Early-Career Surgical Practice for Cerebellopontine Angle Tumors in the Era of Radiosurgery

Physiotherapy Rehabilitation Following Acoustic Neuroma Resection in a Patient With Cerebellopontine Angle Tumour: A Case Report

Acoustic neuroma excision in patients with cerebellopontine angle (CPA) tumours offers particular rehabilitation problems due to the complicated architecture of the cerebellum and brainstem tissues involved. CPA tumours (acoustic neuromas) are slow-growing tumours that arise from the vestibulocochlear nerve. Surgical excision of these tumours can cause neurological abnormalities that compromise motor coordination, balance, and facial nerve function. The case study emphasises the importance of a comprehensive physiotherapeutic approach in rehabilitating a patient following acoustic neuroma excision, with a focus on particular CPA tumour deficits. The rehabilitation programme focuses on improving functional outcomes through balance, proprioception, and vestibular rehabilitation that is customised to the demands and deficiencies of the patient. Our comprehensive approach seeks to improve patients' quality of life, promote neurological healing, and support easy reintegration into normal activities following CPA tumour surgery.

Deadly complication of sacrificing superior petrosal vein during cerebellopontine angle tumor resection: A case report and literature review

Background:

Tumors of the cerebellopontine angle (CPA) are challenging to resect and have been proven difficult for neurosurgeons to manage optimally. Superior petrosal vein complex (SPVC) as the main drainage system and close proximity to CPA could be an obstacle during operation. There is an incidence ranging from 55% to 84% of injury to one part of the SPVC during CPA tumor surgery.

Case Description:

We report a case of 65-year-old woman with CPA tumor, who complained of unilateral hearing loss, dizziness, and facial pain. During tumor resection, one part of SPV complex was injured, then cerebellar edema develops.

Conclusion:

This case provides an overview of surgical complication associated with venous sacrifice. This would support the agreement to preserve SPV regarding risks and improve the quality of surgical decision making.

Neurosurgery residency program in Yogyakarta, Indonesia: improving neurosurgical care distribution to reduce inequality

OBJECTIVE

Educating future neurosurgeons is of paramount importance, and there are many aspects that must be addressed within the process. One of the essential issues is the disproportion in neurosurgical care, especially in low- and middle-income countries (LMICs). As stated in their report "Global Surgery 2030," The Lancet Commission on Global Surgery has emphasized that the availability of adequate neurosurgical care does not match the burden of neurosurgical disease. A strong partnership with the local and national government is very desirable to improve the way everyone addresses this issue. In addition, international collaborative effort is absolutely essential for the transfer of knowledge and technology from a developed country to an LMIC. This paper shows what the authors have done in Yogyakarta to build an educational model that helps to improve neurosurgical care distribution in Indonesia and reduce the inequity between provinces.

METHODS

The authors gathered data about the number of neurosurgical procedures that were performed in the sister hospital by using data collected by their residents. Information about the distribution of neurosurgeons in Indonesia was adapted from the Indonesian Society of Neurological Surgeons.

RESULTS

The data show that there remains a huge disparity in terms of distribution of neurosurgeons in Indonesia. To tackle the issue, the authors have been able to develop a model of collaboration that can be applied not only to the educational purpose but also for establishing neurosurgical services throughout Indonesia. Currently they have signed a memorandum of understanding with four sister hospitals, while an agreement with one sister hospital has come to an end. There were more than 400 neurosurgical procedures, ranging from infection to trauma, treated by the authors' team posted outside of Yogyakarta.

CONCLUSIONS

Indonesia has a high level of inequality in neurological surgery care. This model of collaboration, which focuses on the development of healthcare providers, universities, and related stakeholders, might be essential in reducing such a disparity. By using this model, the authors hope they can be involved in achieving the vision of The Lancet Commission on Global Surgery, which is "universal access to safe, affordable surgical and anesthesia care when needed."

Small Cerebellopontine Angle Meningioma-Surgical Experience of 162 Patients and Literature Review

Objective

To retrospective analyze the clinical data of 162 patients with small cerebellopontine angle meningiomas. To compare with the nature of tumors, symptoms pre- and post-treatments, neurological deficit, and prognosis in literatures. To explore the surgical outcomes of small cerebellopontine angle meningiomas and summarize the surgical experience.

Methods

All of 162 patients with small cerebellopontine angle meningiomas underwent surgery between January 2010 and December 2019 in the neurosurgery department of the First Affiliated Hospital of Soochow University. This cohort of eight literatures reported about stereotactic radiotherapy of small cerebellopontine angle meningiomas between January 2010 and December 2019. All clinical data were obtained for analysis.

Results

Compared with stereotactic radiotherapy, surgical treatment for small cerebellopontine angle meningiomas lead to the better results in relieving symptoms and inhibiting tumor progression. Surgical treatment can obtain the exact pathological examination results to guide the further treatment.

Conclusions

Surgical treatment should be the first choice for small cerebellopontine angle meningiomas.

A modified park bench position: the "Dormeuse" position

BACKGROUND

Because of the restricted volume of the cisternal space, proper patient positioning on the operating table is of utmost importance during surgery by retrosigmoid approaches. Three positions are commonly used: supine, with the head rotated to the side contralateral to the lesion; the semi-sitting position; and the park bench position. Each position has advantages and disadvantages, and the surgeon should choose the one best suited to the individual patient and the pathology to be treated.

METHODS

We describe a modified park bench position that we call the Dormeuse position.

CONCLUSION

The Dormeuse position guarantees decrease in the posterior fossa pressure and allows optimal neural and vascular manipulation and control of any aspect of the cerebellopontine angle.