1
|
Tugend M, Washington E, Sekula RF. Outcomes of trigeminal ganglion sparing surgical resection of non-acoustic cerebellopontine angle tumors causing trigeminal neuralgia. World Neurosurg 2024:S1878-8750(24)00548-5. [PMID: 38583565 DOI: 10.1016/j.wneu.2024.03.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE Tumors may be responsible for up to 5% of trigeminal neuralgia (TN) cases. Predictors of long-term pain relief after surgical resection of various cerebellopontine angle (CPA) tumor types are not well understood. Previous studies found that size and extent of resection predict long-term pain status, although resection of tumor involving the trigeminal ganglion (TG) may be associated with high morbidity. This study evaluated predictors of TN pain freedom after resection of a non-acoustic CPA tumor, with avoidance of any portion involving the TG. METHODS In a retrospective cohort study, we evaluated clinical outcomes and complications after surgical resection of non-acoustic CPA tumors with purposeful avoidance of the TG causing trigeminal neuralgia. The primary outcome was pain-freedom. We performed logistic regression analyses to examine the relationship between pain-freedom at last follow-up and age, side of symptoms, pre-operative symptom duration, tumor diameter, tumor type, and concurrent neurovascular compression (NVC). RESULTS Of 18 patients with non-acoustic CPA tumors causing TN treated with surgical resection, 83.3% were pain-free at last follow-up (mean 44.6 months). Age(p=0.12), side (p=0.41), pre-operative symptom duration(p=0.85), tumor diameter(p=0.29), tumor type(p=0.37), and NVC presence (p=0.075) were not associated with long-term pain freedom. CONCLUSIONS This study provides additional evidence that various tumor types causing trigeminal neuralgia may safely undergo surgical resection and decompression of the trigeminal nerve to treat TN. This study presents a cohort of patients that underwent resection of a non-acoustic CPA tumor, with purposeful avoidance of the TG to minimize complications, demonstrating high rates of long-term pain freedom.
Collapse
Affiliation(s)
- Margaret Tugend
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York, New York, United States
| | - Evan Washington
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York, New York, United States
| | - Raymond F Sekula
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York, New York, United States.
| |
Collapse
|
2
|
Mehta A, Yadav M, Shilpakar SK, Bohara S, Yadav D. Extra-axial cerebellopontine angle nodular medulloblastoma mimicking meningioma: a case report with literature review. Ann Med Surg (Lond) 2024; 86:1669-1675. [PMID: 38463083 PMCID: PMC10923268 DOI: 10.1097/ms9.0000000000001713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/26/2023] [Indexed: 03/12/2024] Open
Abstract
Introduction Medulloblastoma, a highly malignant embryonal tumor predominantly found in the pediatric population, typically arises within the cerebellum. This case report holds particular importance due to the rarity of medulloblastoma within the cerebellopontine angle (CPA). The distinct anatomical challenge posed by the CPA complex neurovascular structures, along with the absence of pathognomonic clinical or radiographic features, highlights the unique diagnostic and management challenge of this case. Case presentation A 5-year-old boy presented with mild, progressively worsening headaches on CT/MRI imaging, which revealed a solid mass in the left CPA. Radiologically, the lesion closely resembled a CPA meningioma. The patient underwent a left retrosigmoid suboccipital craniectomy, utilizing a modified park bench position and careful burrhole creation. Intraoperatively, the tumor exhibited well-defined margins, firm adherence to cranial nerves, and complex tissue characteristics. Postoperatively, histopathological analysis identified nodular medulloblastoma, WHO grade IV, with immunohistochemical markers confirming its subtype. Discussion This case highlights the critical role of surgical intervention in addressing rare tumors, emphasizing the need for multidisciplinary collaboration in both diagnosis and management to achieve a favorable outcome. Uncommon tumor locations, such as the CPA, require tailored approaches, and the utilization of advanced diagnostic techniques, including immunohistochemistry, aids in accurate subtype classification. Conclusion This case highlights the critical role of surgical intervention in addressing rare tumors, emphasizing the need for multidisciplinary collaboration in both diagnosis and management to achieve a favorable outcome.
Collapse
Affiliation(s)
| | - Manish Yadav
- Maharajgunj Medical Campus, Tribhuvan University, Nepal
| | | | - Sandip Bohara
- Department of Neurosurgery, Tribhuvan University Teaching Hospital
| | - Digraj Yadav
- Maharajgunj Medical Campus, Tribhuvan University, Nepal
| |
Collapse
|
3
|
Akhtar N, Shahid F, Ali AS, Muhammad QUA, Azam NM, Dhakal B, Ibrahim M, Nadeem N. Paraganglioma at the cerebellopontine angle: A case report and review of literature. Clin Case Rep 2024; 12:e8584. [PMID: 38444925 PMCID: PMC10912100 DOI: 10.1002/ccr3.8584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/10/2024] [Accepted: 02/20/2024] [Indexed: 03/07/2024] Open
Abstract
Paragangliomas (PGLs) are rare neuroendocrine tumors. Sometimes, these tumors secrete excessive catecholamines, which results in the manifestations of various signs and symptoms, usually with a triad of hypertension, tachycardia, and headache. We report the case of a 42-year-old woman presenting with uncontrolled hypertension, right facial palsy, vomiting, and disturbed gait. Diagnosis for PGL was confirmed on postoperative histological examination of the excised mass and correlated with preoperative clinical and radiological findings. Tumor excision was done via a suboccipital craniotomy approach. Our case presents the typically severe features of a jugulotympanic PGL, but most importantly, it highlights the necessity of biochemical diagnosing, thorough probing of the causes of hypertension, and a multi-disciplinary approach in dealing with these tumors. Moreover, the case emphasizes necessitating the use of preoperative embolization in vascular tumors of the head and neck to avoid a hemorrhagic crisis during surgery. Unfortunately, due to a lack of adequate hospital funds, the surgeon had to proceed without preoperative embolization. Despite such a risk, the excision was a success.
Collapse
Affiliation(s)
- Nadeem Akhtar
- Department of NeurosurgeryRawalpindi Teaching HospitalPunjabPakistan
| | - Fatimah Shahid
- Department of NeurosurgeryRawalpindi Medical UniversityPunjabPakistan
| | | | | | - Noor Mahal Azam
- Department of NeurosurgeryRawalpindi Medical UniversityPunjabPakistan
| | - Bishal Dhakal
- Department of NeurologyNepalese Army Institute of Health SciencesKathmanduNepal
| | - Muhammad Ibrahim
- Department of NeurosurgeryRawalpindi Medical UniversityPunjabPakistan
| | - Nehal Nadeem
- Department of Internal MedicineShifa College of MedicineIslamabadPakistan
| |
Collapse
|
4
|
Joo W. Microsurgical anatomy of the glossopharyngeal nerve. Clin Anat 2024. [PMID: 38380502 DOI: 10.1002/ca.24143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/22/2024] [Accepted: 02/06/2024] [Indexed: 02/22/2024]
Abstract
The glossopharyngeal nerve is a complicated and mixed nerve including sensory, motor, parasympathetic, and visceral fibers. It mediates taste, salivation, and swallowing. The low cranial nerves, including IXth, Xth, and XIth, are closely related, sharing some nuclei in the brainstem. The glossopharyngeal nerve arises from the spinal trigeminal nucleus and tract, solitary tract and nucleus, nucleus ambiguous, and inferior salivatory nucleus in the brainstem. There are communicating branches forming a neural anastomotic network between low cranial nerves. Comprehensive knowledge of the anatomy of the glossopharyngeal nerve is crucial for performing surgical procedures without significant complications. This review describes the microsurgical anatomy of the glossopharyngeal nerve and illustrates some pictures involving the glossopharyngeal nerve and its connective and neurovascular structures.
Collapse
Affiliation(s)
- Wonil Joo
- Department of Neurosurgery, Eunpyeong St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, South Korea
| |
Collapse
|
5
|
Tugend M, Dattero J, Shore T, Korobeynikov V, Sekula RF. Primary central nervous system post-transplant lymphoproliferative disorder after allogeneic stem cell transplantation: a case report. Front Oncol 2024; 14:1284577. [PMID: 38313803 PMCID: PMC10837847 DOI: 10.3389/fonc.2024.1284577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 01/03/2024] [Indexed: 02/06/2024] Open
Abstract
Purpose Primary central nervous system, diffuse large B-cell lymphoma, post-transplant lymphoproliferative disorder in the cerebellopontine angle after an allogeneic stem cell transplantation has never been reported in the literature. Typically, diffuse large B-cell lymphoma is non-polyploid. We report the first case of a patient with polyploid post-transplant lymphoproliferative disorder in the cerebellopontine angle who presented with back pain. Case presentation A 45-year-old man with a history of nodular sclerosing classic Hodgkin lymphoma stage IIB treated with systemic chemotherapy, external radiation and autologous stem cell transplant and double umbilical cord allogeneic transplant presented with several weeks of back pain. He was found to have a small right cerebellopontine angle mass thought to be consistent with a meningioma. Patient presented again two weeks later with acute onset of severe headache, right sided ptosis, right facial numbness, weakness and possible seizure event. Repeat MRI scans showed an interval and significant increase of the right cerebellopontine angle lesion. Biopsy of the cerebellopontine angle lesion was planned with suspicion of lymphoma. Intraoperative pathology consultation findings were not consistent with an acoustic neuroma, meningioma, or epidermoid cyst. Lymphoma could not be definitively identified by intra-operative frozen section. However, it was suspected, and a portion of fresh specimen was submitted for flow cytometry analysis. A near total resection of the tumor and decompression of the brainstem was achieved. Final pathologic analysis was positive for post-transplant lymphoproliferative disorder, monomorphic type, diffuse large B-cell lymphoma, non-germinal center B-cell type, EBV+, post-transplant (allogeneic stem cell) setting (post-transplant lymphoproliferative disorder (PTLD), monomorphic type, diffuse large B-cell lymphoma, non-germinal center B-cell type (non-GCB), EBV-positive under pre-2022 WHO terminology). The patient began a high-dose methotrexate-based regimen (the MATRIX regimen). Conclusions Our case illustrates an unusual presentation of post-transplant lymphoproliferative disorder in the cerebellopontine angle in a patient with a remote history of allogeneic stem cell transplantation. It demonstrates the importance of keeping primary central nervous system post-transplant lymphoproliferative disorder on the differential for patients who present with back pain or headache that have a history of allogeneic stem cell transplant.
Collapse
Affiliation(s)
- Margaret Tugend
- Department of Neurological Surgery, Columbia University, New York Presbyterian Hospital, New York, NY, United States
| | - Jordan Dattero
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Boston, MA, United States
| | - Tsiporah Shore
- Department of Medicine, Division of Hematology/Oncology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, United States
| | - Vladislav Korobeynikov
- Department of Pathology, Columbia University, New York Presbyterian Hospital, New York, NY, United States
| | - Raymond F Sekula
- Department of Neurological Surgery, Columbia University, New York Presbyterian Hospital, New York, NY, United States
| |
Collapse
|
6
|
Gupta S, Siddiqui SA, Sinha U, Gupta G. Multimodal Intraoperative Neurophysiological Monitoring in Cranial and Spinal Tumour Surgeries: A Descriptive Observational Study. Cureus 2023; 15:e49411. [PMID: 38149147 PMCID: PMC10750011 DOI: 10.7759/cureus.49411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2023] [Indexed: 12/28/2023] Open
Abstract
Intraoperative neurophysiological monitoring (IONM) involves monitoring the functional integrity of critical brain regions and pathways as well as identifying and preserving functionally viable neural tissues (mapping) during surgery using electrophysiological techniques. Multimodality combines various neurophysiological techniques to optimise diagnostic effectiveness and to improve the outcomes of the surgeries. The present study is a case series with comprehensive and illustrative descriptions of the neurophysiological changes in five neuromonitored cases of cranial and spinal cord tumour surgeries conducted with a multimodal approach. The cases were monitored with somatosensory evoked potentials (SSEP), transcranial motor evoked potentials (TcMEP), and both free run and triggered electromyography (fEMG and tEMG). No false negative outcomes were identified in the cases studied as there was an association of absence of change in SSEP and TcMEP both, with no neurological deficit postoperatively. Two cases were identified as having true positive neuromonitoring alerts. No false positive alerts were found in any case. Multimodal monitoring using SSEP, TcMEP, and EMG (fEMG and tEMG) in cranial and spinal tumour surgeries can improve performance with fewer false-negative and false-positive results. Neuromonitoring approaches used in combination can provide reliable information regarding postoperative neurological outcomes.
Collapse
Affiliation(s)
- Sangeeta Gupta
- Physiology, All India Institute of Medical Sciences, Gorakhpur, Gorakhpur, IND
| | | | - Upasna Sinha
- Radiology, All India Institute of Medical Sciences, Patna, Patna, IND
| | - Gaurav Gupta
- General Surgery, All India Institute of Medical Sciences, Gorakhpur, Gorakhpur, IND
| |
Collapse
|
7
|
Palmisciano P, Doyle EJ, Hoz SS, Cass D, Samy RN, Andaluz N, Zuccarello M. Transcanal Transpromontorial Approaches to the Internal Auditory Canal: A Systematic Review. Laryngoscope 2023; 133:2856-2867. [PMID: 37078512 DOI: 10.1002/lary.30703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 02/24/2023] [Accepted: 03/25/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE Exclusive endoscopic (EETTA) and expanded (ExpTTA) transcanal transpromontorial approaches have shown promising results for treating internal auditory canal (IAC) lesions. We reviewed the literature to answer the question: "Do EETTA and ExpTTA achieve high rates of complete resection and low rates of complications in treating patients with IAC pathologies?" DATA SOURCES PubMed, EMBASE, Scopus, Web of Science, and Cochrane were searched. REVIEW METHODS Studies reporting EETTA/ExpTTA for IAC pathologies were included. Indications and techniques were discussed and meta-analyzed rates of outcomes and complications were obtained with random-effect model meta-analyses. RESULTS We included 16 studies comprising 173 patients, all with non-serviceable hearing. Baseline FN function was mostly House-Brackmann-I (96.5%; 95% CI: 94.9-98.1%). Most lesions were vestibular/cochlear schwannomas (98.3%; 95% CI: 96.7-99.8%) of Koos-I (45.9%; 95% CI: 41.3-50.3%) or II (47.1%; 95% CI: 43-51.1%). EETTA was performed in 101 patients (58.4%; 95% CI: 52.4-64.3%) and ExpTTA in 72 (41.6%; 95% CI: 35.6-47.6%), achieving gross-total resection in all cases. Transient complications occurred in 30 patients (17.3%; 95% CI: 13.9-20.5%), with meta-analyzed rates of 9% (95% CI: 4-15%), comprising FN palsy with spontaneous resolution (10.4%; 95% CI: 7.7-13.1%). Persistent complications occurred in 34 patients (19.6%; 95% CI: 17.1-22.2%), with meta-analyzed rates of 12% (95% CI: 7-19%), comprising persistent FN palsy in 22 patients (12.7%; 95% CI: 10.2-15.2%). Mean follow-up was 16 months (range, 1-69; 95% CI: 14.7-17.4). Post-surgery FN function was stable in 131 patients (75.8%; 95% CI: 72.1-79.5%), worsened in 38 (21.9%; 95% CI: 18.8-25%), and improved in 4 (2.3%; 95% CI: 0.7-3.9%), with meta-analyzed rates of improved/stable response of 84% (95% CI: 76-90%). CONCLUSION Transpromontorial approaches offer newer routes for IAC surgery, but their restricted indications and unfavorable FN outcomes currently limit their use. Laryngoscope, 133:2856-2867, 2023.
