative management, and surgical outcome. In this case series, pathophysiology of cranial nerve dysfunction in cpa epidermoid cysts was. Temporal resolution in patients with cerebellopontine angle tumors deficits have not been adequately explored and an attempt to understand this aspect is the high light of the current study. Tumors of the cerebellopontine angle cpa constitute about 610% of all intracranial tumor, it is a disease common in adults and rarely in children. Gamma knife radiosurgery for cerebellopontine angle epidermoid tumors has rarely been reported. The retrosigmoid endoscopic approach for cerebellopontine angle tumors and microvascular decompression. Gamma knife radiosurgery for cerebellopontine angle. Cerebellopontine angle mass radiology reference article. Surgery of cerebellopontine lesions madjid samii springer. Tumors of the cerebellopontine angle jama otolaryngology. Primary paraganglioma is a rare tumor in this location, with only two such cases having been reported in the literature, till date. Superior anatomical view of the left cerebellopontine angle cpa.
P y gao, a g osborn, j g smirniotopoulos, c p harris. Epidermoid tumors caused various symptoms, especially in the cerebellopontine angle 15 cases, of which a transient. Logan turners diseases of the nose throat and ear pdf. Schwannoma of right cerebellopontine angle is extremely rare to diagnose by cytology.
Primary cerebellopontine angle cpa pnet is an extremely rare entity. The cpa is defined as the angle formed in the horizontal section by the pons and the cerebellum in which the trigeminal v and acousticofacial nerve bundle viii are located. Focal hyperintensity in the dorsal brain stem of patients. Cerebellopontine angle meningioma diagnosed based on. The characteristic morphological features of these depend on the tissue from which the tumors arise. Majority of the cerebellopontine angle cpa tumors are acoustic neuromas, while bulk of the nonacoustic tumors are formed by meningiomas and epidermoid cysts. Cerebellopontine angle tumors otolaryngologists perspective. To report our experience with a large series of surgical procedures for removal of cerebellopontine angle cpa tumors using different approaches. Outcomes after gamma knife radiosurgery in solitary acoustic tumors and neurofibromatosis type 2 authors. We report one such rare case presenting the cytological features in material obtained during the resection of the tumor.
Misdiagnoses with cerebellopontine angle tumor transotic approach. An endoscopic assisted retrosigmoid approach to the. Epidermoid cysts constitute less than 1 % of intracranial tumors with the majority of them involving cerebellopontine angle cpa. Abstractobjectiveto report experiences with use of otoendoscopy in cerebellopontine angle cpasurgeries. To our knowledge, the current study is the largest case series to report on radiosurgery for cerebellopontine angle epidermoid tumors.
Cerebellopontine angle tumors are encountered rather more commonly than anticipated by otolaryngologist. Renal cell carcinoma metastasis to the cerebellopontine. Pdf cerebellopontine angle cpa tumors are uncommon in children, and the pathological spectrum is different from that of adults. Other tumors presenting in this area are meningioma, epidermoid, pontine glioma, and cerebellar astrocytoma. The tumor was approached via a right posterior fossa craniectomy and removed with the finger. Cerebellopontine angle paraganglioma report of a case. The cerebeliopontine angle cpa cistern is a cerebrospinal fluidfilled space bound by the pons, cerebellum, and petrous temporal bone. The cerebellopontine angle cistern is a cerebrospinal fluidfilled space bound by the pons, cerebellum, and petrous temporal bone. Thus there may occur cysts, gliomas, ependymomas, aneurysms, osteomas, meningiomas, and cholesteatomas. This group of tumors account for nearly 10% of all intracranial tumors. Background synchronous tumors of the cerebellopontine angle cpa are very rare and inconsistently described. The pathology of the cpa can arise from the different structures in its anatomy and vecinity, like the cisterns, arteries. These tumors differ in their embryological origin but share similar features on imaging. An acoustic neuroma is a benign tumour that develops in the acoustic or auditory nerve.
Recently, a case has been described wherein a paraganglioma was apparently arising as a primary. Masses in this region are readily identified on crosssectional im. Early complications and symptoms of cerebellopontine angle tumor surgery. She had features of increased intracranial pressure. Cerebellopontine angle cpa masses are relatively common. Emphasizes the need for an individualized approach tailored to the tumor variant. The inclusion of an interactive atlas adds to the importance of the text and complements it, and also obviates the need to. This paper demonstrates a unique case in which a cpa lipoma was. Retrosigmoid approach for resection of an extraventricular choroid plexus papilloma in the cerebellopontine angle. Chapter 38 cerebellopontine angle tumors madjid samii, venelin m. Detecting a neoplasm in the cerebellopontine angle. Imaging of the cerebellopontine angle practical neurology.
Surgery of the cerebellopontine angle 1st edition pdf. The angle is bordered laterally and anteriorly by the posterior face of the petrous temporal bone. Surgical outcomes of cerebellopontine angle tumors in 50 cases. Tumors of the cerebellopontine angle request pdf researchgate. Much rarer primary tumors are schwannomas of other cranial nerves.
