Management of posterior cranial fossa meningiomas

Posterior cranial fossa meningiomas: Comparison of results between patients older and younger than 70 years

Introduction

Surgical strategy for meningioma resection in the elderly is controversial: diverse studies in the literature have pointed at the age as a negative prognostic factor in terms of postoperative results.

Research question

The aim of this study is to compare surgical outcomes after resection of posterior fossa meningiomas in <70 and ≥ 70 years-old age groups.

Material and methods

We reviewed 72 patients affected by posterior fossa meningiomas who underwent surgical treatment at San Filippo Neri Hospital, Rome, Italy between September 2010 and December 2022. We analyzed data regarding tumor size, clinical presentation, extent of resection and complication/mortality.

Results

The groups consisted of 52 (72,2%) young and 20 (27,8%) elderly patients. Gross total resection rate was significantly higher among youngsters (p = 0,013), mainly for planned subtotal removal in older patients. At 3-month follow-up, clinical improvement was seen in 19 (36,5%) young and 7 (35,0%) elderly patients, which raised at last follow-up, being 84,6% (44) and 80,0% (16), respectively (p = 0,406). Two cases of progression/recurrence among the elderly and 1 among youngsters were observed; one case of mortality among the elderly was reported.

Discussion and conclusions

Safety data regarding postoperative complications and mortality in our series seem to confirm that there is no significant difference between older and younger patients, as long as older patients are carefully selected. Therefore, if surgery is proposed, it should be radical if gross total resection could be safely attempted.

Cochlear Implants and Health Status: A Comparison with other Hearing-Impaired Patients

Eighty-four adult cochlear implant (CI) users were compared with 3 other groups of severely to profoundly hearing impaired adults concerning quality of life (QOL): 1) 19 CI candidates who were accepted as candidates for implantation, but who were not operated on; 2) 16 CI candidates whose impairment was not severe enough for implantation; and 3) 60 users of acoustic hearing aids. Generic and disease-specific QOL questionnaires were used. The CI group scored significantly better than the CI candidates who met the criteria for implantation, but who were not operated on, on 2 of 6 categories of a disease-specific QOL measure. The CI patients had significantly less anxiety and depression than the unoperated CI candidates who met the criteria for implantation. Validation and reliability testing of 2 disease-specific QOL measures were performed by factor analyses.

Comparison of vestibular function between large cerebellopontine angle meningioma and schwannoma

CONCLUSION

Abnormal caloric and vestibular evoked myogenic potential (VEMP) responses are frequently encountered with a large cerebellopontine angle (CPA) schwannoma, while normal caloric responses and abnormal VEMPs are noted with a large CPA meningioma. This difference may possibly exist because schwannoma causes vestibular deficits via parenchymal involvement, while vestibular deficits in the meningioma are mostly due to compression neuropathy.

OBJECTIVES

This study aimed to compare the tumor characteristics in relation to vestibular function, i.e. caloric and VEMP responses, between large-sized (>2.5 cm) meningioma and schwannoma in the CPA.

PATIENTS AND METHODS

Five patients with large CPA meningioma and nine patients with large CPA schwannoma were enrolled in this study. Each patient underwent a battery of tests including audiometry, caloric test, VEMP test, and MRI study.

RESULTS

The meningioma group showed 20% caloric abnormality and 75% VEMP abnormality, while the schwannoma group revealed 100% caloric and 100% VEMP abnormalities. A significant difference existed in relation to caloric abnormality between the two groups, but not in relation to VEMP abnormality.

Posterior petrous face meningiomas

OBJECTIVE

To define the clinical presentation, treatment options, and outcomes for a subset of meningiomas of the posterior fossa skull base that arise from the posterior petrous face between the region of the porus acousticus and the sigmoid sinus.

STUDY DESIGN AND SETTING

A retrospective chart review from a large skull base surgery practice at a tertiary care institution.

RESULTS

This cohort of patients presented with minimal symptoms, yet large tumors, averaging 3.8 cms and causing significant cerebellar compression. Retrosigmoid craniotomies afforded excellent exposure.

CONCLUSION AND SIGNIFICANCE

Patients with large tumors emanating from the posterior fossa aspect of the temporal bone should be evaluated on the basis of their site of origin. Patients with tumors emanating from the anterior or ventral portion of the temporal bone have greater symptoms and greater operative complications than those emanating from the posterior petrous face, between the porus acousticus and sigmoid sinus.

Meningiomas of the cerebellopontine angle

BACKGROUND

Meningiomas of the cerebellopontine angle (CPA), although uniform in location, are diverse with regard to the site of dural origin and displacement of neurovascular structures. A study of patients with CPA meningiomas was undertaken to gain more information regarding the relationship between site of dural attachment, clinical presentation, operative approach, and outcome.

METHODS

In this report, we retrospectively review 40 patients with CPA meningiomas managed surgically.

