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At least 19 recordsLinked to original sources
PubMed1999

Diffusion-weighted MRI postoperative assessment of an epidermoid tumour in the cerebellopontine angle.

Cerebellopontine angle epidermoid tumour generally has a typical appearance with conventional MRI sequences. The lesion is irregular in shape and gives slightly higher signal than cerebrospinal fluid on T1- and T2-weighted images, with a characteristic marbled inner pattern on T1-weighted images. Diffusion-weighted imaging (DWI) can be useful for the diagnosis of an atypical epidermoid tumour. Our case report illustrates the usefulness of DWI for postoperative assessment of residual foci of tumour. The specific appearance of an epidermoid tumour is illustrated, with emphasis on apparent diffusion coefficient (ADC) measurements.

Adult↗
PubMed2006

[Anatomy of the cerebellopontine angle].

The cerebellopontine angle (CPA) is an anatomically complex region of the brain. In this article we describe the anatomy of the CPA cisterns, of the internal auditory canal, the topography of the cerebellum and brainstem, and the neurovascular structures of this area.

Brain Stem↗
PubMed1986

Cerebellopontine angle lipoma.

Cerebellopontine angle lipomas are rare lesions that differ from other intracranial lipomas in that they typically present with slowly progressive focal signs and symptoms identical to those of other tumors of this location, and by their propensity for intimate involvement of the adjacent cranial nerves. The lipomas in this study demonstrated this tendency to splay apart and infiltrate the cranial nerves, with the fatty tissue adjacent to the nerves invariably containing portions of the cranial nerves. Hence, the dissection of the adipose tissue from the nerves led to greater than anticipated postoperative neurologic deficits. Therefore, minimal excision of tumor is recommended to achieve decompression. Since preoperative evaluation does not distinguish with certainty this lesion from others more common to this location, intraoperative examination of frozen sections is required to confirm the diagnosis.

Adipose Tissue↗
PubMed2002

Choroid plexus papillomas of the cerebellopontine angle.

The cerebellopontine angle (CPA) is a rare site for the growth of choroid plexus papilloma (CPP). The clinicoradiological diagnosis of this tumor in the CPA is difficult because of the nonspecific clinical presentation and radiological features. Five cases of choriod plexus papilloma (3 males, 2 females) operated upon at this center are reviewed. All the cases were operated upon by retromastoid suboccipital craniectomy. As they all presented with a typical CPA syndrome without any distinctive radiological feature, a clinicoradiological diagnosis of CPP could not be reached in any of these. The diagnosis of CPP could only be suspected at the operation table and established on histopathological examination. Two patients developed recurrences at the primary site following surgery. One patient developed recurrence twice despite gross total excision of tumor in each sitting. Subsequently, this patient remained symptom free for a follow-up period of 1 year. Another patient developed recurrence 2 years following surgery, but he died due to septicemia and aspiration pneumonitis. Therefore definitive surgery could not be performed. Radiotherapy was offered to one of the patients having residual mass post operatively, to render her symptom free for a 4 year follow-up. The remaining two patients have also showed progressive improvement in their symptoms following surgery for 4 years on follow-up. Hydrocephalus was a common feature in all the cases preoperatively, but only one required shunt CSF diversion, because of rapid deterioration in visual equity. In all other cases, hydrocephalus was managed conservatively. Surgery remains the main modality of treatment for CPP, both for primary and recurrent tumors, but radiotherapy may have a role in cases of recurrence, which are quite frequent.

Adult↗
PubMed2002

Anesthetic management of a parturient with cerebellopontine-angle meningioma.

Cerebellopontine-angle meningioma is a rare intracranial neoplasm. It presents a difficult problem in pregnancy. A 27-year-old multigravida presented with headache, vomiting and visual disturbances at 30 weeks' gestation and cerebellopontine angle meningioma and hydrocephalus were diagnosed. A ventriculoperitoneal shunt was placed under general anesthesia to reduce the symptoms of raised intracranial pressure and to prevent the risk of cerebellar herniation. At 32 weeks a cesarean section was performed under general anesthesia and a healthy baby delivered. A smooth induction and maintenance of anesthesia along with lidocaine and mannitol were used to prevent a rise in intracranial pressure. The intraoperative and postoperative course was uneventful. Thus, immediate neurosurgical decompression improved the patient's condition, and allowed time for fetal maturity and uneventful delivery by cesarean section under general anesthesia.

Journal Article↗
PubMed2000

[Cerebellopontine angle tumors in adults].