Collapse
Affiliation(s)
- Paolo Palmisciano
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Edward J Doyle
- Department of Otolaryngology Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Samer S Hoz
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Daryn Cass
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Ravi N Samy
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Department of Otolaryngology Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Norberto Andaluz
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Mario Zuccarello
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| |
Collapse
|
8
|
Kosarchuk J, Patel S, Dent W, Heilman CB. Strangulation of the abducens nerve by an arachnoid band within an epidermoid cyst: illustrative case. J Neurosurg Case Lessons 2023; 6:CASE23383. [PMID: 37782964 PMCID: PMC10555606 DOI: 10.3171/case23383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 08/04/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Intracranial epidermoid cysts (ECs) are rare benign lesions of ectodermal origin that can be found in the cerebellopontine angle (CPA). If large enough, they compress surrounding structures, causing cranial neuropathies, cerebellar dysfunction, and hydrocephalus. OBSERVATIONS In this case report, the authors present a patient with headaches and diplopia secondary to a CPA EC. The cyst had wrapped itself around and was strangulating the abducens nerve. This choking of the nerve was believed to have been the cause of the patient's double vision. The arachnoid band was released with a myringotomy knife. LESSONS Intracranial ECs typically cause symptoms from mass effect on surrounding structures; it is unusual for one to have choked off the nerve in the fashion presented in this case. Knowledge of the potential ways that ECs can affect nervous structures is critical for resecting them without injuring normal tissue.
Collapse
|
9
|
Dang DD, Gong AD, Dang JV, Mugge LA, Mansinghani S, Ziu M, Cohen AL, Vyas N. Systematic Review of WHO Grade 4 Astrocytoma in the Cerebellopontine Angle: The Impact of Anatomic Corridor on Treatment Options and Outcomes. J Neurol Surg Rep 2023; 84:e129-e139. [PMID: 37854309 PMCID: PMC10580070 DOI: 10.1055/a-2172-7770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 09/03/2023] [Indexed: 10/20/2023] Open
Abstract
Background Despite advances in multimodal oncologic therapies and molecular genetics, overall survival (OS) in patients with high-grade astrocytomas remains poor. We present an illustrative case and systematic review of rare, predominantly extra-axial World Health Organization (WHO) grade 4 astrocytomas located within the cerebellopontine angle (CPA) and explore the impact of anatomic location on diagnosis, management, and outcomes. Methods A systematic review of adult patients with predominantly extra-axial WHO grade 4 CPA astrocytomas was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines through December 2022. Results Eighteen articles were included comprising 21 astrocytomas: 13 exophytic tumors arising from the cerebellopontine parenchyma and 8 tumors originating from a cranial nerve root entry zone. The median OS was 15 months with one-third of cases demonstrating delayed diagnosis. Gross total resection, molecular genetic profiling, and use of ancillary treatment were low. We report the only patient with an integrated isocitrate dehydrogenase 1 (IDH-1) mutant diagnosis, who, after subtotal resection and chemoradiation, remains alive at 40 months without progression. Conclusion The deep conical-shaped corridor and abundance of eloquent tissue of the CPA significantly limits both surgical resection and utility of device-based therapies in this region. Prompt diagnosis, molecular characterization, and systemic therapeutic advances serve as the predominant means to optimize survival for patients with rare skull base astrocytomas.
Collapse
Affiliation(s)
- Danielle D. Dang
- Department of Neurosurgery, Inova Fairfax Hospital, Falls Church, Virginia, United States
| | - Andrew D. Gong
- Department of Neurosurgery, Inova Fairfax Hospital, Falls Church, Virginia, United States
| | - John V. Dang
- Department of Internal Medicine, Walter Reed Military Medical Center, Bethesda, Maryland, United States
| | - Luke A. Mugge
- Department of Neurosurgery, Inova Fairfax Hospital, Falls Church, Virginia, United States
| | - Seth Mansinghani
- Department of Neurosurgery, Inova Fairfax Hospital, Falls Church, Virginia, United States
| | - Mateo Ziu
- Department of Neurosurgery, Inova Fairfax Hospital, Falls Church, Virginia, United States
| | - Adam L. Cohen
- Department of Neuro-Oncology, Inova Schar Cancer Institute, Inova Health System, Fairfax, Falls Church, Virginia, United States
| | - Nilesh Vyas
- Department of Neurosurgery, Inova Fairfax Hospital, Falls Church, Virginia, United States
| |
Collapse
|
10
|
Zhao X, Prather KY, Tavakol SA, Gernsback JE. Bilateral cerebellopontine angle lipomas in an infant with encephalocele: illustrative case. J Neurosurg Case Lessons 2023; 6:CASE23315. [PMID: 37773761 PMCID: PMC10555580 DOI: 10.3171/case23315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/15/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Bilateral cerebellopontine angle (CPA) lipomas are extremely rare. Herein the authors present a case of bilateral CPA lipomas in an infant along with a literature review of bilateral CPA lipomas. OBSERVATIONS A newborn girl was incidentally found to have bilateral CPA lipomas during the workup for an occipital encephalocele. The encephalocele was repaired primarily on day 2 after birth. The patient demonstrated no symptoms associated with the bilateral CPA lipomas. Eight cases of bilateral CPA lipomas were identified in the literature review and are summarized. Conservative management is the consensus strategy, given minimum growth of the tumor and the high risk of surgical intervention. LESSONS This is the first reported case of bilateral CPA lipomas in an infant as well as the first with a coexisting intracranial malformation. Intracranial lipomas share an extremely low growth rate and typically do not cause severe symptoms. The management of asymptomatic or mildly symptomatic bilateral CPA lipomas is usually conservative.
Collapse
|
11
|
Ovalle Torres CS, Efe IE, Ramirez MDJE, Diaz Juarez E, Ruano Calderon A, Nurmukhametov R, Campero A, Ramirez Pena IJ, Montemurro N. Surgical Management of Temporal Lobe Epilepsy Secondary to Epidermoid Cysts: A Case Report With Review of the Literature. Cureus 2023; 15:e45360. [PMID: 37849566 PMCID: PMC10577610 DOI: 10.7759/cureus.45360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 10/19/2023] Open
Abstract
Epidermoid cysts represent roughly 1% of all intracranial tumors. They are frequently located in the cerebellopontine angle but rarely extend to the supratentorial brain. Epilepsy is an extremely uncommon manifestation of this neoplasm. We suggest the surgical management of a 35-year-old male who presented with a six-month history of intractable temporal lobe epilepsy. His seizures were characterized by a focal onset in the form of déjà vu experiences, followed by a secondarily generalized tonic-clonic seizure. Imaging revealed a heterogeneous cystic mass in the right cerebellopontine angle, extending supratentorially causing a mass effect on the mesial temporal region. Gross total resection was achieved through a combined subtemporal-retrosigmoid approach. Histopathology revealed an epidermoid cyst. The patient was entirely seizure-free at the three-month follow-up. Epidermoid cysts may present with epileptic seizures. Seizure freedom can be achieved with surgical management in most cases. The patient's symptoms, imaging findings, and epileptogenic focus must be considered to select the appropriate surgical strategy.
Collapse
Affiliation(s)
| | - Ibrahim E Efe
- Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, DEU
| | | | | | | | | | - Alvaro Campero
- Neurosurgery, Hospital Ángel C. Padilla, San Miguel de Tucumán, ARG
| | | | - Nicola Montemurro
- Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), Pisa, ITA
| |
Collapse
|
12
|
Bonek K, Brożek-Mądry E, Wroński J, Płaza M, Zielińska A, Helon K, Wójcik K, Wisłowska M. Combination Treatment of Locoregionally Aggressive Granulomatosis with Polyangiitis and Cranial Base Infiltration. Brain Sci 2023; 13:1140. [PMID: 37626497 PMCID: PMC10452321 DOI: 10.3390/brainsci13081140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/16/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023] Open
Abstract
OBJECTIVES To present a personalized approach in three cases of treatment-resistant, locoregionally aggressive forms of cANCA-positive granulomatosis with polyangiitis (GPA) and skull base involvement. METHODS Three patients with GPA and skull base involvement were described alongside a critical review of the current literature. RESULTS All presented patients suffered from GPA with an inflammatory tumor at the skull base, alongside cerebellopontine angle involvement, cranial nerve palsies, cerebellar disorders, concomitant hearing loss, and severe otalgia. Symptoms were associated with progressive granulomatous destruction of the temporal bone, laryngopharynx, and central nervous system infiltration. Treatment with cyclophosphamide and high doses of glucocorticoid steroids were ineffective but subsequent therapy with rituximab was successful in the presented cases. The literature review showed that the course of the disease with skull base involvement is associated with poorer clinical and radiological responses to standard pharmacotherapies. CONCLUSION Granulomatous inflammation localized in the skull base is associated with a more aggressive disease progression and is less likely to respond to pharmacotherapy. Standard induction therapy with cyclophosphamide and glucocorticoid steroids may be ineffective. A better response may be achieved by using rituximab and concomitant local treatment with glucocorticoid steroid injections.
Collapse
Affiliation(s)
- Krzysztof Bonek
- Department of Rheumatology, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland
| | - Eliza Brożek-Mądry
- Department of Otorhinolaryngology, National Institute of Medicine of the Ministry of Interior and Administration, 02-507 Warsaw, Poland
| | - Jakub Wroński
- Department of Rheumatology, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland
| | - Mateusz Płaza
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland
| | - Agnieszka Zielińska
- Department of Rheumatology, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland
| | - Katarzyna Helon
- Department of Rheumatology, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland
| | - Krzysztof Wójcik
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, 31-007 Krakow, Poland
- POLVAS Consortium, Jagiellonian University Medical College, 31-007 Krakow, Poland
| | - Małgorzata Wisłowska
- Department of Rheumatology, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland
- POLVAS Consortium, Jagiellonian University Medical College, 31-007 Krakow, Poland
| |
Collapse
|
13
|
Roethlisberger M, Eberhard NE, Rychen J, Al-Zahid S, Jayapalan RR, Zweifel C, Karuppiah R, Waran V. Supratentorial cerebrospinal fluid diversion using image-guided trigonal ventriculostomy during retrosigmoid craniotomy for cerebellopontine angle tumors. Front Surg 2023; 10:1198837. [PMID: 37288135 PMCID: PMC10242017 DOI: 10.3389/fsurg.2023.1198837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 04/24/2023] [Indexed: 06/09/2023] Open
Abstract
Background Cerebellar contusion, swelling and herniation is frequently encoutered upon durotomy in patients undergoing retrosigmoid craniotomy for cerebellopontine angle (CPA) tumors, despite using standard methods to obtain adequate cerebellar relaxation. Objective The aim of this study is to report an alternative cerebrospinal fluid (CSF)-diversion method using image-guided ipsilateral trigonal ventriculostomy. Methods Single-center retro- and prospective cohort study of n = 62 patients undergoing above-mentioned technique. Prior durotomy, CSF-diversion was performed to the point where the posterior fossa dura was visibly pulsatile. Outcome assessment consisted of the surgeon's intra- and postoperative clinical observations, and postoperative radiological imaging. Results Fifty-two out of n = 62 (84%) cases were eligible for analysis. The surgeons consistently reported successful ventricular puncture and a pulsatile dura prior durotomy without cerebellar contusion, swelling or herniation through the dural incision in n = 51/52 (98%) cases. Forty-nine out of n = 52 (94%) catheters were placed correctly within the first attempt, with the majority of catheter tips (n = 50, 96%) located intraventricularly (grade 1 or 2). In n = 4/52 (8%) patients, postoperative imaging revealed evidence of a ventriculostomy-related hemorrhage (VRH) associated with an intracerebral hemorrhage [n = 2/52 (4%)] or an isolated intraventricular hemorrhage [n = 2/52 (4%)]. However, these hemorrhagic complications were not associated with neurological symptoms, surgical interventions or postoperative hydrocephalus. None of the evaluated patients demonstrated radiological signs of upward transtentorial herniation. Conclusion The method described above efficiently allows CSF-diversion prior durotomy to reduce cerebellar pressure during retrosigmoid approach for CPA tumors. However, there is an inherent risk of subclinical supratentorial hemorrhagic complications.