RESULTS

Common clinical presentations were hearing loss, unsteadiness, and dysequilibrium. Findings upon physical examination included hearing loss (73%), cerebellar signs (32%), trigeminal neuropathy (16%), and facial nerve dysfunction (16%). The most common site of dural origin was the petrous ridge (anterior to the IAC [26%], posterior [21%], superior [18%], and inferior [16%]). Less common sites of dural origin included the tentorium (31%), the clivus (15%), the IAC (10%), and the jugular foramen (8%). Site of dural origin determined the direction of displacement of the facial/vestibulocochlear nerve bundle. The most common microsurgical complication was facial nerve dysfunction (30%). Gross total resection was achieved in 82% of cases, whereas 18% underwent subtotal resection. Two patients died. Follow-up ranged from three months to 13 years with three recurrences.

CONCLUSIONS

CPA meningiomas displace the seventh and eighth cranial nerves in various directions depending on the site of dural origin. Total surgical excision can be accomplished in the majority of cases with acceptable morbidity.

The effect of long-term deafness on speech recognition in postlingually deafened adult CLARION cochlear implant users

Research suggests that duration of deafness prior to cochlear implantation affects postoperative speech recognition in adults. Duration of deafness usually is defined as the number of years between the onset of profound deafness and implantation. The purpose of this study was to examine the effects of duration of deafness--expressed as percentage of life with deafness--independent of age at implantation on postoperative speech recognition in adult postlingually deafened CLARION Multi-Strategy Cochlear Implant users. Speech recognition tests (CID sentences and NU6 words) were administered to 202 consecutively implanted adults preoperatively and at 3 and 6 months after initial device fitting. Patients implanted at a younger age and those with smaller percentages of their lives with deafness achieved the highest levels of short-term postoperative speech recognition. Patients who had been deaf for > or =60% of their lives demonstrated a slower rate of speech recognition improvement than those with shorter durations of deafness, but still continued to improve with increased implant experience.

Correlation of acoustic threshold measures and spiral ganglion cell survival in severe to profound sensorineural hearing loss: implications for cochlear implantation

In a temporal bone study of 26 ears from 13 patients who, in life, had severe sensorineural hearing loss, the segmental and total spiral ganglion cell (SGC) counts were correlated with hearing thresholds and with the difference between hearing thresholds in the two ears, the age at death, the duration of deafness, and the duration of hearing loss. A statistically significant correlation was found between the interaural differences in total SGC counts and the interaural difference in pure tone averages for 3, 4, and 5 frequencies. The total SGC count was higher in the ear with the better residual hearing in 11 of 12 cases. Approximately 41% of the variability in interaural difference in pure tone average was explained by the difference in SGC counts. The findings would suggest that in a given individual, selection of the ear with better residual hearing for cochlear implantation is likely to result in accessing a higher number of residual SGCs. This, in turn, may result in better speech recognition with the implant.

Audio-vestibular findings in meningioma of the cerebello-pontine angle: a retrospective review

The aim of this study was the determination of the incidence of symptoms of audio-vestibular dysfunction and of abnormalities on audio-vestibular testing in patients found to have a unilateral meningioma of the cerebello-pontine angle (CPA). The case notes of 25 patients diagnosed with unilateral, sporadic and histologically proven CPA meningioma were retrospectively reviewed. The age range of this series was 31-71 years, with a mean age of 50 years. Two patients were male (eight per cent) and 23 were female (92 per cent). The mean length of history was 44.7 months. The distribution of tumour size was skewed toward larger tumours, with 15 cases (60 per cent) having tumours with a maximum diameter greater than 3.5 cm on imaging. Pure tone audiometry was normal in five cases (20 per cent), and no patients exhibited the high frequency sensorineural hearing loss that is characteristic of vestibular schwannoma. Speech audiometry was normal in 50 per cent of cases. Caloric testing was abnormal in 77 per cent of the 18 cases tested, whilst auditory brainstem responses (ABR) were abnormal in 100 per cent of the 18 cases who had sufficient hearing for this test to be possible. The presence of normal audiometry in patients with a proven CPA lesion indicates that, if in a protocol for investigation, asymmetry of hearing is mandatory then some pathology will be missed. Any suspicion of a CPA lesion warrants investigation even in the absence of hearing loss. The investigation of choice for the identification of CPA lesions has become magnetic resonance imaging (MRI). If this technique is not available then this study indicates that ABR is a suitable and sensitive investigation. It should be borne in mind however that the data in this study has been derived from a series of predominantly large tumours, and the sensitivity of ABR to smaller CPA meningiomata may fall, as is the case for vestibular schwannoma.

Meningioma of the internal auditory canal

Meningiomas are the second most common tumor to involve the cerebellopontine angle (CPA), but controversy exists as to whether they can arise within the internal auditory canal (IAC) or whether involvement of the IAC occurs secondarily by extension from the CPA. This paper reports on a patient with an enhancing IAC meningioma that then grew and on subsequent scans was found to involve the CPA. This case demonstrates that these tumors can arise within the IAC and can grow out to involve the CPA. These findings are discussed within the context of meningioma tumor genetics and the histologic evidence for precursor cells in the IAC. The radiologic findings useful in distinguishing an acoustic neuroma from a meningioma are reviewed in the light of this case. While an enhancing mass projecting into the IAC is most often an acoustic neuroma, this radiologic findings is not pathognomonic.