Surgical Outcomes of Cerebellopontine angle Tumors in 50 Cases (original) (raw)
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Results of Surgery of Cerebellopontine angle Tumors
2015
Introduction: To report our experience with a large series of surgical procedures for removal of cerebellopontine angle (CPA) tumors using different approaches. Materials and Methods: This was a retrospective analysis of 50 patients (mean age, 49 years) with CPA tumors (predominantly acoustic neuroma) who underwent surgical removal using appropriate techniques (principally a translabyrinthine approach) during a 4-year period. Results: One death occurred during this study. There were nine cases (18%) of cerebrospinal fluid leak, and five patients (10%) were diagnosed as having bacterial meningitis. Complete gross tumor removal was not achieved in four patients (8%). Facial nerve function as measured by the House Brackmann system was recorded in all patients 1 year following surgery: 32% had a score of 1 or 2; 26% had a score of 3 or 4; and 8% had a score of 5 or 6. Other complications included four cases of wound infection. Conclusion: The translabyrinthine approach was predominantly...
Clinical features and outcomes in patients with non-acoustic cerebellopontine angle tumours
Journal of Neurology, Neurosurgery & Psychiatry, 1999
Objectives-Non-acoustic tumours of the cerebellopontine angle diVer from vestibular schwannomas in their prevalence, clinical features, operative management, and surgical outcome. These features were studied in patients presenting to the regional neuro-otological unit. Methods-A retrospective analysis of clinical notes identified 42 patients with non-acoustic tumours of the cerebellopontine angle. Data were extracted regarding presenting clinical features, histopathological data after surgical resection, surgical morbidity and mortality, and clinical outcome (mean 32 months follow up). Results-The study group comprised 25 meningiomas (60%), 12 epidermoid cysts/ cholesteatomata (28%), and five other tumours. In patients with meningiomas, symptoms diVered considerably from patients presenting with vestibular schwannomas. Cerebellar signs were present in 52% and hearing loss in only 68%. Twenty per cent of patients had hydrocephalus at the time of diagnosis. After surgical resection, normal facial nerve function was preserved in 75% of cases. In the epidermoid group, fifth, seventh, and eighth nerve deficits were present in 42%, 33%, and 66% respectively. There were no new postoperative facial palsies. There were two recurrences (17%) requiring reoperation. Overall, there were two perioperative deaths from pneumonia and meningitis. Conclusions-Patients with non-acoustic lesions of the cerebellopontine angle often present with diVerent symptoms and signs from those found in patients with schwannomas. Hearing loss is less prevalent and cerebellar signs and facial paresis are more common as presenting features. Hydrocephalus is often present in patients presenting with cerebellopontine angle meningiomas. Non-acoustic tumours can usually be resected with facial nerve preservation. (J Neurol Neurosurg Psychiatry 1999;66:768-771)
A retrospective study of cerebellopontine angle tumours: A single instituitional study
IP Indian Journal of Anatomy and Surgery of Head, Neck and Brain
Introduction: Cerebellopontine angle (CPA) tumors are rare intracranial neoplasms that arise in the region between the cerebellum and the pons. 1 These tumors can be challenging to treat due to their complex anatomy and proximity to critical neurovascular structures. Surgical intervention is often necessary to achieve a favorable outcome. Aims and Objectives: The primary objectives of this retrospective study are to analyze the clinical and radiological characteristics of cerebellopontine angle tumors, identify pathological types, assess surgical resectability, and evaluate postoperative outcomes. Materials and Methods: The study enrolled 14 patients who underwent surgical intervention for cerebellopontine angle tumors at Armed forces medical college, Pune. A retrospective analysis was performed, considering demographic data, clinical presentations, imaging characteristics and surgical outcomes. Results: Vestibular schwannoma was the predominant tumor type with majority of tumors manifesting between third to fifth decades. Clinical manifestation included SNHL, cerebellar dysfunction, headache and sensory trigeminal dysfunction. A substantial proportion (86%) presented with no useful hearing preoperatively. Surgical outcomes indicated varying degrees of success, with total resection achieved in a subset of cases. Notably, anatomical preservation of the facial nerve was accomplished in a significant proportion of patients. Postoperative assessments, using the House Brackmann system, revealed positive facial nerve function outcomes in a substantial percentage. Complications included cerebrospinal fluid leak (14%), meningitis(7%) and lower cranial nerve paresis (7%). Conclusion: In conclusion, surgical intervention plays a crucial role in the management of cerebellopontine tumors. The choice of surgical approach should be individualized based on tumor characteristics and patient factors, with the goal of achieving maximum tumor resection while minimizing complications. Further research and advancements in surgical techniques are needed to optimize outcomes for patients with cerebellopontine tumors. This is an Open Access (OA) journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
Surgical Outcome of Cerebellopontine Angle Tumors
2019
Objectives: The purpose of this study was to evaluate the clinical features and surgical outcome of CP tumors with retractorless method.Material and Methods: It is a retrospective study of 7 cases operated in Neurosurgery Unit 1, PINS/Lahore General Hospital, Lahore. Study span was 2 months and follow up duration was 15 days. Predominating symptoms were related to cranial nerves 5th, 6th, 7th, 8th and cerebellum.Results: Age range was 25 – 45 years with an average age of 35 years. 4 patients were male and 3 patients were female. In all patients, surgery was performed. Clinical presentation was tinnitus, decrease hearing, hearing loss, abnormal balance, headache, facial numbness, buccal numbness, ataxia and trigeminal neuralgia in one case. All patients were operated through retrosigmoid sub-occipital approach with retractorless method. VP shunt was inserted in 3 cases and EVD was done in all other cases just before surgery. Histopathology report was 4 patients were of vestibular sch...