Collapse
Affiliation(s)
- Michel Roethlisberger
- Department of Neurosurgery, University Hospital Basel, University of Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Department of Surgery, Division of Neurosurgery, University Malaya, Jalan Universiti, Kuala Lumpur, Malaysia
- Department of Otorhinolaryngology (ORL), University Malaya Specialist Centre, University of Malaya, Jalan Universiti, Kuala Lumpur, Malaysia
| | | | - Jonathan Rychen
- Department of Neurosurgery, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Saif Al-Zahid
- Department of Otorhinolaryngology (ORL), University Malaya Specialist Centre, University of Malaya, Jalan Universiti, Kuala Lumpur, Malaysia
- Department of Otorhinolaryngology, Hereford County Hospital, Hereford, United Kingdom
| | - Ronie Romelean Jayapalan
- Department of Surgery, Division of Neurosurgery, University Malaya, Jalan Universiti, Kuala Lumpur, Malaysia
| | - Christian Zweifel
- Department of Neurosurgery, University Hospital Basel, University of Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Department of Neurosurgery, Cantonal Hospital Graubuenden, Chur, Graubuenden, Switzerland
| | - Ravindran Karuppiah
- Department of Surgery, Division of Neurosurgery, University Malaya, Jalan Universiti, Kuala Lumpur, Malaysia
| | - Vicknes Waran
- Department of Surgery, Division of Neurosurgery, University Malaya, Jalan Universiti, Kuala Lumpur, Malaysia
| |
Collapse
|
14
|
Eatz TA, Elarjani T, Chen SH, Lu VM, Wu EM, Saad AG, Shah A, Komotar RJ, Morcos JJ, Benjamin CG, Ivan ME. Malignant transformation of an intracranial epidermoid cyst 25 years after initial surgery: a case report and systematic review. World Neurosurg 2023:S1878-8750(23)00649-6. [PMID: 37201791 DOI: 10.1016/j.wneu.2023.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 05/09/2023] [Indexed: 05/20/2023]
Abstract
OBJECTIVE We report a unique case of a suspected recurrent intracranial epidermoid cyst (EDC) that was found on pathology to have undergone malignant transformation to squamous cell carcinoma (SCC) approximately 25 years after initial resection. Additionally, we performed a systematic review including 94 studies reporting intracranial EDC to SCC transformation. METHODS 94 studies were included in our systematic review. PubMed, Scopus, Cochrane Central, and EMBASE were searched in April 2020 for studies regarding histologically confirmed SCC arising within an EDC. Kaplan-Meier estimations were used to estimate time to event including survival, and log rank tests were used to test for significance. All analyses were conducted using STATA 14.1 (StataCorp, College Station, Texas); tests were two-sided, and statistical significance was defined using the alpha threshold of 0.05. RESULTS The overall median time to transformation was 60 months (95% CI, 12-96). Transformation time was significantly shorter in the no surgery group (10 months, 95% CI undefined) versus the other two groups (60 months, 95% CI, 12-72 in surgery only and 70 months, 95% CI, 9-180 in surgery + adjuvant therapy group, both P<0.01). Overall survival (OS) was significantly longer in the surgery + adjuvant therapy group (13 months, 95% CI, 9-24) versus the other two groups (3 months, 95% CI, 1-7 in surgery only and 6 months, 95% CI, 1-12 in the no surgery group, both P<0.01). CONCLUSION We report a rare case of delayed malignant transformation of an intracranial EDC to SCC, occurring nearly 25 years after initial resection. Transformation time in the no-surgery group was statistically significantly shorter as compared to the surgery only and surgery + adjuvant therapy groups. OS was statistically significantly higher in the surgery + adjuvant therapy group as compared to the surgery only and no surgery groups.
Collapse
Affiliation(s)
- Tiffany A Eatz
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, 1475 NW 12(th) Ave Miami, FL 33136, United States of America.
| | - Turki Elarjani
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, 1475 NW 12(th) Ave Miami, FL 33136, United States of America
| | - Stephanie H Chen
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, 1475 NW 12(th) Ave Miami, FL 33136, United States of America
| | - Victor M Lu
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, 1475 NW 12(th) Ave Miami, FL 33136, United States of America
| | - Eva M Wu
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, 1475 NW 12(th) Ave Miami, FL 33136, United States of America
| | - Ali G Saad
- Department of Pathology and Laboratory Medicine, University of Miami, Miller School of Medicine, 1475 NW 12(th) Ave Miami, FL 33136, United States of America
| | - Ashish Shah
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, 1475 NW 12(th) Ave Miami, FL 33136, United States of America
| | - Ricardo Jorge Komotar
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, 1475 NW 12(th) Ave Miami, FL 33136, United States of America
| | - Jacques J Morcos
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, 1475 NW 12(th) Ave Miami, FL 33136, United States of America
| | - Carolina Gesteira Benjamin
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, 1475 NW 12(th) Ave Miami, FL 33136, United States of America
| | - Michael E Ivan
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, 1475 NW 12(th) Ave Miami, FL 33136, United States of America
| |
Collapse
|
15
|
Pham D, Nguyen AD, Do TTT, Kieu HD. Surgical outcomes of premeatal and retromeatal cerebellopontine angle meningioma in Vietnam: a single-center prospective cross-sectional study. Ann Med Surg (Lond) 2023; 85:1626-1632. [PMID: 37228921 PMCID: PMC10205309 DOI: 10.1097/ms9.0000000000000553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 03/17/2023] [Indexed: 05/27/2023] Open
Abstract
Cerebellopontine angle (CPA) meningiomas are the second most common tumor of the CPA. Depending on the site of dural attachment, the relationship between the tumor and critical neurovascular structures of the CPA is variable. This study aims to evaluate the influence of CPA meningioma location in relation to the internal auditory canal (IAC) on clinical symptoms, radiological presentations, and surgical treatments and outcomes which has been rarely reported in Vietnam. Patients and methods A prospective study on 33 patients treated with microsurgery from August 2020 to May 2022 at the Neurosurgery Center, Viet Duc University Hospital. Results The mean age of 27 females (85%) and 6 (15%) males was 54±12 years. Based on their location to the IAC, there were 16 premeatal cases (49%) (anterior to the IAC) and 17 retromeatal cases (15%) (posterior to the IAC). The time of diagnosis of the retromeatal group was later (16.5 vs. 9.7 months), the average tumor size of the 2 groups was not different, but when there was brainstem compression, the average tumor size of retromeatal group was larger (49 vs. 44 mm). The clinical presentations of the retromeatal group were related to the cerebellar symptoms, while trigeminal neuropathy symptoms all came from the premeatal group. Gross total resection of the premeatal group was 31% and of the retrometal group was 71%. The results of preserving the facial nerve function of the premeatal group were lower (44 vs. 82%). Postoperative Karnofsky score of the retromeatal group improved, while the premeatal group did not change. Conclusions Classification of CPA meningiomas according to their location to the IAC plays an important role in diagnosis and treatment, affecting clinical symptoms, surgical strategy as well as surgical outcomes.
Collapse
Affiliation(s)
- Duy Pham
- Hanoi Medical University
- Neurosurgery Department II, Viet Duc University Hospital
| | - Anh Duc Nguyen
- Neurosurgery Department II, Viet Duc University Hospital
| | | | - Hung Dinh Kieu
- Hanoi Medical University
- Department of Neurosurgery and Spine Surgery, Hanoi Medical University Hospital, Hanoi, Vietnam
| |
Collapse
|
16
|
Li D, Shanker R, Borys E, Leonetti JP, Anderson DE. Internal Auditory Canal Glioneural Hamartoma: A Rare Mass Masquerading as a Vestibular Schwannoma. Cureus 2023; 15:e37361. [PMID: 37182073 PMCID: PMC10170578 DOI: 10.7759/cureus.37361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2023] [Indexed: 05/16/2023] Open
Abstract
Glioneural hamartomas are exceedingly rare lesions. When localized to the internal auditory canal (IAC), they can cause symptoms referrable to seventh and eighth cranial nerve compression. Here, the authors present a rare case of an IAC glioneural hamartoma. A 57-year-old male presented for evaluation of presumed intracanalicular vestibular schwannomas found on work-up of dizziness and progressive right-sided hearing loss. Surgical intervention pursued progressive symptoms and new onset headaches. The patient underwent uncomplicated retrosigmoid craniectomy for gross total resection. Histopathological evaluation revealed a glioneural hamartoma. A MEDLINE database search used the terms' cerebellopontine angle' OR 'internal auditory canal' AND 'hamartoma' OR 'heterotopia'. Clinicopathological characteristics and outcomes of the present case were compared to those in the literature. The literature review yielded nine articles describing 11 cases (eight females, three males; median age 40 years, range 11-71) of intracanalicular glioneural hamartomas. Patients most commonly presented with hearing loss and were presumed to have a diagnosis of vestibular schwannoma before histologic diagnosis. Glioneural hamartomas are rare lesions that may be found in the IAC. Although benign, they may be safely resected for cranial nerve function preservation goals with a low risk of recurrence.
Collapse
Affiliation(s)
- Daphne Li
- Neurosurgery, Loyola University Medical Center, Maywood, USA
- Pediatric Neurosurgery, Advocate Lutheran General Hospital, Park Ridge, USA
| | - Rachyl Shanker
- General Surgery, University of Illinois Chicago, Chicago, USA
| | - Ewa Borys
- Neuropathology and Renal Pathology, Loyola University Medical Center, Maywood, USA
- Neuropathology and Renal Pathology, Edward Hines Jr. Veterans Administration Hospital, Hines, USA
| | - John P Leonetti
- Otolaryngology, Loyola University Medical Center, Maywood, USA
| | - Douglas E Anderson
- Neurological Surgery, Loyola University Medical Center, Maywood, USA
- Neurological Surgery, Edward Hines Jr. Veterans Administration Hospital, Hines, USA
| |
Collapse
|
17
|
Zhang Y, Zhou E, Xue X, Chen X. Intraoperative brainstem auditory evoked potential monitoring during cerebellopontine angle surgery via retrosigmoid approach. Ear Nose Throat J 2023:1455613221150574. [PMID: 36680392 DOI: 10.1177/01455613221150574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Brainstem auditory evoked potential (BAEP) monitoring was used to identify the influence of auditory function during cerebellopontine angle (CPA) surgery for cranial neuropathy via the retrosigmoid approach. METHODS This prospective study included 20 patients who underwent CPA surgery for cranial neuropathy via the retrosigmoid approach with intraoperative BAEP monitoring and pure tone audiometry (PTA). The latency and interpeak latency were analyzed at each surgical step in combination with the pre- and postoperative PTA. RESULTS Follow-up data were available for 17 patients. The mean pre- and postoperative PTA values were 25.65 dB and 20.70 dB, respectively. Two patients (2/17, 11.76%) developed hearing loss postoperatively. The latency of wave І significantly changed during direct auditory nerve manipulation and at the end of the surgery, while that of wave III only changed during direct auditory nerve manipulation. The appearance of wave V peak was delayed during CPA surgery. CONCLUSIONS CPA surgery for cranial neuropathy via the retrosigmoid approach can cause hearing loss to varying degrees, and intraoperative BAEP monitoring can reduce the occurrence of hearing loss. Intraoperative hearing function can be estimated by the latency of wave I. Hearing loss due to stretching of the brainstem can be estimated by the latency of wave III, and wave V is an early indicator of intraoperative hearing loss. Waves I and III remained stable both pre- and postoperatively, whereas wave V was unstable despite no surgery. Therefore, a precise operation and well-defined operative steps for surgeons during CPA surgery could facilitate maximal preservation of the anatomical structure and function.
Collapse
Affiliation(s)
- Yi Zhang
- Department of Otorhinolaryngology, Pudong New Area Gongli Hospital, Shanghai, China
| | - Enhui Zhou
- Department of Otorhinolaryngology, Pudong New Area Gongli Hospital, Shanghai, China
| | - Xiaocheng Xue
- Department of Otorhinolaryngology, Pudong New Area Gongli Hospital, Shanghai, China
| | - Xiaoping Chen
- Department of Otorhinolaryngology, Pudong New Area Gongli Hospital, Shanghai, China
| |
Collapse
|
18
|
Budohoski KP, Rennert RC, Gordon SA, Raheja A, Brandon C, Henson JC, Azab MA, Patel NS, Karsy M, Gurgel RK, Shelton C, Couldwell WT. Factors associated with hearing outcomes after a middle fossa approach in 131 consecutive patients with vestibular schwannomas. J Neurosurg 2022:1-10. [PMID: 36461828 DOI: 10.3171/2022.10.jns221525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/18/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The middle fossa approach is an effective option for the treatment of small (Koos grade I and II) vestibular schwannomas (VSs) when the goal is hearing preservation. The authors evaluated the rates of hearing preservation and examined the factors associated with improved hearing outcomes after the middle fossa approach for VSs. METHODS In this retrospective, single-center cohort study evaluating the clinical outcomes after resection of small VSs using the middle fossa approach, consecutive adult patients (> 18 years) who underwent surgery between January 2000 and December 2021 were included. Clinical and imaging characteristics were analyzed, including baseline hearing status, duration of surgery, anesthetic parameters, and imaging characteristics of the surgically treated tumors. RESULTS Among the 131 included patients, 102 had valid and discoverable pre- and postoperative audiology assessments. The mean follow-up was 26 months (range 1-180 months). There were 85 patients with serviceable hearing preoperatively, defined as American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) class A or B, of whom 78% retained class A or B hearing at the last follow-up. Binary logistic regression demonstrated that preoperative hearing AAO-HNS class (OR 0.19, 95% CI 0.05-0.77; p = 0.02), overlap between fundus and cochlea (OR 0.32, 95% CI 0.11-0.96; p = 0.04), and duration of anesthesia (OR 0.98, 95% CI 0.97-0.99; p = 0.03) were independent predictors of hearing outcomes. Additionally, 75% of patients with high diffusion-weighted imaging signal in the tumor (p = 0.009) and 67% of patients with the tumor originating at the modiolus of the cochlea (p = 0.004) had poor hearing outcomes. CONCLUSIONS The hearing preservation rates after microsurgical resection of small VSs using the middle fossa approach are high, with 78% of patients maintaining AAO-HNS class A or B hearing. Poor hearing status at baseline, longer duration of anesthesia, and large overlap between the fundus of the internal auditory canal and the cochlea were independently associated with unfavorable hearing outcomes. Imaging characteristics can be used to stratify patients' risk of hearing loss.