Cerebellopontine angle tumors in adults are mainly benign and extra-axial. Magnetic resonance imaging is the first method for their diagnosis, CT being more useful for bony structures evaluation. Vestibular schwannoma is the most common lesion, it presents as a rounded mass centered along the axis of the internal acoustic meatus, the largest portion being in the cerebellopontine angle. The tumor enhances after Gadolinium administration. Meningioma is the second most common tumor; this slow growing mass has a wide attachment to the adjacent dural mater and is dramatically enhanced by contrast. Epidermoid cyst the third mass, is an extra-axial lesion with the signal is similar to the one of cerebrospinal fluid. Other lesions such as lipoma, papilloma, glioma or metastasis account for less than 1% of the cerebellopontine angle cistern tumors in adults.

Adult↗
PubMed1997

Experience with cerebellopontine angle epidermoids.

OBJECTIVE: Cerebellopontine angle (CPA) epidermoids, although of benign nature, are of considerable neurosurgical interest because of their close proximity and adherence to the cranial nerves and the brain stem. We describe our experience and attempt to correlate the final outcomes with the extent of surgical removal. METHODS: Twenty-five consecutive patients with CPA epidermoids that were surgically treated were reviewed, and the final outcomes were assessed. RESULTS: Thirteen patients had trigeminal neuralgia. In 7 of the 13 patients, trigeminal neuralgia was the only presenting feature. The epidermoid was confined to the CPA in each of 6 patients, and in each of 18, it had varying degrees of supratentorial extension. One patient had a predominant supratentorial epidermoid with extension to the CPA. The lesions were totally excised in 12 patients. Near-total removal was accomplished in eight patients, and in the remaining five, partial removal was accomplished. Transient worsening of the cranial nerve functions occurred in 11 patients, probably as a result of aggressive dissection of the capsule from the cranial nerves. In 9 of the 11 patients, the cranial nerve functions improved by the time of discharge. All of the patients who had trigeminal neuralgia were relieved of their symptoms. Eighteen patients were followed up for a mean period of 42 months, and none had symptoms of recurrence. CONCLUSION: Aggressive surgical removal results in transient but significant cranial nerve dysfunction in the postoperative period. A conservative approach is indicated for patients in whom the capsule is adherent to the brain stem and the cranial nerves.

Adolescent↗
PubMed1992

[Rare tumors of the cerebellopontine angle].

Tumours of the cerebellopontine angle are essentially benign in adults, are generally treated surgically and require a preoperative assessment as precise as possible. MRI simplifies the diagnostic assessment; it is indicated as the first-line investigation and is usually sufficient whenever a tumour of the posterior cranial fossa is suspected. Acoustic neuromas represent 75% of all tumours of the cerebellopontine angle. Other tumours are rare and essentially consist of meningioma, detected in 10 to 14% of cases and cholesteatoma in 1 to 5% of cases. Cholesteatoma, with a pathognomonic appearance, must be distinguished from arachnoid cyst. Other tumours are exceptional. The authors define the diagnostic criteria based on their experience and present a recent review of the literature.

Cerebellar Neoplasms↗
PubMed2006

[Disorders of the cerebellopontine angle].

Disorders of the cerebellopontine angle may present by symptoms like vertigo, hearing problems, affection of the trigeminal or facial nerve. Ipsilateral ataxia and contralateral hemiparesis develop in case of a rather large tumor in this region and display an involvement of the cerebellum and/or brainstem. However, some of these typical symptoms are not recognized by the patient. Thus, in case of a suspicion of a disorder of the cerebellopontine angle the relevant functions have to be tested clinically. In addition, electrophysiology can confirm dysfunction of these cranial nerves. Mainstay of the therapy should be the treatment of the underlying cause. Nevertheless, not seldom it is necessary to treat symptoms like vertigo or facial pain.

Cerebellar Diseases↗
PubMedDate not supplied

Lipoma of the cerebellopontine angle.