Early complications and symptoms of cerebellopontine angle tumor surgery: a prospective analysis
European Archives of Oto-Rhino-Laryngology, 2011
Our objective is to prospectively report very early complications and outcomes of cerebellopontine angle (CPA) surgery. Between January and August 2007, 72 patients were operated on by different transpetrosal approaches in a tertiary referral center. During preoperative assessment, facial nerve function (House-Brackmann grading system), the presence of vertigo or tinnitus and caloric test results were recorded and correlated with complications and symptoms occurring daily from day (D) 1 to D 8. The overall number of complications did not differ from those of former retrospective studies; nevertheless, the prospective feature of this study prompts several comments. Even slight (grade II) preoperative facial impairments increased the risk of severe postoperative facial dysfunction. Keratitis was frequent (42%) even in patients with normal facial function. Thrombo-embolic complications only occurred after long air-travel (C5 h). Preoperative caloric test status was predictive of postoperative vestibular disturbance occurrence. With respect to the activity recovery; younger patients (\40 years old) displayed faster central compensations than the older ([60 years old) patients. This study highlights several features that may be used for preoperative patient counseling and complication management. In particular, the practitioner has to pay attention to even minor preoperative clinical signs of facial dysfunction to properly inform the patient of facial outcome. Routine ophthalmologic evaluation should be practiced, even when facial function is normal or subnormal. Level of evidence: 1b.
Giant cerebellopontine Angle Tumor Surgery: Experience of a Tertiary Care Center in Lahore, Pakistan
Pakistan Journal Of Neurological Surgery
Objectives: In this case series, we report our experience of microsurgical resection of large and giant CPA tumors at the Department of Neurosurgery, Punjab Institute of Neurosciences (PINS). Materials and Methods: This was a retrospective case series of 328 patients (mean age, 40 years) with large and giant CPA tumors (predominantly vestibular schwannomas) who underwent surgical removal using a retro sigmoid approach over 4 years. Results: In the study, there were 58% (190) females while 42% (138) were males. 60% (197) of the tumors were right – sided and 40% (131) left – sided. Hearing loss was the main presenting complaint with 73% of the patients having non-serviceable hearing. There were 14 (4.3%) deaths reported during the retrospective analytic study. There were 3 cases of postoperative hemorrhage, and 11 patients expired due to post-operative wound infection. There were 13 cases diagnosed as having post-operative bacterial meningitis. Gross total tumor excision was achiev...
Non-acoustic tumors of the cerebellopontine angle
Neurosurgical Review, 1992
52 patients with non-acoustic neurinoma tumors of the cerebellopontine angle undergoing surgery over a 16 year period (1974-1989) are analyzed with regard to epidemiologic factors, presenting symptoms, neurological findings, diagnostic procedures, surgical approaches, recurrences, and longterm survival rates. Meningiomas (20 cases) and epiderrnoid tumors (16 cases) outnumber the rare tumors which exhibit wide histological variation. Trigeminal neuralgia was found as a significantly frequent sign of epidermoids. Total removal was possible in nine meningiomas (45 %), fourteen epidermoid tumors (87.5%) and 11 (69%) mostly malignant rare tumors. There were many longterm survivors in meningioma and epidermoid groups with a median follow-up period of 4.1 years. The results are compared to those reported in the literature and a brief review of reported rare tumors of the angle is presented.
Early-Career Surgical Practice for Cerebellopontine Angle Tumors in the Era of Radiosurgery
Journal of Neurological Surgery Part B: Skull Base, 2017
We analyzed the outcomes of patients with large cerebellopontine angle (CPA) tumors treated by a skull-base team in which two surgeons (one neurosurgeon and one otological surgeon) were in the beginning of their careers (<40 years old). Data of patients operated on between April 2012 and March 2016 were reviewed. All factors related to surgical training were considered. Thirty-one patients had vestibular schwannomas, while 26 had meningiomas. Mean tumor diameter was 30.6 mm (range, 23–49 mm) for schwannomas and 35 mm (range, 22–51 mm) for meningiomas. Satisfactory postoperative facial nerve function (House–Brackmann's grade I or II) was achieved in 20 (64.5%) schwannoma patients and 21 (80.7%) meningioma patients. Gross total and near-total resections (residual tumor < 5 mm) were achieved in 21 (67.7%) and 9 (29%) schwannoma patients, respectively. Gross total resection (Simpson's grade II) was achieved in 18 (69.2%) meningioma patients. In both groups, the retrosigmoi...
Neurosurgery, 1998
Great advances in neuroimaging, intraoperative cranial nerve monitoring, and microsurgical technique have shifted the focus of acoustic neuroma surgery from prolonging life to preserving cranial nerve function in patients. An appreciation of the vascular and cranial nerve microanatomy and the intimate relationship between neurovascular structures and the tumor is essential to achieve optimum results. In this paper the authors analyze the microanatomical variations in location of the facial and cochlear nerves in the cerebellopontine angle (CPA) associated with acoustic neuromas and, additionally, describe the frequency of involvement of surrounding neural and vascular structures with acoustic tumors of varying size. The authors base their findings on their experience treating 1006 consecutive patients who underwent surgery via a retrosigmoid or translabyrinthine approach.