Collapse
Affiliation(s)
- Karol P Budohoski
- 1Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Robert C Rennert
- 1Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Steven A Gordon
- 2Division of Otolaryngology, University of Utah, Salt Lake City, Utah
| | - Amol Raheja
- 3Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Cameron Brandon
- 4College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
| | - J Curran Henson
- 5University of Arkansas for Medical Sciences, Little Rock, Arkansas; and
| | - Mohammed A Azab
- 6Biomolecular Sciences Graduate Programs, Boise State University, Boise, Idaho
| | - Neil S Patel
- 2Division of Otolaryngology, University of Utah, Salt Lake City, Utah
| | - Michael Karsy
- 1Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Richard K Gurgel
- 2Division of Otolaryngology, University of Utah, Salt Lake City, Utah
| | - Clough Shelton
- 2Division of Otolaryngology, University of Utah, Salt Lake City, Utah
| | - William T Couldwell
- 1Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| |
Collapse
|
19
|
Muacevic A, Adler JR. Vestibular Schwannoma Leading to Contacting Aneurysm Rupture: An Unusual Presentation. Cureus 2022; 14:e32716. [PMID: 36686143 PMCID: PMC9850019 DOI: 10.7759/cureus.32716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 01/24/2023] Open
Abstract
Subarachnoid hemorrhage (SAH) is a rare manifestation of brain tumors, being even rarer in vestibular schwannomas. We report the second case of a posterior circulation aneurysm close to the tumor capsule, responsible for SAH as an initial manifestation of a vestibular schwannoma. A 67-year-old female was admitted to the Emergency Department with sudden onset of nausea and headache. A diagnosis of a SAH and a tumor of the right cerebellopontine angle was made. An angiography showed an aneurysm in the dependency of the right anterior inferior cerebellar artery (AICA), juxtaposed to the tumor capsule. The patient underwent surgery, the tumor was removed, and the aneurysm was treated. This case highlights that SAH in patients with vestibular schwannoma may originate from a contact aneurysm. Although exceedingly rare, surgeons should consider this scenario in vestibular schwannoma presenting with SAH, and angiography is important for its diagnosis.
Collapse
|
20
|
Adachi S, Yamashita K, Nakamizo A, Amano T, Momosaki S, Noguchi T. Unusual imaging characteristics of cystic meningioma in cerebellopontine angle. Neuroradiol J 2022; 35:777-779. [PMID: 35503008 PMCID: PMC9626835 DOI: 10.1177/19714009221096831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We report a case of cystic meningioma at the left cerebellopontine angle (CPA). Magnetic resonance imaging demonstrated both solid and cystic components in the tumor. The cystic component appeared slightly hyperintense compared to cerebrospinal fluid on fluid-attenuated inversion recovery (FLAIR) imaging. A hypointense tubular structure was identified in the cystic component on 3D driven equilibrium sequencing. These imaging findings are unusual for cystic meningioma. However, awareness of these unusual imaging features is important to determine appropriate treatment strategies although cystic meningioma at the CPA is extremely rare.
Collapse
Affiliation(s)
- Saki Adachi
- Department of Radiology, Clinical Research
Institute, National Hospital Organization Kyushu Medical
Center, Fukuoka, Japan
| | - Koji Yamashita
- Department of Radiology, Clinical Research
Institute, National Hospital Organization Kyushu Medical
Center, Fukuoka, Japan
| | - Akira Nakamizo
- Department of Neurosurgery, Clinical
Research Institute, National Hospital Organization Kyushu Medical
Center, Fukuoka, Japan
| | - Toshiyuki Amano
- Department of Neurosurgery, Clinical
Research Institute, National Hospital Organization Kyushu Medical
Center, Fukuoka, Japan
| | - Seiya Momosaki
- Department of Pathology, Clinical Research
Institute, National Hospital Organization Kyushu Medical
Center, Fukuoka, Japan
| | - Tomoyuki Noguchi
- Department of Radiology, Clinical Research
Institute, National Hospital Organization Kyushu Medical
Center, Fukuoka, Japan
| |
Collapse
|
21
|
Pant I, Chaturvedi S, S Gautam VK, Sarma P, Satti DK. Extra-axial adult cerebellopontine angle medulloblastoma: Revisiting a rare entity. J Cancer Res Ther 2022; 18:770-773. [PMID: 35900553 DOI: 10.4103/jcrt.jcrt_675_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
A purely extra-axial position of medulloblastoma in adults at cerebellopontine (CP) angle is extremely rare. To the best of our knowledge, only ten cases have been reported till date. The authors report a case of extra-axial medulloblastoma in a 30-year-old female located at right CP angle. It was surgically treated with a provisional diagnosis of meningioma. Histopathological diagnosis of desmoplastic/nodular medulloblastoma was made with the routine hematoxylin eosin (HE) stain and immunohistochemical markers. This case report highlights the fact that, although extremely rare, the possibility of an extra-axial CP angle mass being a medulloblastoma still needs to be considered in the differential diagnoses, even in adults.
Collapse
Affiliation(s)
- Ishita Pant
- Department of Pathology, Institute of Human Behaviour and Allied Sciences, New Delhi, India
| | - Sujata Chaturvedi
- Department of Pathology, Institute of Human Behaviour and Allied Sciences, New Delhi, India
| | - Vinod K S Gautam
- Department of Neurosurgery, Institute of Human Behaviour and Allied Sciences, New Delhi, India
| | - Pragyan Sarma
- Department of Neurosurgery, Guru Teg Bahadur Hospital, University College of Medical Sciences, New Delhi, India
| | - Dinesh Kumar Satti
- Department of Neurosurgery, Guru Teg Bahadur Hospital, University College of Medical Sciences, New Delhi, India
| |
Collapse
|
22
|
Bai J, Li M, Fu J, Xiao X. Surgical resection of petroclival meningiomas of the cerebellopontine angle and/or diaphragma sellae extension via an extended intradural anterior transpetrous approach. Br J Neurosurg 2022:1-8. [PMID: 35285360 DOI: 10.1080/02688697.2021.1999393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 10/22/2021] [Indexed: 11/02/2022]
Abstract
OBJECTIVE This study aimed to describe the extended intradural anterior transpetrous approach (ATPA) and its usefulness for the surgical resection of petroclival meningiomas (PCMs) of the cerebellopontine angle (CPA) and/or diaphragma sellae (DS) extension. METHODS Between January 2017 and December 2019, a total of 22 patients with PCMs extending to the CPA/or DS underwent surgery via extended intradural ATPA by the senior author (Xr.X.). We retrospectively analysed the clinical data, radiological findings, surgical treatment, complications, and outcomes of patients and discussed the operative technique. RESULTS In 22 patients, the tumours were gross totally removed (Simpson I and II) in 18 patients (81.8%), subtotally (Simpson III) in 3 patients (13.6%), and partially (Simpson IV) in 1 patient (4.5%). One patient died 48 days after the operation, and no recurrence was found in 21 patients during a median follow-up of 26 months. Postoperative complications included in abducens nerve palsy in 12 patients with recovery in 10 patients, facial numbness in 4 patients with recovery in 3 patients, and hemiplegia and oculomotor nerve palsy in 1 patient each with recovery in all patients. The postoperative MRI showed temporal lobe oedema but no clinical symptoms in 3 patients. CONCLUSION Extended intradural ATPA is an alternative approach for PCMs of the CPA and/or DS extension. The single approach can expose both the sellar region and the posterolateral area of the IAC, which is advantageous for extended intradural ATPA.
Collapse
Affiliation(s)
- Jie Bai
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Mingchu Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jiayue Fu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xinru Xiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
23
|
Krajewski S, Furtak J, Zawadka-Kunikowska M, Kachelski M, Birski M, Harat M. Comparison of the Functional State and Motor Skills of Patients after Cerebral Hemisphere, Ventricular System, and Cerebellopontine Angle Tumor Surgery. Int J Environ Res Public Health 2022; 19:2308. [PMID: 35206503 PMCID: PMC8871731 DOI: 10.3390/ijerph19042308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/08/2022] [Accepted: 02/15/2022] [Indexed: 01/27/2023]
Abstract
Brain tumor location is an important factor determining the functional state after brain tumor surgery. We assessed the functional state and course of rehabilitation of patients undergoing surgery for brain tumors and assessed the location-dependent risk of loss of basic motor skills and the time needed for improvement after surgery. There were 835 patients who underwent operations, and 139 (16.6%) required rehabilitation during the inpatient stay. Karnofsky Performance Scale, Barthel Index, and the modified Rankin scale were used to assess functional status, whereas Gait Index was used to assess gait efficiency. Motor skills, overall length of stay (LOS) in hospital, and LOS after surgery were recorded. Patients were classified into four groups: cerebral hemisphere (CH), ventricular system (VS), and cerebellopontine angle (CPA) tumors; and a control group not requiring rehabilitation. VS tumor patients had the lowest scores in all domains compared with the other groups before surgery (p < 0.001). Their performance further deteriorated after surgery and by the day of discharge. They most often required long-lasting postoperative rehabilitation and had the longest LOS (35 days). Operation was most often required for CH tumors (77.7%), and all metrics and LOS parameters were better in these patients (p < 0.001). Patients with CPA tumors had the best outcomes (p < 0.001). Most patients (83.4%) with brain tumors did not require specialized rehabilitation, and LOS after surgery in the control group was on average 5.1 days after surgery. VS tumor patients represent a rehabilitation challenge. Postoperative rehabilitation planning must take the tumor site and preoperative condition into account.
Collapse
Affiliation(s)
- Stanisław Krajewski
- Department of Physiotherapy, University of Bydgoszcz, Unii Lubelskiej 4, 85-059 Bydgoszcz, Poland
- Department of Neurosurgery, 10th Military Research Hospital and Polyclinic, 85-681 Bydgoszcz, Poland; (J.F.); (M.K.); (M.B.); (M.H.)
| | - Jacek Furtak
- Department of Neurosurgery, 10th Military Research Hospital and Polyclinic, 85-681 Bydgoszcz, Poland; (J.F.); (M.K.); (M.B.); (M.H.)
- Franciszek Łukaszczyk Oncology Center, Department of Neurooncology and Radiosurgery, 85-796 Bydgoszcz, Poland
| | - Monika Zawadka-Kunikowska
- Department of Human Physiology, LudwikRydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Torun, Karłowicza 24, 85-092 Bydgoszcz, Poland;
| | - Michał Kachelski
- Department of Neurosurgery, 10th Military Research Hospital and Polyclinic, 85-681 Bydgoszcz, Poland; (J.F.); (M.K.); (M.B.); (M.H.)
| | - Marcin Birski
- Department of Neurosurgery, 10th Military Research Hospital and Polyclinic, 85-681 Bydgoszcz, Poland; (J.F.); (M.K.); (M.B.); (M.H.)
| | - Marek Harat
- Department of Neurosurgery, 10th Military Research Hospital and Polyclinic, 85-681 Bydgoszcz, Poland; (J.F.); (M.K.); (M.B.); (M.H.)
- Department of Neurosurgery and Neurology, LudwikRydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Torun, M. Sklodowskiej-Curie 9, 85-094 Bydgoszcz, Poland
| |
Collapse
|
24
|
Véleine Y, Brenet E, Labrousse M, Chays A, Bazin A, Kleiber JC, Dubernard X. Long-term efficacy of vestibular neurotomy in disabling Ménière's disease and Tumarkin drop attacks. J Neurosurg 2022; 137:1-7. [PMID: 34996039 DOI: 10.3171/2021.10.jns21145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 10/16/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE When Ménière's disease (MD) becomes disabling due to the frequency of attacks or the appearance of drop attacks (i.e., Tumarkin otolithic crisis) despite "conservative" medical and surgical treatments, a radical treatment like vestibular neurotomy (VN) is possible. An ideal MD treatment would relieve symptoms immediately and persist after the therapy. The aim of this study was to identify if VN was effective after 10 years of follow-up regarding vertigo and drop attacks, and to collect the immediate complications. METHODS The authors report a retrospective, single-center (i.e., in a single tertiary referral center with otoneurological surgery activity) cohort study conducted from January 2003 to April 2020. All patients with unilateral disabling MD who had received a VN with at least 10 years of follow-up were included. The therapeutic efficacy was defined by complete disappearance of vertigo and drop attacks. The postoperative complications (CSF leak, total deafness, meningitis, death) were determined immediately after the surgery, and the hearing thresholds were determined during the patient follow-up with the pure tone average (PTA). RESULTS A total of 74 patients (of 85 who were eligible), average age 51.9 ± 11.1 years, including 38 men (51.4%), with disabling MD and/or Tumarkin drop attacks (24.3%) received VN, with at least 10 years of follow-up after surgery. After an average follow-up of 12.4 ± 1.7 years (range 10.0-16.3 years), 67 patients (90.5%) no longer presented any vertiginous attacks, and no patient experienced drop attack. The mean variation in early pre- and postoperative PTA was not statistically significant (n = 64, 2.2 ± 10.3 decibels hearing level [range -18 to 29], 95% CI [-0.4 to 4.37]; p = 0.096), and 84.4% of the patients evaluated had unchanged or improved postoperative PTA. Three significant complications were noted, including two surgical revisions for CSF leak. There was no permanent facial paralysis, meningitis, or death. CONCLUSIONS In case of disabling MD (disabling vertigo refractory to conservative vestibular treatments-Tumarkin drop attacks), VN via the retrosigmoid approach must be the prioritized proposal in comparison to intratympanic gentamicin injections, because of the extremely low complication rate and the immediate and long-lasting effect of this treatment on vertigo and falls.