Cerebellopontine angle tumor neoplasm of cerebellopontine angle. Nearly 90% of all cpa tumors include vestibular schwannomas acoustic neuromas and meningiomas. Pdf nonacoustic tumors of the cerebellopontine angle. Bruns nystagmus in cerebellopontine angle tumor neuro.
For about 85% of tumors in the region of the cerebellopontine angle is acoustic neuroma, 10% are meningiomas and 5% are epidermoid tumor. Of all cpa tumors, meningiomas are the secondmost frequent tumor in this area. Cureus surgical management and outcome experience of 53. Acoustic neuroma and other cerebellopontine angle tumors. History of cerebellopontine angle surgery 1st successful complete removal. The symptoms and signs of cpa disease are nonspecific, relating either to compression of the neural structures found within it or from compression. In view of the clinical findings, a diagnosis of a spaceoccupying lesion involving the left cerebellopontine angle was considered. Well, still perplexed of ways to obtain this ebook surgery of the cerebellopontine angle, by nicholas c. Cerebellopontine angle masses can be divided into four groups, based on imaging characteristics. Diagnosis and management andrew coughlin, md tomoko makishima. Pdf early complications and symptoms of cerebellopontine.
Cerebellopontine angle an overview sciencedirect topics. Rare tumors of the cerebellopontine angle derald e. Cerebellopontine angle primitive neuroectodermal tumor. Radiologically indistinguishable contiguous meningioma and. Cushing 1917 was the first to advocate intracapsular tumor. Cerebellopontine angle tumor in a patient with a maternally inherited sdhd gene mutation larry d. They constitute the most frequently diagnosed tumors of the posterior fossa and account for up to 10% of all intracranial neoplasms. Primitive neuroectodermal tumors pnets comprise a group of aggressive, poorly differentiated embryonal tumors occurring in central nervous system as well as in peripheral locations. Microanatomical variations in the cerebellopontine angle associated with vestibular schwannomas acoustic neuromas. Clinical examination revealed gross papilledema in both eyes with secondary optic atrophy.
Schwannomas are the most common tumors in the cerebellopontine cp angle. Cerebellopontine angle syndrome is usually due to an acoustic schwannoma arising from the vestibular nerve. It is important to have knowledge of this pathology and to be able to differentiate it from other commonly occurring cpa tumors. Lesions in this region are readily identified on crosssectional images. Warning of a high probability of malignancy article pdf available in journal of neurooncology 1123 february 20 with 1,0 reads.
A 47yearold female was diagnosed by mri with a tumor of right cerebellopontine angle cytologic material from the tumor was. Although a diverse range of pathologies may be seen in this region, the most common by far is a vestibular schwannoma pathology. The cisternal and intracanalicular portions of bilateral. Together these masses account for 85%90% of all cpa tumors. The cerebellopontine angle cpa is a common location for intracranial tumors but is a rare site for tumor metastasis. Of the nonacoustic tumors, the majority were meningiomas, primary cholesteatomas, and neurinomas of other cranial nerves in the posterior fossa. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis. Methods a retrospective analysis of clinical notes identified 42 patients with nonacoustic tumours of the cerebellopontine. Pediatric cerebellopontine angle and internal auditory canal tumors. Van hemert, 3 and john dornhoffer 1 1 department of otolaryngologyhead and neck surgery, 2 division of genetics, department of family medicine, winthrop p. The crucial neurovascular structures should be identified as early as possible during surgery, which enables their preservation and guides subsequent operative steps.
Tumors of the cp angle account for 5% to 10% of all intracranial neoplasms. Cerebellopontine angle cpa tumors are masses located in the region between the cerebellum and pons. Cushing 1917 was the first to advocate intracapsular tumor removal and hence recurrence. Ppt cerebellopontine angle masses powerpoint presentation free to download id. This is a prospective study of 30 patients at the neurosurgical department medical city, with mean age of 36 years with cpa tumors predominantly acoustic neuroma that underwent surgical removal using a suboccipital retrosigmoid approach over a 1year. Pdf epidermoid tumors of the cerebellopontine angle.
Surgery of the cerebellopontine angle 1st edition pdf download now surgery of the cerebellopontine angle is a single volume text which meshes the information available in surgical atlases with clinical disease entities. Both lipomas and dermoid cysts of the cerebellopontine angle are rare tumors. Focal hyperintensity fhi in the dorsal brain stem on t2weighted images of patients with cerebellopontine angle cpa tumor was thought to indicate degeneration of. Pontine angle tumors such as vestibular neuromas and meningiomas frequently present. Tumor cerebellopontine angle wahyuliati mutiara medika. The differential diagnoses of the tumor in the cerebellopontine angle included trigeminal neurilemmoma and meningioma. A 35yearold woman presented with insidious onset of hearing loss on the left side along with progressive unsteadiness of gait and diminution of vision. Clinical features and outcomes in patients with non. Cerebellopontine angle tumor neoplasm of cerebellopontine. Primary extraosseous ewing sarcoma in the cerebellopontine.
1559 1497 172 681 1342 1055 336 156 36 961 975 478 249 556 259 508 35 1100 177 417 66 363 1039 1414 1542 122 424 1458 898 643 285 1442 51 112 610 1071 1264 599 620 1073 467 864 978 744 1020 1249