Reliability of clinical diagnosis of masses of the cerebellopontine angle: A retrospective multi-institutional study

Cerebellopontine angle ependymoma presenting as isolated hearing loss in an elderly patient: A case report and literature review

Background:

Ependymoma is an uncommon tumor accounting for approximately 1.9% of all adult central nervous system tumors. Ependymomas at the cerebellopontine angle (CPA) are even more rare and only previously described in isolated case reports. Typically, acoustic neuromas and meningiomas represent the bulk of adult CPA tumors. Diagnosis can be challenging, as ependymomas have clinical findings and imaging characteristics that overlap with more common tumor histologies at the CPA.

Case Description:

We present the case of a 70-year-old male patient with progressive, isolated left-sided hearing loss found to have a World Health Organization (WHO) Grade II CPA ependymoma, representing one of the oldest recorded patients presenting with this primarily pediatric malignancy in this unique location. The patient presentation with isolated hearing loss was particularly unusual. When associated with neurologic deficits, CPA ependymomas more characteristically result in facial nerve impairment with fully preserved hearing, while vestibular schwannomas tend to present with isolated hearing loss. The standard of care for pediatric ependymomas is maximal safe resection with adjuvant radiotherapy, but treatment paradigms in adult CPA ependymoma are not well defined particularly for WHO Grade II disease. After resection, he received adjuvant radiation to decrease the risk of local recurrence. Twenty-nine months after resection, the patient remains free of treatment-related toxicity or disease recurrence.

Conclusion:

We review this patient’s clinical course in the context of the literature to highlight the challenges associated with timely diagnosis of this rare tumor and the controversial role of adjuvant therapy in preventing local recurrence in these patients.

Endoscopic retrosigmoid keyhole approach in cerebellopontine angle tumors. A surgical cohort

INTRODUCTION AND OBJECTIVES

To determine the safety and efficacy of endoscopic keyhole surgery in patients with cerebellopontine angle tumours.

MATERIALS AND METHODS

This was a retrospective study of patients with cerebellopontine angled tumours treated by fully endoscopic retrosigmoid keyhole approach in a tertiary centre during a period of four years. Preoperative, transoperative and postoperative variables were analysed.

RESULTS

A number of 40 patients were included. The age average was 49.4 years and male/female proportion was 0.4-1. We found 31 vestibular schwannomas (77.5%), five meningiomas (12.5%), two cholesteatomas (5.0%) and two metastases (5.0%). Vestibular schwannomas Hannover type IIIb, IVa and IVb predominated. The surgical resection was total or near-total 92.5% of patients. Hearing preservation rate was 62.5% and acceptable facial function nerve function rate was 80% after six months. Hospital stay was 7.5 days. The total or near total resection and functionally preservation rate was high. Complications were unusual.

CONCLUSIONS

Endoscopic retrosigmoid keyhole approach represented a safe and efficient procedure in selected patients with cerebellopontine angle tumours.

Surgical management of intraoperatively diagnosed facial nerve schwannoma located at internal auditory canal and cerebellopontine angle - our experiences of 14 cases

BACKGROUND

Facial nerve schwannomas located at internal auditory canal and cerebellopontine angle (IAC/CPA FNS) were diagnosed intraoperatively, it poses a therapeutic dilemma to the surgeon.

OBJECTIVE

To report our experience in managing IAC/CPA FNS and to propose a treatment strategy.

METHODS

A total of 14 patients with IAC/CPA FNS who were diagnosed intraoperatively and treated by operation between 2015 and 2019 were retrospectively studied.

RESULTS

Unilateral hearing loss was the most common symptom and all these patients had normal facial nerve function preoperatively. Surgical approaches used in these patients including translabyrinthine (2 cases), retrosigmoid (RS) (11 cases), and middle cranial fossa (MCF) approach (1 case). Eight patients underwent partial resection, three patients underwent subtotal resection and three patients had complete tumor removal with facial nerve reconstruction. All partial resection patients and two patients underwent subtotal resection achieved a long-term HB grade I facial nerve function. The long-term facial nerve function of patients underwent complete resection and nerve grafting was no better than HB grade III.1 of the eight patients underwent partial resection experienced tumor regrowth during the follow-up.

CONCLUSIONS

Partial or subtotal resection for IAC/CPA FNS may provide an opportunity of retaining excellent facial nerve function. Regular postoperative imaging is helpful to monitor the recurrence.

Endoscopic retrosigmoid keyhole approach in cerebellopontine angle tumors. A surgical cohort

INTRODUCTION AND OBJECTIVES

To determine the safety and efficacy of endoscopic keyhole surgery in patients with cerebellopontine angle tumors.

MATERIALS AND METHODS

This was a retrospective study of patients with cerebellopontine angled tumors treated by fully endoscopic retrosigmoid keyhole approach in a tertiary center during a period of four years. Preoperative, transoperative and postoperative variables were analyzed.

RESULTS

A number of 40 patients were included. The age average was 49.4 years and male/female proportion was 0.4-1. We found 31 vestibular schwannomas (77.5%), five meningiomas (12,5%), two cholesteatomas (5,0%) and two metastases (5.0%). Vestibular schwannomas Hannover type IIIb, IVa and IVb predominated. The surgical resection was total or near-total 92.5% of patients. Hearing preservation rate was 62.5% and acceptable facial function nerve function rate was 80% after six months. Hospital stay was 7.5 days. The total or near total resection and functionally preservation rate was high. Complications were unusual.

CONCLUSIONS

Endoscopic retrosigmoid keyhole approach represented a safe and efficient procedure in selected patients with cerebellopontine angle tumors.