Collapse
Affiliation(s)
- Yohanan Véleine
- 1Department of Otorhinolaryngology, Head and Neck Division, Robert Debré Hospital, Reims University Hospital
| | - Esteban Brenet
- 1Department of Otorhinolaryngology, Head and Neck Division, Robert Debré Hospital, Reims University Hospital
| | - Marc Labrousse
- 1Department of Otorhinolaryngology, Head and Neck Division, Robert Debré Hospital, Reims University Hospital
| | - André Chays
- 1Department of Otorhinolaryngology, Head and Neck Division, Robert Debré Hospital, Reims University Hospital
- 2Otoneurosurgical Institute of Champagne-Ardenne, Head and Neck Division, Maison Blanche Hospital, Reims University Hospital; and
| | - Arnaud Bazin
- 2Otoneurosurgical Institute of Champagne-Ardenne, Head and Neck Division, Maison Blanche Hospital, Reims University Hospital; and
- 3Department of Neurosurgery, Head and Neck Division, Maison Blanche Hospital, Reims University Hospital, Reims, Grand Est Region, France
| | - Jean-Charles Kleiber
- 2Otoneurosurgical Institute of Champagne-Ardenne, Head and Neck Division, Maison Blanche Hospital, Reims University Hospital; and
- 3Department of Neurosurgery, Head and Neck Division, Maison Blanche Hospital, Reims University Hospital, Reims, Grand Est Region, France
| | - Xavier Dubernard
- 1Department of Otorhinolaryngology, Head and Neck Division, Robert Debré Hospital, Reims University Hospital
- 2Otoneurosurgical Institute of Champagne-Ardenne, Head and Neck Division, Maison Blanche Hospital, Reims University Hospital; and
| |
Collapse
|
25
|
Grigoryan GY, Grigoryan YA. Dysfunctions and anatomical relationships of cranial nerves in epidermoids of the cerebellopontine angle. Zh Vopr Neirokhir Im N N Burdenko 2022; 86:56-65. [PMID: 36252194 DOI: 10.17116/neiro20228605156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To evaluate the correlation of neurological symptoms with anatomical relationships of cranial nerves, lesions and vessels in patients with epidermoids of the cerebellopontine angle. MATERIAL AND METHODS We analyzed neurological symptoms, magnetic resonance data, intraoperative findings and postoperative functional outcomes in 25 patients (14 females and 11 males aged 22-77 years) with epidermoids of the cerebellopontine angle. RESULTS Cranial nerve dysfunctions were noted in 15 patients. Involvement of cochlear (n=9) and trigeminal (9 cases including 4 ones with sensory impairment and 5 patients with neuralgia) nerves was the most common. There were 10 patients with ataxia, hemiparesis and seizures without cranial nerve dysfunction. In 15 patients, epidermoids spread to supratentorial space and contralateral cerebellopontine angle. Lesion-induced brainstem compression was found in 22 cases. Cranial nerves and cerebellar arteries were partially or completely enclosed by lesion in all cases. Severe compression and dislocation of the nerve root entry/exit zone were found in all cases. One patient with trigeminal neuralgia had vascular compression of trigeminal nerve caused by superior cerebellar artery. Total resection was achieved in 16 patients. Small capsule remnants were left on vessels, nerves or brainstem in 9 patients. Postoperative complete or partial restoration of cranial nerve functions was noted in 11 cases. Deterioration of preoperative neurological deficit in 4 patients and postoperative neurological symptoms de novo in 3 patients were temporary. CONCLUSION Cranial nerve dysfunctions are caused by compression of the nerve root entry/exit zones by epidermoids of the cerebellopontine angle. Surgical intervention is effective in alleviating symptoms of cranial neuropathy and brainstem compression. Vascular decompression should be performed in patients with trigeminal neuralgia.
Collapse
|
26
|
Abbou Z, Djennati R, Khalil Z. A rare association between a dermoid cyst and arachnoid cyst of the cerebellopontine angle: a case report. Pan Afr Med J 2021; 40:125. [PMID: 34909093 PMCID: PMC8641637 DOI: 10.11604/pamj.2021.40.125.32040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 10/23/2021] [Indexed: 11/11/2022] Open
Abstract
Supratentorial arachnoid cysts are usually asymptomatic and may be discovered by chance at autopsy; however, infratentorial arachnoid cysts, which correspond to liquid forms enclosed by an arachnoid sheet but whose pathogenesis is unknown, might cause symptoms. They don't need to be treated if they're asymptomatic and were discovered by chance. A variety of neurological symptoms can be present depending on their localization. Intracranial dermoid cysts are uncommon tumours that develop from ectopic epithelial cells in the brain. They are benign, slow-growing, and rarely rupture. The association between the two diseases is extremely rare and when it is present may suggest the existence of a common factor. We present a unique case of a young girl who developed headache and ataxia as a result of an intracranial infratentorial dermoid cyst and an arachnoid cyst of the cerebellopontine angle. Complete removal of the dermoid cyst and drainage of the cyst leads to a full recovery. Dermoid and arachnoid cyst are two pathologies with a possible common embryogenic factor, early surgery can give a better outcome in the long term.
Collapse
Affiliation(s)
- Zoubeyr Abbou
- Department of Neurosurgery, Faculty of Medicine, Abou Bekr Belkaid University, Tlemcen, Algeria
| | | | - Zeyad Khalil
- Manchester Foundation Trust-South, Manchester, United Kingdom
| |
Collapse
|
27
|
Greve T, Wang L, Katzendobler S, Geyer LL, Schichor C, Tonn JC, Szelényi A. Bilateral and Optimistic Warning Paradigms Improve the Predictive Power of Intraoperative Facial Motor Evoked Potentials during Vestibular Schwannoma Surgery. Cancers (Basel) 2021; 13:6196. [PMID: 34944816 DOI: 10.3390/cancers13246196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/23/2021] [Accepted: 12/02/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary During surgery for vestibular schwannomas, the facial nerve is monitored via motor evoked potentials (facial nerve MEP). The established warning criteria for facial nerve MEP signal changes mostly refer to the ipsilateral side and disregard the contralateral side. Furthermore, the surgeon is warned as soon as the signal of a single facial muscle deteriorates. We examined how the predictive power of the facial nerve MEP would change if we used the percent change in ipsilateral versus contralateral MEP stimulation intensity over time as warning criterion; additionally, if we warned in a novel optimistic manner, a manner in which the surgeon would be warned only if all derived facial muscles deteriorate significantly, as opposed to the traditional method, in which the surgeon is warned as soon as a single muscle deteriorates. We retrospectively compared this approach to actual intraoperative warnings (based on unilateral threshold change, A-trains, and MEP loss) and show that with our method, the facial nerve MEP was significantly more specific and triggered fewer unnecessary warnings. Abstract Facial muscle corticobulbar motor evoked potentials (FMcoMEPs) are used to monitor facial nerve integrity during vestibular schwannoma resections to increase maximal safe tumor resection. Established warning criteria, based on ipsilateral amplitude reduction, have the limitation that the rate of false positive alarms is high, in part because FMcoMEP changes occur on both sides, e.g., due to brain shift or pneumocephalus. We retrospectively compared the predictive value of ipsilateral-only warning criteria and actual intraoperative warnings with a novel candidate warning criterion, based on “ipsilateral versus contralateral difference in relative stimulation threshold increase, from baseline to end of resection” (BilatMT ≥ 20%), combined with an optimistic approach in which a warning would be triggered only if all facial muscles on the affected side deteriorated. We included 60 patients who underwent resection of vestibular schwannoma. The outcome variable was postoperative facial muscle function. Retrospectively applying BilatMT, with the optimistic approach, was found to have a significantly better false positive rate, which was much lower (9% at day 90) than the traditionally used ipsilateral warning criteria (>20%) and was also lower than actual intraoperative warnings. This is the first report combining the threshold method with an optimistic approach in a bilateral multi-facial muscle setup. This method could substantially reduce the rate of false positive alarms in FMcoMEP monitoring.
Collapse
|
28
|
Laghaei Farimani P, Fatehi M, Chaharyn BM, Akagami R. Large Subependymoma Inferior to the Cerebellopontine Angle With Significant Obstructive Hydrocephalus: A Case Report on an Extremely Rare Tumor. Cureus 2021; 13:e18686. [PMID: 34790451 PMCID: PMC8584333 DOI: 10.7759/cureus.18686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2021] [Indexed: 12/28/2022] Open
Abstract
Subependymomas are rare yet benign tumors that are commonly found within the ventricular system. We describe the case of a 51-year-old male presenting with hydrocephalus and progressive headaches found to have a right cerebellopontine angle (CPA) lesion encasing multiple blood vessels and cranial nerves (CN). The lesion was resected subtotally via a retrosigmoid approach and was found to be a subependymoma. CPA subependymomas are extremely rare lesions. The neuroimaging and histopathological findings as well as a comprehensive literature review of similar cases are discussed.
Collapse
Affiliation(s)
- Pedram Laghaei Farimani
- Division of Neurosurgery, Vancouver General Hospital, Vancouver, CAN.,Department of Medicine, University of British Columbia, Vancouver, CAN
| | - Mostafa Fatehi
- Division of Neurosurgery, Vancouver General Hospital, Vancouver, CAN.,Department of Clinical Neurosciences, University of Calgary, Calgary, CAN
| | | | - Ryojo Akagami
- Division of Neurosurgery, Vancouver General Hospital, Vancouver, CAN
| |
Collapse
|
29
|
Ali S, Qasim A, Tasdique S, Sarwar MR, Shams S. Extra-axial Desmoplastic Medulloblastoma in Adult Cerebellopontine Angle: Case Report and Noninvasive Molecular Subgrouping Utilizing Magnetic Resonance Imaging-Based Radiomics Nomogram. Asian J Neurosurg 2021; 16:618-622. [PMID: 34660382 PMCID: PMC8477825 DOI: 10.4103/ajns.ajns_525_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/01/2021] [Accepted: 03/20/2021] [Indexed: 12/04/2022] Open
Abstract
Cerebellopontine angle (CPA) is an atypical site for adult medulloblastoma (MB) with only 12 cases reported in pure extra-axial location. None was predicted on preoperative imaging while the most common misdiagnosis was petrous meningioma. We add the 13th case to this list, attempting to reiterate the radiological features for preoperative prediction of this rare pathology on conventional magnetic resonance imaging (MRI). Molecular subtyping also is not yet reported for adult extra-axial CPA MB. We propose the routine use of MRI-based nomograms, in atypical CPA extra-axial masses, for noninvasive prediction of molecular subgroup, especially in resource-limited setups that lack the facility of genetic profiling.
Collapse
Affiliation(s)
- Sundus Ali
- Department of Neurosurgery, Mayo Hospital, King Edward Medical University, Lahore, Pakistan
| | - Adnan Qasim
- Department of Neurosurgery, Mayo Hospital, King Edward Medical University, Lahore, Pakistan
| | - Shahzaib Tasdique
- Department of Neurosurgery, Mayo Hospital, King Edward Medical University, Lahore, Pakistan
| | - Muhammad Rizwan Sarwar
- Department of Neurosurgery, Mayo Hospital, King Edward Medical University, Lahore, Pakistan
| | - Shahzad Shams
- Department of Neurosurgery, Mayo Hospital, King Edward Medical University, Lahore, Pakistan
| |
Collapse
|
30
|
Kinoshita Y, Zomorodi AR, Friedman AH, Sato H, Carter JH, Bawornvaraporn U, Nakamura H, Fukushima T. Retrolabyrinthine transsigmoid approach to complex parabrainstem tumors in the posterior fossa. J Neurosurg 2021; 136:1097-1102. [PMID: 34624849 DOI: 10.3171/2021.5.jns204130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 05/17/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The surgical management of large and complex tumors of the posterior fossa poses a formidable challenge in neurosurgery. The standard retrosigmoid craniotomy approach has been performed at most neurosurgical centers; however, the retrosigmoid approach may not provide enough working space without significant retraction of the cerebellum. The transsigmoid approach provides wider and shallower surgical fields; however, there have been few clinical and no cadaveric studies on its usefulness. In the present study, the authors describe the transsigmoid approach in clinical cases and cadaveric specimens. METHODS For the clinical study, the authors retrospectively reviewed the medical records and operative charts of patients who had been surgically treated for parabrainstem tumors using the transsigmoid approach between 1997 and 2019. They analyzed patient demographic and clinical data, as well as surgical and clinical outcomes. In the cadaveric study, they compared the surgical views obtained in different approaches (retrosigmoid, presigmoid, retrolabyrinthine, and transsigmoid) and measured the sigmoid sinus width at the level of the endolymphatic sac and the distance between the anterior edge of the sigmoid sinus and the endolymphatic sac on 35 sides in 19 cadaveric specimens. RESULTS A total of 21 patients (6 males and 15 females) with a mean age of 42.2 (range 15-67) years were included in the clinical study. Eleven patients had meningioma, 7 had vestibular schwannoma, 2 had hemangioblastoma, and 1 had epidermoid cyst. Gross-total, near-total, and subtotal removal were achieved in 7 (33.3%), 3 (14.3%), and 11 (52.4%) patients, respectively. In the cadaveric study, 19 cadaveric specimens were used. The sigmoid sinus was cut in the middle, and the incision was extended from the retrosigmoid to the presigmoid dura. The dura was then retracted upward and downward like opening a door. The results indicated that this technique can widen the operative field anteriorly by approximately 2 cm as compared to the retrosigmoid approach and provides a better view anterior to the brainstem. CONCLUSIONS The transsigmoid approach is useful for complex parabrainstem tumors in the posterior fossa because it provides a wider and shallower operative view with less retraction of the cerebellum. This enables safer tumor removal with less damage to important structures in the posterior fossa, resulting in better operative and clinical outcomes.
Collapse
Affiliation(s)
- Yusuke Kinoshita
- 1Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Japan
| | - Ali R Zomorodi
- 2Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Allan H Friedman
- 2Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Hikari Sato
- 3Department of Neurosurgery, Moriyama Memorial Hospital, Tokyo, Japan; and
| | - James H Carter
- 2Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Udom Bawornvaraporn
- 2Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Hirohiko Nakamura
- 1Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Japan
| | - Takanori Fukushima
- 2Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina.,4Raleigh Neurosurgical Clinic, Raleigh, North Carolina
| |
Collapse
|
31
|
Sattar R, Ratha V, Kandallu SBR, Kapilavayi S, Sampath N, Sankaran V, Balasundaram P. Mature cystic teratoma of the right cerebellopontine angle: a rare case report. Br J Neurosurg 2021:1-4. [PMID: 34410217 DOI: 10.1080/02688697.2021.1967287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 05/17/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND IMPORTANCE Intracranial mature cystic teratomas are benign neoplasms that commonly occur at the midline. Mature cystic teratomas at the cerebellopontine (CP) angle are very rare. They are unique germ cell tumours curable by safe total surgical resection and have good prognosis. This case report documents the clinical, radiological, histological features and operative findings of mature cystic teratoma at CP angle. CLINICAL PRESENTATION We present a rare case of a mature cystic teratoma at the CP angle in a 24-year-old woman who presented with brainstem compression and cranial nerve deficits. Brain MRI showed atypical findings like hyperintense areas in both T1 and T2 weighted images, calcification and diffusion restriction in part of the lesion. She underwent near total resection of the tumour via right retrosigmoid approach. Intraoperatively, the lesion was intra-arachnoidal unlike schwannomas and the cyst contained sebum-like material, fibrous areas with calcification which are unusual features of common CP angle tumours. Histopathological examination showed well differentiated mature tissues from all three germinal layers and confirmed the diagnosis of a mature cystic teratoma arising from the right CP angle. Patient had good outcome with neurologic recovery. CONCLUSIONS Mature cystic teratoma is a rare clinical entity and should be considered in patients with CP angle tumours when there are atypical findings in brain MRI imaging. Cysts with sebum-like material, fibrous areas with calcification and poor tumour-arachnoid plane intraoperatively strongly suggest the possibility of mature cystic teratoma.