Lipomas of the cerebellopontine angle (CPA) are unusual tumors that typically present with hearing loss, tinnitus, dizziness, and occasionally facial neuropathies. We describe the case of a healthy 42-year-old woman who presented with left-sided hearing loss and facial synkinesis. T1-weighted magnetic resonance imaging revealed an enhancing lesion of the left CPA with no signal on fat suppression sequences. Despite conservative therapy, the patient developed progressive hemifacial spasm, and a suboccipital craniotomy approach was used to debulk the tumor, which encased cranial nerves V, VII, VIII, IX, X, and XI. Surgical histopathology demonstrated mature adipocytes, consistent with lipoma. Two years after surgery, the patient remains free of facial nerve symptoms. Cerebellopontine angle lipomas are rare lesions of the skull base and are reliably diagnosed with T1-weighted and fat suppression magnetic resonance sequences, which we recommend in the routine radiologic workup of CPA tumors. Accurate preoperative diagnosis is crucial because most CPA lipomas should be managed conservatively. Partial surgical resection is indicated only to alleviate intractable cranial neuropathies or relieve brainstem compression.

Adult↗
PubMed1996

Meningiomas of the cerebellopontine angle.

Meningiomas of the cerebellopontine angle (CPA) represent a clinically and surgically interesting entity. The opportunity of complete surgical excision and the incidence of impairment of nerval structures largely depend on the tumour biology that either leads to displacement of surrounding structures by an expansive type of growth or to an enveloping of nerval and vascular structures by an en plaque type of growth. As the origin and the direction of growth are very variable, the exact tumour extension in relation to the nerval structures and the tumour origin can be identified sometimes only at the time of surgery. Out of a series of 230 meningiomas of the posterior skull base operated between 1978 and 1993, data of 134 meningiomas involving the cerebellopontine angle are presented. There were 20% male and 80% female patients, age at the time of surgery ranging from 18 to 76 years, on the average 51 years. The clinical presentation was characterized by a predominant disturbance of the cranial nerves V (19%), VII (11%), VIII (67%) and the caudal cranial nerves (6%) and signs of ataxia (28%). 80% of the meningiomas were larger than 30 mm in diameter, 53% led to evident brainstem compression or dislocation and 85% extended anteriorly to the internal auditory canal. Using the lateral suboccipital approach in the majority of cases and a combined presigmoidal or combined suboccipital and subtemporal approaches in either sequence in 5%, complete tumour removal (Simpson I and II) was accomplished in 95% and subtotal tumour removal in 5%. Histologically the meningiotheliomatous type was most common (49%) followed by the mixed type (19%), fibroblastic (16%), psammomatous (7%), hemangioblastic (7%) and anaplastic (2%) types. Major post-operative complications were CSF leakage (8%) requiring surgical revision in 2% and hemorrhage (3%) requiring revision in 2%. While the majority of neurological disturbances showed signs of recovery, facial nerve paresis or paralysis was encountered in 17%, and facial nerve reconstruction was necessary in 7%. Hearing was preserved in 82% with improvement of hearing in 6%. The variability of tumour extension, the implications and limitations for complete surgical excision are discussed along with the experiences from the literature.

Adolescent↗
PubMed2002

Differentiation between cerebellopontine angle tumors in cancer patients.

OBJECTIVE: The possibility of metastasis to the cerebellopontine angle should be considered when a cancer patient has inner ear-related symptoms, although such metastasis is rare. Distinguishing between an independent tumor and a metastasis presents a challenge to the clinician once magnetic resonance imaging reveals a space-occupying lesion in the cerebellopontine angle. This study attempted to differentiate between primary benign and metastatic malignant cerebellopontine angle tumors in cancer patients. SETTING: University hospital. PATIENTS: A total of 174 cancer patients with inner ear-related symptoms such as vertigo, hearing loss, or tinnitus were seen at the university hospital from January 1994 to December 2000. All patients underwent a battery of audiologic and neurotologic tests. Magnetic resonance imaging was performed either when the clinical presentation suggested vertigo of central origin or when sensorineural hearing loss developed. RESULTS: Magnetic resonance imaging confirmed tumors of the cerebellopontine angle in 6 (3%) of the 174 patients, including 3 men and 3 women. Their ages ranged from 46 to 80 years (mean 62 years). The final diagnoses were breast cancer with cerebellopontine angle metastasis (1), breast cancer with cerebellopontine angle epidermoid cyst (1), colon cancer with cerebellopontine angle metastasis (1), colon cancer with acoustic neuroma (1), nasopharyngeal carcinoma with cerebellopontine angle metastasis (1), and nasopharyngeal carcinoma with cerebellopontine angle benign tumor (1). CONCLUSIONS: When a cerebellopontine angle tumor is discovered in a cancer patient, metastatic cancer should be suspected when the tumor presents with deficits of the VIIth and VIIIth cranial nerves of rapid progression or bilateral involvement, or extracranial systemic metastasis. Laboratory examinations such as cytologic study of the cerebrospinal fluid and serologic study can assist in the diagnosis.