Collapse
Affiliation(s)
- Reshma Sattar
- Department of Neurosurgery, Institute of Neurosciences, SRM Institute for Medical Science, Chennai, India
| | - Vishwaraj Ratha
- Department of Neurosurgery, Institute of Neurosciences, SRM Institute for Medical Science, Chennai, India
| | - Suresh Bapu R Kandallu
- Department of Neurosurgery, Institute of Neurosciences, SRM Institute for Medical Science, Chennai, India
| | - Sunil Kapilavayi
- Department of Neurosurgery, Institute of Neurosciences, SRM Institute for Medical Science, Chennai, India
| | - Nishanth Sampath
- Department of Neurosurgery, Institute of Neurosciences, SRM Institute for Medical Science, Chennai, India
| | - Vijay Sankaran
- Department of Neurosurgery, Institute of Neurosciences, SRM Institute for Medical Science, Chennai, India
| | - Partheeban Balasundaram
- Department of Neurosurgery, Institute of Neurosciences, SRM Institute for Medical Science, Chennai, India
| |
Collapse
|
32
|
Gürün E, Akdulum İ, Kılıç P, Tokgöz N, Uçar M. Evaluation of schwannoma using the 3D-SPACE sequence: comparison with the 3D-CISS sequence in 3T-MRI. Turk J Med Sci 2021; 51:1123-1135. [PMID: 33387986 PMCID: PMC8283456 DOI: 10.3906/sag-2010-30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 01/01/2021] [Indexed: 12/03/2022] Open
Abstract
Background/aim The purpose of this study is to compare the diagnostic accuracy and interobserver reliability of the T2-weighted 3D-SPACE (three-dimensional sampling perfection with application-optimized contrasts by using different flip angle evolutions) sequence in comparison with T2-weighted 3D-CISS (three-dimensional constructive interference in steady state) sequences for diagnosis of schwannomas. Materials and methods Forty patients with cerebellopontine angle (CPA), internal acoustic canal (IAC), and cochlear schwannoma who had undergone magnetic resonance imaging (MRI) using the 3D-CISS and 3D-SPACE sequences were identified. The sequences were retrospectively evaluated by two radiologists for the qualitative analyses, which were subsequently compared using the Mann–Whitney U test. Following this, kappa values were used for interobserver agreement. P < 0.05 was considered to be of statistical significance. Results The interobserver agreement was found to be excellent between the two observers for the interpretation of all qualitative analyses for both sequences (kappa value > 0.8). The 3D-SPACE sequences demonstrated significantly better qualitative scores and fewer artifacts compared with the 3D-CISS sequences (p < 0.05). Conclusion Our results demonstrate that 3D-SPACE is superior to 3D-CISS in the imaging process of the schwannoma in terms of image quality, description of the relationship between the lesion and cranial nerve, signal differentiation between lesion and cistern, and signal differentiation between the lesion and adjacent brain.
Collapse
Affiliation(s)
- Enes Gürün
- Department of Radiology, İskilip Atıf Hoca State Hospital, Çorum, Turkey
| | - İsmail Akdulum
- Department of Radiology, Gazi University Hospital, Ankara, Turkey
| | - Pınar Kılıç
- Department of Radiology, Pursaklar State Hospital, Ankara, Turkey
| | - Nil Tokgöz
- Department of Radiology, Gazi University Hospital, Ankara, Turkey
| | - Murat Uçar
- Department of Radiology, Gazi University Hospital, Ankara, Turkey
| |
Collapse
|
33
|
Grigoryan GY, Sitnikov AR, Grigoryan YA. [Trigeminal radiculopathy in vestibular schwannomas]. Zh Vopr Neirokhir Im N N Burdenko 2021; 85:29-43. [PMID: 34156205 DOI: 10.17116/neiro202185031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the correlation of trigeminal radiculopathy with anatomical relationships of trigeminal nerve root, brainstem, tumors and vessels in patients with vestibular schwannomas. MATERIAL AND METHODS A retrospective analysis included 153 patients (106 females and 47 males aged 22-82 years) with vestibular schwannomas who underwent surgery via retromastoid approach. Preoperative trigeminal radiculopathy (facial pain and sensory disturbances) was examined after microsurgical resection. Brainstem compression was analyzed by comparison of transverse size of contralateral to vestibular schwannoma half of brainstem and ipsilateral side. RESULTS Tumor-induced brainstem and trigeminal nerve compression was found in 115 cases. Sixty-four of these patients had trigeminal radiculopathy symptoms. Degree of brainstem compression was significantly higher in trigeminal radiculopathy group. Facial hypoesthesia was found in 61patients, trigeminal neuralgia - in 5 cases, neuropathic pain - in 3 patients. Thirty-seven patients without brainstem compression had no trigeminal nerve involvement. One patient had trigeminal neuralgia following compression by superior cerebellar artery. Total resection with brainstem and trigeminal nerve decompression were performed in all cases. Isolated or combined compression of trigeminal nerve root was noted in 9 patients with trigeminal neuralgia and neuropathic pain, in 2 with facial numbness and in 2 patients without trigeminal symptoms. In case of trigeminal neuralgia following compression by superior cerebellar artery, vascular decompression was performed only in patients with facial pain and numbness. Facial pain completely resolved in all patients. Complete or partial sensory restoration was noted in 25 cases. No facial sensory disorders were noted in 26 cases, transient sensory deterioration - in 10 patients. CONCLUSION Trigeminal radiculopathy is caused by severe brainstem compression following vestibular schwannomas and usually results sensory disturbances and rarely facial pain. The impact of tumor on trigeminal nerve root and brainstem trigeminal pathways can be accompanied by vascular compression by superior cerebellar artery. Regression of trigeminal radiculopathy symptoms after resection of vestibular schwannoma is caused by decompression of trigeminal nerve root and brainstem. In case of concomitant neurovascular syndrome, vascular decompression is indicated.
Collapse
Affiliation(s)
| | - A R Sitnikov
- Treatment and Rehabilitation Center, Moscow, Russia
| | | |
Collapse
|
34
|
Hostettler IC, Jayashankar N, Bikis C, Wanderer S, Nevzati E, Karuppiah R, Waran V, Kalbermatten D, Mariani L, Marbacher S, Guzman R, Madduri S, Roethlisberger M. Clinical Studies and Pre-clinical Animal Models on Facial Nerve Preservation, Reconstruction, and Regeneration Following Cerebellopontine Angle Tumor Surgery-A Systematic Review and Future Perspectives. Front Bioeng Biotechnol 2021; 9:659413. [PMID: 34239858 PMCID: PMC8259738 DOI: 10.3389/fbioe.2021.659413] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background and purpose: Tumorous lesions developing in the cerebellopontine angle (CPA) get into close contact with the 1st (cisternal) and 2nd (meatal) intra-arachnoidal portion of the facial nerve (FN). When surgical damage occurs, commonly known reconstruction strategies are often associated with poor functional recovery. This article aims to provide a systematic overview for translational research by establishing the current evidence on available clinical studies and experimental models reporting on intracranial FN injury. Methods: A systematic literature search of several databases (PubMed, EMBASE, Medline) was performed prior to July 2020. Suitable articles were selected based on predefined eligibility criteria following the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines. Included clinical studies were reviewed and categorized according to the pathology and surgical resection strategy, and experimental studies according to the animal. For anatomical study purposes, perfusion-fixed adult New Zealand white rabbits were used for radiological high-resolution imaging and anatomical dissection of the CPA and periotic skull base. Results: One hundred forty four out of 166 included publications were clinical studies reporting on FN outcomes after CPA-tumor surgery in 19,136 patients. During CPA-tumor surgery, the specific vulnerability of the intracranial FN to stretching and compression more likely leads to neurapraxia or axonotmesis than neurotmesis. Severe FN palsy was reported in 7 to 15 % after vestibular schwannoma surgery, and 6% following the resection of CPA-meningioma. Twenty-two papers reported on experimental studies, out of which only 6 specifically used intracranial FN injury in a rodent (n = 4) or non-rodent model (n = 2). Rats and rabbits offer a feasible model for manipulation of the FN in the CPA, the latter was further confirmed in our study covering the radiological and anatomical analysis of perfusion fixed periotic bones. Conclusion: The particular anatomical and physiological features of the intracranial FN warrant a distinguishment of experimental models for intracranial FN injuries. New Zealand White rabbits might be a very cost-effective and valuable option to test new experimental approaches for intracranial FN regeneration. Flexible and bioactive biomaterials, commonly used in skull base surgery, endowed with trophic and topographical functions, should address the specific needs of intracranial FN injuries.
Collapse
Affiliation(s)
- Isabel C Hostettler
- Department of Neurosurgery, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Narayan Jayashankar
- Department of Oto-Rhino-Laryngology, Nanavati Super Speciality Hospital, Mumbai, India
| | - Christos Bikis
- Department of Biomedical Engineering, Biomaterials Science Center, University of Basel, Allschwil, Switzerland.,Integrierte Psychiatrie Winterthur - Zürcher Unterland, Winterthur, Switzerland
| | - Stefan Wanderer
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Edin Nevzati
- Department of Neurosurgery, Kantonsspital Luzern, Lucerne, Switzerland
| | - Ravindran Karuppiah
- Department of Neurosurgery, University Malaya Specialist Centre, University of Malaya, Kuala Lumpur, Malaysia
| | - Vicknes Waran
- Department of Neurosurgery, University Malaya Specialist Centre, University of Malaya, Kuala Lumpur, Malaysia
| | - Daniel Kalbermatten
- Department of Plastic Surgery, University Hospital Geneva, Geneva, Switzerland.,Department of Surgery, Biomaterials and Neuro Tissue Bioengineering, University of Geneva, Geneva, Switzerland
| | - Luigi Mariani
- Department of Neurosurgery, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Raphael Guzman
- Department of Neurosurgery, University Hospital of Basel, University of Basel, Basel, Switzerland.,Department of Biomedicine, Brain Ischemia and Regeneration, University of Basel, Basel, Switzerland.,Department of Biomedical Engineering, Center for Bioengineering and Regenerative Medicine, University of Basel, Basel, Switzerland
| | - Srinivas Madduri
- Department of Surgery, Biomaterials and Neuro Tissue Bioengineering, University of Geneva, Geneva, Switzerland.,Department of Biomedicine, Brain Ischemia and Regeneration, University of Basel, Basel, Switzerland.,Department of Biomedical Engineering, Center for Bioengineering and Regenerative Medicine, University of Basel, Basel, Switzerland
| | - Michel Roethlisberger
- Department of Neurosurgery, University Malaya Specialist Centre, University of Malaya, Kuala Lumpur, Malaysia.,Department of Neurosurgery, University Hospital of Basel, University of Basel, Basel, Switzerland.,Department of Biomedical Engineering, Center for Bioengineering and Regenerative Medicine, University of Basel, Basel, Switzerland
| |
Collapse
|
35
|
Jia XH, Gao Z, Yuan YS, Zhao WD. Surgical management of intraoperatively diagnosed facial nerve schwannoma located at internal auditory canal and cerebellopontine angle - our experiences of 14 cases. Acta Otolaryngol 2021; 141:594-598. [PMID: 33827370 DOI: 10.1080/00016489.2021.1907615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
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.
Collapse
Affiliation(s)
- Xian-hao Jia
- Department of Otology and Skull Base Surgery, Eye & ENT Hospital, Fudan University, Shanghai, PR China
- Shanghai Auditory Medical Center, Shanghai, PR China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, PR China
| | - Zhen Gao
- Department of Otology and Skull Base Surgery, Eye & ENT Hospital, Fudan University, Shanghai, PR China
- Shanghai Auditory Medical Center, Shanghai, PR China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, PR China
| | - Ya-sheng Yuan
- Department of Otology and Skull Base Surgery, Eye & ENT Hospital, Fudan University, Shanghai, PR China
- Shanghai Auditory Medical Center, Shanghai, PR China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, PR China
| | - Wei-dong Zhao
- Department of Otology and Skull Base Surgery, Eye & ENT Hospital, Fudan University, Shanghai, PR China
- Shanghai Auditory Medical Center, Shanghai, PR China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, PR China
| |
Collapse
|
36
|
Rodriguez Rubio R, Xie W, Vigo V, Lee A, Tomasi OS, El-Sayed IH, Abla A. Immersive Surgical Anatomy of the Retrosigmoid Approach. Cureus 2021; 13:e16068. [PMID: 34367740 PMCID: PMC8336623 DOI: 10.7759/cureus.16068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 06/30/2021] [Indexed: 11/20/2022] Open
Abstract
The retrosigmoid approach (RS) approach is the workhorse of the posterolateral neurosurgical techniques to access various posterior fossa structures and even extends into the middle fossa. Many studies have detailed two-dimensional (2D) descriptions of the RS technique from either the lateral or posterior view. This study is the first to provide a comprehensive analysis of the RS technique, soft tissue, extracranial landmarks, and intracranial structures of the posterolateral region using interactive three-dimensional (3D) volumetric models (VMs). The visuospatial understanding of the neuroanatomical structures and landmarks of the RS approach is critical for successful surgeries with minimal complications. This study aims to create a collection of VMs and stereoscopic media for the relevant layer-by-layer soft tissue anatomy and step-by-step surgical technique of the RS approach using cadaveric dissections. Five embalmed heads and one dry skull were used to generate stereoscopic images and VMs using 3D scanning technology (i.e., photogrammetry and structured light scanning) to illustrate and simulate the RS approach. The extracranial structures were divided into myofascial, superficial vascular, superficial nerve, and bony anatomy. The RS approach was divided into seven major steps: patient positioning, incision of the skin, dissection of the scalp flap, dissection of the muscles, craniotomy, dural opening, and closure. Additionally, we described an anatomical classification of surgical corridors based on the cisternal segments of the cranial nerves exposed during the RS approach. We discussed the nuances of the keyhole variations of the RS approach and intradural modifications of the RS approach using 3D VMs to illustrate the surgical corridors and the intradural structures accessed. These interactive VMs allow for clear visualization and dynamically immersive experience for neuroanatomical studies of the RS approach in 360-degrees and virtual reality (VR). Computer graphics can be implemented in neurosurgery to facilitate our topographic knowledge, which is crucial for anatomical education, surgical planning, intraoperative decision making, and postoperative care.
Collapse
Affiliation(s)
| | - Weipeng Xie
- Neurological Surgery, University of California San Francisco, San Francisco, USA
| | - Vera Vigo
- Neurological Surgery, University of California San Francisco, San Francisco, USA
| | - Anthony Lee
- Neurological Surgery, University of California San Francisco, San Francisco, USA
| | | | - Ivan H El-Sayed
- Otolaryngology, University of California San Francisco, San Francisco, USA
| | - Adib Abla
- Neurological Surgery, University of California San Francisco, San Francisco, USA
| |
Collapse
|
37
|
Teixeira BCDA, Constanzo F, Sens P, Ramina R, Escuissato DL. Brainstem hyperintensity in patients with vestibular schwannoma is associated with labyrinth signal on magnetic resonance imaging but not vestibulocochlear tests. Neuroradiol J 2021; 34:180-186. [PMID: 33325805 PMCID: PMC8165906 DOI: 10.1177/1971400920980165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Focal hyperintensity in the dorsal brainstem (HDB) has been described in large cerebellopontine angle tumours and is thought to represent vestibular nuclei degeneration, but its functional significance has not been thoroughly investigated. Our aim was to analyse its relationship to imaging characteristics of the tumour and inner-ear structures and to vestibulocochlear functional tests. METHODS We retrospectively reviewed 54 patients with a histological diagnosis of vestibular schwannoma (VS). Magnetic resonance imaging tumour characteristics (size, cystic composition and distance from the cochlear aperture), signal intensity ratio of the cochlea and vestibule in fluid-attenuated inversion recovery (FLAIR) and fast imaging employing steady-state acquisition (FIESTA)/fast spin-echo imaging with variable flip angles (CUBE) and vestibulocochlear function tests (audiometry, auditory brainstem response (ABR) and video head impulse testing (vHIT)) were obtained. Statistical analyses were performed to evaluate their relation to focal HDB. RESULTS Focal HDB was found in 22% of VS. It was significantly associated with large (p < 0.001) and cystic (p = 0.004) tumours and also with tumours located further from the cochlear aperture (p = 0.039). The signal intensity ratio of the cochlea on FLAIR was higher in patients with HDB (p < 0.014), but this difference was not observed in FIESTA/CUBE (p = 0.981). Audiometry, ABR and vHIT results did not significantly differ in patients with HDB, but ABR results were worse in patients with higher cochlear signal intensity on FLAIR sequences (p = 0.026). CONCLUSIONS Focal HDB in patients with VS was associated with increased signal intensity ratio of the cochlea on FLAIR in patients with VS but not directly to the results of vestibulocochlear function tests.
Collapse
Affiliation(s)
- Bernardo Corrêa de Almeida Teixeira
- Department of Neuroradiology, Neurological Institute of Curitiba (INC), Brazil
- Department of Internal Medicine, Federal University of Paraná (UFPR), Brazil
| | - Felipe Constanzo
- Department of Neurosurgery, Neurological Institute of Curitiba (INC), Brazil
| | - Patricia Sens
- Department of Otorhinolaryngology, Neurological Institute of Curitiba (INC), Brazil
| | - Ricardo Ramina
- Department of Neurosurgery, Neurological Institute of Curitiba (INC), Brazil
| | | |
Collapse
|
38
|
Abstract
The typical distinction between cerebellopontine angle (CPA) medulloblastoma and other primary CPA tumors was not fully known. While CPA medulloblastoma is very uncommon, it should be included in the differential diagnosis of patients with CPA tumors.
Collapse
Affiliation(s)
- Le Thanh Dung
- Department of RadiologyViet Duc HospitalHa NoiVietnam
- Department of RadiologyHanoi Medical UniversityHa NoiVietnam
| | - Nguyen Minh Duc
- Department of RadiologyHanoi Medical UniversityHa NoiVietnam
- Department of RadiologyPham Ngoc Thach University of MedicineHo Chi Minh CityVietnam
- Department of RadiologyChildren's Hospital 2Ho Chi Minh CityVietnam
| |
Collapse
|
39
|
Guo X, Zhu Y, Wang X, Xu K, Hong Y. Peritumoral Edema Is Associated With Postoperative Hemorrhage and Reoperation Following Vestibular Schwannoma Surgery. Front Oncol 2021; 11:633350. [PMID: 33767998 PMCID: PMC7985450 DOI: 10.3389/fonc.2021.633350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/15/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Postoperative hemorrhage (POH) is a severe complication following vestibular schwannoma surgery that may require surgical treatment. The purpose of our study is to identify risk factors associated with POH and reoperation following the resection of vestibular schwannoma. Methods: We retrospectively recruited 452 vestibular schwannoma patients treated with retrosigmoid approach. The primary outcome was POH, and the secondary outcome was reoperation for POH. Clinical and radiographic data were compared by performing univariate analysis and logistic regression analysis. Results: Among the 452 patients, 37 patients (8.2%) presented with POH and14 patients (3.1%) required reoperation within a 30-day hospitalization period. The univariate analysis showed that peritumoral edema, tumor diameter >30 mm, severe postoperative hypertension, and length of hospital stay were associated with POH and reoperation for POH. Logistic regression analysis showed that peritumoral edema [odds ratio (OR) 4.042, 95% confident interval (CI) 1.830–8.926, P = 0.001] and tumor diameter >30 mm (OR 3.192, 95% CI 1.421–7.168, P = 0.005) were independent predictive factors for POH. Peritumoral edema (OR 7.071, 95% CI 2.342–21.356, P = 0.001) was an independent predictive factor for reoperation by using logistic regression analysis. Further analysis revealed that larger tumor and incomplete tumor resection were both associated with a higher incidence of peritumoral edema. Conclusion: Peritumoral edema and tumor size are independent risk factors for POH following vestibular schwannoma surgery. And larger hematoma occurs more commonly in tumors with peritumoral edema which may require reoperation. Tumor size and extent of tumor resection are associated with peritumoral edema. Close attention should be paid to high-risk patients especially for those who presented with severe postoperative hypertension.
Collapse
Affiliation(s)
- Xiaoming Guo
- Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Department of Neurosurgery, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Yueli Zhu
- Department of Geriatrics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaoyu Wang
- Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ke Xu
- Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuan Hong
- Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
40
|
Kabashi S, Ugurel MS, Dedushi K, Mucaj S. The Role of Magnetic Resonance Imaging (MRI) in Diagnostics of Acoustic Schwannoma. Acta Inform Med 2021; 28:287-291. [PMID: 33627932 PMCID: PMC7879442 DOI: 10.5455/aim.2020.28.287-291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Acoustic neuromas are also called vestibular schwannoma, acoustic neurinoma, vestibular neuroma, and acoustic neurofibroma. These are tumors that evolve from Schwann cell sheath and can be either intracranial or extra-axial. They usually occur adjacent to the cochlear or vestibular nerve. Anatomically, acoustic neuromas tend to occupy the cerebellopontine angle. About 20% of internal carotid artery (ICA) tumors are meningiomas and may occur elsewhere in the brain. Bilateral acoustic neuromas also tend to be exclusively in individuals with type 2 neurofibromatosis. Objective: The aim was to asses the role of MRI in evaluation of cerebellopontine angle acoustic schwannomas, the role of the cyber knife treatment in eliminating the tumor with a maximum protection of healthy tissue. Methods: MRI, GE 1.5 Tesla unit and standard protocol: Pre-contrast MRI images of the temporal bones and posterior fossa were obtained using Ax 3D Fiesta T2W Hi-resolution; Ax 3D T1 Fat-Suppressed, Thin-slice (2mm) Coronal T2W, Sag 3D FiestaT2W Hi-resolution images. Post-contrast images were obtained using Ax 3D T1 Fat-Suppressed Cor 3D T1 Fat-suppressed sequences. FLAIR sequence axial). Case report: A woman 62 years of age, reported sudden tinnitus, dizziness, hearing loss in her left ear. After one years she began to experience vertigo, headache. Results: MRI of brain temporal bone with contrast show acoustic schwannoma measuring 20x9 mm on the left cerebellopontine angle extending into and enlarging the left IAC, solid enhancing component is seen the acoustic meatus and peripheral contrast cystic component in the left cerebellopontine angle, after cyber knife treatment MRI result was the solid component of the mass, filling the left internal acoustic canal shows marked post-contrast enhancement and is measured 10x5x4mm, cystic component of it filling the left cerebellopontine angle cistern is enlarged to 25x19x12mm), it extends down till the left lateral aspect of medullary cistern, abutting the CN-XII at its entrance to left hypoglossal canal. After 5 month control show, a 15mm long and 5mm thick neoplastic soft-tissue in the left internal acoustic canal, with post-contrast enhancement, measured up to 12mm at the level of porus acusticus but cystic component of the mass in left cerebellopontine angle cistern is no longer visible in this MRI exam. Conclusion: The sensitivity of MRI for correctly diagnosing acoustic schwannoma was 100 % and specificity was 92.86 % with a positive predictive value of 94.12 % and accuracy of 96.67 %. MRI is considered as an excellent noninvasive investigation for pontocerebral angle Schwannoma’s.
Collapse
Affiliation(s)
- Serbeze Kabashi
- Faculty of Medicine, Pristine University, Pristine City, Kosovo.,Department of Radiology, Diagnostic Centre, UCCK, Pristine City, Kosovo
| | | | - Kreshnike Dedushi
- Faculty of Medicine, Pristine University, Pristine City, Kosovo.,Department of Radiology, Diagnostic Centre, UCCK, Pristine City, Kosovo
| | - Sefedin Mucaj
- Faculty of Medicine, Pristine University, Pristine City, Kosovo.,National Institute of Public Health of Kosovo, Pristine City, Kosovo
| |
Collapse
|
41
|
Matsushima K, Kohno M, Ichimasu N, Tanaka Y, Nakajima N, Yoshino M. Intraoperative continuous vagus nerve monitoring with repetitive direct stimulation in surgery for jugular foramen tumors. J Neurosurg 2021; 135:1036-1043. [PMID: 33607614 DOI: 10.3171/2020.8.jns202680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 08/18/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Surgery for tumors around the jugular foramen has significant risks of dysphagia and vocal cord palsy due to possible damage to the lower cranial nerve functions. For its treatment, long-term tumor control by maximum resection while avoiding permanent neurological damage is required. To accomplish this challenging goal, the authors developed an intraoperative continuous vagus nerve monitoring system and herein report their experience with this novel neuromonitoring method. METHODS Fifty consecutive patients with tumors around the jugular foramen (34 jugular foramen schwannomas, 11 meningiomas, 3 hypoglossal schwannomas, and 2 others) who underwent microsurgical resection under continuous vagus nerve monitoring within an 11-year period were retrospectively investigated. Evoked vagus nerve electromyograms were continuously monitored by direct 1-Hz stimulation to the nerve throughout the microsurgical procedure. RESULTS The average resection rate was 96.2%, and no additional surgery was required in any of the patients during the follow-up period (average 65.0 months). Extubation immediately after surgery and oral feeding within 10 days postoperatively were each achieved in 49 patients (98.0%). In 7 patients (14.0%), dysphagia and/or hoarseness were mildly worsened postoperatively at the latest follow-up, but tracheostomy or gastrostomy was not required in any of them. Amplitude preservation ratios on intraoperative vagus nerve electromyograms were significantly smaller in patients with postoperative worsening of dysphagia and/or hoarseness (cutoff value 63%, sensitivity 86%, specificity 79%). CONCLUSIONS Intraoperative continuous vagus nerve monitoring enables real-time and quantitative assessment of vagus nerve function and is important for avoiding permanent vagus nerve palsy, while helping to achieve sufficient resection of tumors around the jugular foramen.
Collapse
Affiliation(s)
- Ken Matsushima
- 1Department of Neurosurgery, Tokyo Medical University; and
| | - Michihiro Kohno
- 1Department of Neurosurgery, Tokyo Medical University; and.,2Department of Neurosurgery, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Norio Ichimasu
- 1Department of Neurosurgery, Tokyo Medical University; and
| | - Yujiro Tanaka
- 1Department of Neurosurgery, Tokyo Medical University; and
| | | | - Masanori Yoshino
- 2Department of Neurosurgery, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| |
Collapse
|
42
|
Totten DJ, Manzoor NF, Perkins EL, Labadie RF, Bennett ML, Haynes DS. Cerebellopontine Angle and Internal Auditory Canal Lipomas: Case Series and Systematic Review. Laryngoscope 2021; 131:2081-2087. [PMID: 33567134 DOI: 10.1002/lary.29434] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 01/05/2021] [Accepted: 01/21/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Cerebellopontine angle (CPA) and internal auditory canal (IAC) lipomas are rare, benign tumors comprising 0.08% of all intracranial tumors and can be mistaken for other, more common lesions of the CPA/IAC such as vestibular schwannoma. The purpose of this study was to review the literature and assess the evolution of CPA/IAC lipoma diagnosis and management. In addition, we present 17 new lipomas, matching the largest known case series of this rare tumor. STUDY DESIGN Retrospective case series and systematic review. METHODS Systematic review of the literature was performed using PubMed and Google Scholar. References from identified articles were also reviewed to identify potential additional manuscripts. Manuscripts and abstracts were reviewed to identify unique cases. For the case series, the charts of all CPA/IAC lipoma patients seen at a single institution from 2006-2019 were manually reviewed. Logistic regression and chi-squared analysis were performed where appropriate. RESULTS A total of 219 unique lipomas have been reported in the literature, including 17 presented in this study. Surgical management has been performed in 46% of cases and has been conducted less often in recent decades, likely due to improved radiographic diagnostic capabilities and understanding of surgical outcomes. Surgical management is associated with worse neurologic outcomes (P = .002) and has become less common in recent decades. Although growth is unlikely, it has been demonstrated in patients into their 30s. CONCLUSIONS Accurate radiographic diagnosis is imperative for appropriate patient management, as CPA/IAC lipomas should typically be managed through observation and serial imaging whereas vestibular schwannomas and other CPA/IAC lesions may require microsurgical or radiosurgical intervention depending on growth and symptomatology. Laryngoscope, 131:2081-2087, 2021.