Aged↗
PubMed2003

[Cerebellopontine angle surgery. Part 1: General remarks].

OBJECTIVES: Cerebellopontine angle tumors, although uniform in location, are diverse with regard to the site of tumor origin and displacement of the neurovascular structures. With the increasing use of magnetic resonance imaging in the diagnosis of brain lesions, the treatment of tumors of the cerebellopontine angle has changed extraordinarily. An appreciation of the vascular and cranial nerve microanatomy and the intimate relationship between neurovascular structures and the tumor is essential for achieving optimal surgical results METHODS: A review was made of the current literature. RESULTS AND CONCLUSIONS: The different treatment options are compared with microsurgical tumor resection with respect to neurological outcome and long-term follow-up. As microsurgical removal is still the treatment of choice for such tumors, the indication for surgical treatment is analyzed and the different surgical approaches to the cerebellopontine angle are described in terms of their frequency of involvement in the surrounding neural and vascular structures with varying tumor size. The etiology of facial and cochlear nerve injury, as well as complications involving other cranial nerves, are discussed with emphasis on pathophysiological and anatomical considerations. In conclusion, the great variation in the anatomical location and the involvement of neurovascular structures in the cerebellopontine angle is demonstrated.

Cerebellopontine Angle↗
PubMed2000

[Lipoma of the cerebellopontine angle: case report].

Lipoma of the cerebellopontine angle is a very rare tumor. We report the case of a 14-years-old female, with left side deafness during three years, associated with headache. CT scan showed an hypodense mass, without enhancement at the cerebellopontine angle. The patient was treated surgically by left retrosigmoid approach. The lesion involved the eighth and seventh cranial nerves and only a partial removal was performed. The postoperative course was uneventful. She had no more headache; the deafness of the left side remained unchanged. Asymptomatic lipoma of the cerebellopontine angle can be treated conservatively, although those with progressive symptoms should be treated surgically, with total or partial remove based on their neurovascular involvement.

Adolescent↗
PubMed1980

Surgical management of cerebellopontine angle tumors.

Of the 50 cerebellopontine angle tumors diagnosed during a three and one half year period, 36 were removed (all totally) using one of the three approaches to the cerebellopontine angle. Six patients, all elderly (over age 70) with obstructive hydrocephalus and complicating medical problems, had ventriculoperitoneal shunts inserted. One of these subsequently required tumor excision 10 months later. Of the 35 patients with normal functioning facial nerves pre-operatively, 34 (97 per cent) had the nerve spared surgically. Of 12 patients in whom hearing conservation was attempted, the cochlear nerve was spared in eight. However, useful hearing was preserved in one, with sound appreciated only in another.

Adult↗
PubMed2001

Primary malignant melanoma of the cerebellopontine angle.

BACKGROUND: Malignant tumors of the cerebellopontine angle are very rare, accounting for less than 1% of lesions at this site. These may be primary or secondary tumors of the temporal bone, central nervous system (CNS), or leptomeninges. Malignant melanoma is uncommon, accounting for 1.5% of all types of malignant tumors. Metastatic melanoma is a frequent cause of CNS metastasis, often with leptomeningeal spread. Primary leptomeningeal melanoma is, however, rare and even more so at the cerebellopontine angle. The prognosis for CNS malignant melanoma is generally very poor. PATIENT: The authors describe the case of a 29-year-old woman with unilateral hearing loss and facial paresis. Magnetic resonance imaging (MRI) demonstrated a mass that was thought to be an acoustic neuroma but was seen to involve the cochlea as well as the internal auditory meatus and cerebellopontine angle. The lesion was subsequently excised completely by a trans-labyrinthine approach, with facial nerve preservation, and was shown on histologic examination to be a malignant melanoma. Further comprehensive investigation did not reveal a primary extracranial site or any sign of CNS spread. The clinical features of this case, including the radiologic and histologic findings, are described, and literature concerning management is reviewed.

Adult↗
PubMed1985

Sudden hearing loss and cerebellopontine angle tumors.

Lesions of the cerebellopontine angle may cause a sudden hearing loss. To illustrate and reaffirm the importance of a thorough neurotologic evaluation we performed a retrospective review of the audiologic and clinical data available on 506 patients with proven lesions of the cerebellopontine angle. Seventy-seven patients (15.2%) were found to have a history commensurate with sudden hearing loss. We reviewed the relevant audiologic data as well as the clinical circumstances of this select patient population.

Adult↗