Collapse
Affiliation(s)
- Douglas J Totten
- Vanderbilt University School of Medicine, Nashville, Tennessee, U.S.A
| | - Nauman F Manzoor
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Elizabeth L Perkins
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Robert F Labadie
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Marc L Bennett
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - David S Haynes
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| |
Collapse
|
43
|
Mula-Hussain L, Malone J, dos Santos MP, Sinclair J, Malone S. CSF Rhinorrhea: A Rare Clinical Presentation of Choroid Plexus Papilloma. Curr Oncol 2021; 28:750-756. [PMID: 33572678 PMCID: PMC7985760 DOI: 10.3390/curroncol28010073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/25/2021] [Accepted: 01/27/2021] [Indexed: 11/16/2022] Open
Abstract
Choroid plexus papilloma (CPP) is a rare brain tumour occurring mostly in infants and children. Most CPPs are intraventricular and present with symptoms and signs of increased intracranial pressure (ICP). This case report describes a middle-aged female who presented with spontaneous cerebrospinal fluid (CSF) rhinorrhea from a tumour located in the cerebellopontine angle (CPA). She underwent craniotomy with subtotal tumour resection and remained progression and rhinorrhea-free for several years. Upon clinical progression, the patient was treated with Cyberknife stereotactic radiosurgery. The patient clinically improved and demonstrated a favourable radiologic response to radiosurgery.
Collapse
Affiliation(s)
- Layth Mula-Hussain
- Radiation Oncology Division, The Ottawa Hospital—University of Ottawa, Ottawa, ON K1H 8L6, Canada; (J.M.); (S.M.)
| | - Julia Malone
- Radiation Oncology Division, The Ottawa Hospital—University of Ottawa, Ottawa, ON K1H 8L6, Canada; (J.M.); (S.M.)
| | - Marlise P. dos Santos
- Department of Medical Imaging, The Ottawa Hospital—University of Ottawa, and Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada;
| | - John Sinclair
- Neuro-Surgery Division, The Ottawa Hospital—University of Ottawa, Ottawa, ON K1Y 4E9, Canada;
| | - Shawn Malone
- Radiation Oncology Division, The Ottawa Hospital—University of Ottawa, Ottawa, ON K1H 8L6, Canada; (J.M.); (S.M.)
| |
Collapse
|
44
|
Vernon V, Naik H, Guha A. Surgical management of cerebellopontine angle epidermoid cysts: an institutional experience of 10 years. Br J Neurosurg 2021; 36:203-212. [PMID: 33410366 DOI: 10.1080/02688697.2020.1867058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND 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 brain stem. In this paper, we describe our experience and attempt to correlate the final outcomes with the extent of surgical removal. The main objectives were to study various modes of surgical management of CPA epidermoids with regard to removal and preservation of the cranial nerves and also to evaluate the role of endoscopic assisted microsurgical excision thereby minimizing recurrences. This case series is one of the largest series reported so far worldwide. MATERIALS AND METHODS From 2006 to 2016, 139 patients with CPA epidermoids were operated at Grant Medical College and J. J. Hospital, Mumbai. All patients underwent detailed magnetic resonance imaging (MRI) of brain. Lesions were classified according Rogelio Revuelta-Gutiérrez et al. with respect to their anatomic extent: grade I- within the boundaries of the CPA, grade II- extension to the suprasellar and perimesencephalic cisterns, and grade III-parasellar and temporomesial region involvement. Retrosigmoidal and sub temporal approaches were taken to excise the lesions. Endoscopic assisted microsurgical excision was done in cases with extensions beyond the CPA. Patient follow-up was based on outpatient repeated brain MRI studies. RESULTS The mean duration of symptoms before surgery was 42 months (range, 2 months to 6 years). The mean follow-up period was 27 months (range, 2-60 months). The main presenting sympt om was headache in 69% (96/139) of the cases and trigeminal neuralgia in 30% cases was the second most common cause of consultation. Seventy-five percent of patients had some degree of cranial nerve (CN) involvement. Retrosigmoid approach was taken in 92% patients and 7 patients with supratentorial extension were operated by combined retrosigmoidal and subtemporal approach. Endoscopic assisted microsurgical excision was done in 40% cases. Use of angled views by an endoscope helped to excise residual tumor in 47 (83%) patients. Complete excision was achieved in 67% of cases. In 33% patients, small capsular remnants could not be removed completely because of their adherence to vessels, brainstem and cranial nerves. Compared with their preoperative clinical status, 74% improved and 20% had persistent cranial nerve deficits in the first year of follow up. CONCLUSIONS Epidermoid cysts are challenging entities in current neurosurgery practice due to tumor adhesions to neurovascular structures. Meticulous surgical technique with the aid of neurophysiological monitoring is crucial to achieve safe and effective total or subtotal removal of these lesions. A conservative approach is indicated for patients in whom the fragments of capsule is adhered closely to blood vessels, nerves, or the brainstem, in order to avoid risk of serious neurological deficits related to an inadvertent damage of these structures. Use of angled views by endoscope at the conclusion of the surgery may assure the surgeon of total removal of the tumor.
Collapse
Affiliation(s)
- Velho Vernon
- Department of Neurosurgery, J. J. Group of Hospitals and Grant Medical College, Mumbai, India
| | - Harish Naik
- Department of Neurosurgery, J. J. Group of Hospitals and Grant Medical College, Mumbai, India
| | - Amrita Guha
- Department of Radiology, Tata Memorial Centre, Mumbai, India
| |
Collapse
|
45
|
Torihashi K, Ogura T, Kadowaki M, Sakamoto M, Kurosaki M. Transcondylar fossa approach for the large, high-flow, and diffuse arteriovenous malformation of the posterior fossa. Neurosurg Focus Video 2021; 4:V5. [PMID: 36284626 PMCID: PMC9542486 DOI: 10.3171/2020.10.focvid2045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 10/22/2020] [Indexed: 06/16/2023]
Abstract
Posterior fossa high-grade arteriovenous malformations (AVMs) are challenging diseases. This video presents the treatment of a patient with a diffuse, high-flow AVM of the posterior fossa on the tonsil and cerebellopontine angle (4 cm in diameter) and deep draining veins. The patient had an intraventricular and cerebellar hemorrhage. After conservative treatment, total resection of the AVM was performed with embolization and surgery. The authors resected the nidus after the endovascular embolization, on the same day. The postoperative course was uneventful, and the patient was discharged with almost full recovery. The video can be found here: https://youtu.be/logCCn3uKUc.
Collapse
Affiliation(s)
- Koichi Torihashi
- Division of Neurosurgery, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Takafumi Ogura
- Division of Neurosurgery, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Mitsutoshi Kadowaki
- Division of Neurosurgery, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Makoto Sakamoto
- Division of Neurosurgery, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Masamichi Kurosaki
- Division of Neurosurgery, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Tottori, Japan
| |
Collapse
|
46
|
Grigoryan GY, Sitnikov AR, Grigoryan YA. [Trigeminal nerve lipoma presenting with trigeminal neuralgia: case report and literature review]. Zh Vopr Neirokhir Im N N Burdenko 2021; 85:102-110. [PMID: 34951767 DOI: 10.17116/neiro202185061102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Cerebellopontine angle lipomas are benign mass lesions and rarely result trigeminal neuralgia. A 61-year-old male with right-sided trigeminal neuralgia in V2 and V3 divisions without sensory disturbances is reported in the article. MRI revealed mass lesion 11´11´4 mm on the lateral pontine surface spreading to the right trigeminal nerve root entry zone. No signs of neurovascular compression were found. Microsurgical exploration of the cerebellopontine angle showed a fatty mass adherent to the brainstem with incorporation of inferior part of trigeminal nerve root. Fatty tissue resection was followed by partial sensory trigeminal rhizotomy. Histological examination identified lipoma. Postoperative MRI showed small residual tissue with minimal ischemic area near trigeminal nerve root entry zone. Mild hypoesthesia within V2 and V3 trigeminal branches occurred after surgery. Trigeminal neuralgia completely resolved, and medications were discontinued. This clinical case and literature review clearly demonstrated successful elimination of trigeminal neuralgia in patients with cerebellopontine angle lipoma after resection of mass lesion and partial trigeminal rhizotomy.
Collapse
Affiliation(s)
| | - A R Sitnikov
- Treatment and Rehabilitation Centre, Moscow, Russia
| | | |
Collapse
|
47
|
Han S, Li Y, Li Z, Wang X, Gao J. Two-dimensional structure analysis of hemifacial spasms and surgical outcomes of microvascular decompression. Neurol Res 2020; 43:173-180. [PMID: 33043847 DOI: 10.1080/01616412.2020.1833158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Although studies have indicated that the small posterior fossa plays a role in hemifacial spasm (HFS), few studies have denoted the correlations between local measurements of the cerebellopontine angle and the incidence of HFS and surgical outcomes. METHODS We retrospectively analyzed the demographic and clinical data of HSF patients who underwent microvascular decompression at our institution. Healthy controls were recruited. The divergent prognosis of HFS was defined as an ordinal variable. A multivariable ordinal regression model was generated to estimate the relationship between the variables and outcomes of HFS. RESULTS Between 2013 and 2018, 180 patients who were enrolled in our study met the inclusion criteria. Compared with the control group (n = 94), HFS patients had a smaller internal acousticmeatus-brainstem distance (P < 0.001) on the unaffected side and a larger facial nerve-brainstem angle (P < 0.001). The regression analysis demonstrated that subgroups with more severe facial nerve compression (mild vs severe, OR = 0.269, P = 0.018; moderate vs severe, OR = 0.215, P < 0.001) and a thinner brainstem (OR = 2.368, P = 0.014) were more likely to experience better short-term outcomes, while subgroups with a thinner brainstem (OR = 5.583, P = 0.007) were more likely to experience better long-term outcomes. DISCUSSION Structural changes occurring in patients are risk factors for HFS. The patient's local neurovascular structure and brainstem volume are factors that significantly influence short-term and long-term surgical outcomes.
Collapse
Affiliation(s)
- Shiyuan Han
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College , Beijing, China
| | - Yongning Li
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College , Beijing, China.,Department of International Medical Service, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College , Beijing, China
| | - Zhimin Li
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College , Beijing, China
| | - Xin Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College , Beijing, China
| | - Jun Gao
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College , Beijing, China
| |
Collapse
|
48
|
Ichimasu N, Nakajima N, Matsushima K, Kohno M, Takusagawa Y. Microvascular decompression for trigeminal neuralgia caused by trigeminocerebellar artery. Neurosurg Focus Video 2020; 3:V4. [PMID: 36285268 PMCID: PMC9542230 DOI: 10.3171/2020.7.focvid2017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/14/2020] [Indexed: 06/08/2023]
Abstract
In this operative video, the authors demonstrate the case of a 53-year-old woman who presented with typical right trigeminal neuralgia by a trigeminocerebellar artery (TCA). The TCA was first defined by Marinković as a unique branch of the basilar artery supplying both the trigeminal nerve root and the cerebellar hemisphere. As a result of the close relationship between this vessel and the nerve root, the TCA might compress the nerve root, thereby causing trigeminal neuralgia. However, few cases of trigeminal neuralgia caused by TCA have been reported. This video shows the microvascular decompression for trigeminal neuralgia by the TCA. The video can be found here: https://youtu.be/UnGsCQRK6aY.
Collapse
Affiliation(s)
- Norio Ichimasu
- Department of Neurosurgery, Tokyo Medical University, Tokyo; and
| | | | - Ken Matsushima
- Department of Neurosurgery, Tokyo Medical University, Tokyo; and
| | - Michihiro Kohno
- Department of Neurosurgery, Tokyo Medical University, Tokyo; and
| | - Yutaka Takusagawa
- Department of Neurosurgery, Kosei Chuo General Hospital, Tokyo, Japan
| |
Collapse
|
49
|
Wu PS. Atypical teratoid rhabdoid tumor (AT/RT) at the cerebellopontine angle arising from acoustic nerve with facial nerve palsy: report of a case. Int J Clin Exp Pathol 2020; 13:2377-2380. [PMID: 33042346 PMCID: PMC7539870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/20/2020] [Indexed: 06/11/2023]
Abstract
Atypical teratoid rhabdoid tumor (AT/RT) is a highly aggressive central nervous system embryonic tumor predominantly occurring in infants and young children. The AT/RT can occur in the cerebellopontine angle and cause facial nerve palsy as a presenting sign. We present a case of a 2-year-old girl with a cerebellopontine angle tumor who initially presented with acute facial palsy. Later, asubsequent diagnosis of AT/RT was made.
Collapse
Affiliation(s)
- Pao-Shu Wu
- Department of Pathology, MacKay Memorial HospitalTaipei, Taiwan
- Mackay Junior College of Medicine, Nursing, ManagementTaipei, Taiwan
| |
Collapse
|
50
|
Kishi S, Maeda M, Kogue R, Umino M, Matsubara T, Sakuma H. Hemangioblastoma of the Cerebellopontine Angle Evaluated with Pseudocontinuous Arterial Spin Labeling. Magn Reson Med Sci 2020; 20:18-19. [PMID: 32132312 PMCID: PMC7952204 DOI: 10.2463/mrms.ici.2020-0011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Hemangioblastomas of the cerebellopontine angle (CPA) that emerge extra-axially from the peripheral nervous system are extremely rare. We report a case of hemangioblastoma of the CPA evaluated by pseudocontinuous arterial spin labeling (pCASL). The high rate of tumor blood flow determined using pCASL provided additional useful information for the differential diagnosis of the CPA tumors in this patient.
Collapse
Affiliation(s)
- Seiya Kishi
- Department of Radiology, Mie University School of Medicine
| | - Masayuki Maeda
- Department of Neuroradiology, Mie University School of Medicine
| | - Ryota Kogue
- Department of Radiology, Mie University School of Medicine
| | - Maki Umino
- Department of Radiology, Mie University School of Medicine
| | | | - Hajime Sakuma
- Department of Radiology, Mie University School of Medicine
| |
Collapse
|