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DOI: 10.4103/ajns.AJNS_335_17
Nonvestibular schwannoma tumors in the cerebellopontine angle: A single-surgeon experience
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Background: The most common cerebellopontine angle (CPA) tumor is a vestibular schwannoma. Schwannomas account for 8.5% of all intracranial tumors and more than 90% of the tumors originate from the eighth cranial nerve, but one in five CPA tumors are not vestibular schwannoma. These tumors may have different manifestations and require different management strategies. Methods: We report 224 consecutive NVCPAT operated in the Department of Neurosurgery, P.D. Hinduja National Hospital and Medical Research Centre, Mumbai, by the senior author between 2001 and 2014 and discuss the different approaches and outcomes in NVCPAT. Results: The age range was 20–60 years and there were 129 females and 95 male patients. The clinical material consisted of 81 cases of meningioma (36.1%), 44 cases of epidermoid (19.64%), 34 cases of trigeminal schwannoma (15.17%), 26 cases of jugular foramen schwannoma (11.60%), and 39 cases of other tumors (17.41%). In nonvestibular schwannoma (NVS), symptoms and signs from cranial nerve VIII are less frequent and other cranial nerves and cerebellar symptoms and signs predominate. Conclusion: Symptoms and signs are different in NVCPAT from those found in patients with vestibular schwannoma. Hearing loss is not the predominant symptoms. Cerebellar signs and trigeminal dysfunction are more common. The most common approach used in the current series was retrosigmoid craniotomy. Gamma knife radiosurgery was a useful adjunct in a subset of these patients.
Key-words:
Cerebellopontine angle - endolymphatic sac tumors - epidermoid - meningioma - nonvestibular schwannomaFinancial support and sponsorship
Nil.
Publication History
Article published online:
09 September 2022
© 2019. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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References
- 1 Moffat DA, Ballagh RH. Rare tumours of the cerebellopontine angle. Clin Oncol (R Coll Radiol) 1995;7:28-41.
- 2 Bonneville F, Sarrazin JL, Marsot-Dupuch K, Iffenecker C, Cordoliani YS, Doyon D, et al. Unusual lesions of the cerebellopontine angle: A segmental approach. Radiographics 2001;21:419-38.
- 3 Lalwani AK. Meningiomas, epidermoids, and other nonacoustic tumors of the cerebellopontine angle. Otolaryngol Clin North Am 1992;25:707-28.
- 4 Grey PL, Moffat DA, Hardy DG. Surgical results in unusual cerebellopontine angle tumours. Clin Otolaryngol Allied Sci 1996;21:237-43.
- 5 Brunori A, Scarano P, Chiappetta F. Non-acoustic neuroma tumor (NANT) of the cerebello-pontine angle: A 15-year experience. J Neurosurg Sci 1997;41:159-68.
- 6 Thomsen J, Terkildsen K, Tos M. Acoustic neuromas. Progression of hearing impairment and function of the eighth cranial nerve. Am J Otol 1983;5:20-33.
- 7 Mallucci CL, Ward V, Carney AS, O'Donoghue GM, Robertson I. Clinical features and outcomes in patients with non-acoustic cerebellopontine angle tumours. J Neurol Neurosurg Psychiatry 1999;66:768-71.
- 8 Martuza RL, Parker SW, Nadol JB Jr., Davis KR, Ojemann RG. Diagnosis of cerebellopontine angle tumors. Clin Neurosurg 1985;32:177-213.
- 9 Glasscock ME, Minor LB, McMenomey SO. Meningiomas of the cerebellopontine angle. In: Jackler R, Brackmann D, editors. Neurotology. St. Louis: Mosby; 1994. p. 795-823.
- 10 Nager GT, Masica DN. Meningiomas of the cerebello-pontine angle and their relation to the temporal bone. Laryngoscope 1970;80:863-95.
- 11 Symon L, Pell M, Singh L. Surgical management of posterior cranial fossa meningiomas. Br J Neurosurg 1993;7:599-609.
- 12 Voss NF, Vrionis FD, Heilman CB, Robertson JH. Meningiomas of the cerebellopontine angle. Surg Neurol 2000;53:439-46.
- 13 Granick MS, Martuza RL, Parker SW, Ojemann RG, Montgomery WW. Cerebellopontine angle meningiomas: Clinical manifestations and diagnosis. Ann Otol Rhinol Laryngol 1985;94:34-8.
- 14 Laird FJ, Harner SG, Laws ER Jr., Reese DF. Meningiomas of the cerebellopontine angle. Otolaryngol Head Neck Surg 1985;93:163-7.
- 15 Nicolato A, Foroni R, Pellegrino M, Ferraresi P, Alessandrini F, Gerosa M, et al. Gamma knife radiosurgery in meningiomas of the posterior fossa. Experience with 62 treated lesions. Minim Invasive Neurosurg 2001;44:211-7.
- 16 Misra BK. Management of petroclival meningioma: The role of excision and radiosurgery. In: Al-Mefty O, editor. Controversies in Neurosurgery II. 2nd ed. New York: Thieme Publishers; 2014. p. 30-6.
- 17 Samii M, Ammirati M, Mahran A, Bini W, Sepehrnia A. Surgery of petroclival meningiomas: Report of 24 cases. Neurosurgery 1989;24:12-7.
- 18 Sekhar LN, Janneta PJ, Burkhat LE, Janosky JE. Meningioma involving the clivus: A six- year experience with 41 patients. Neurosurgery 1990;27:764-781
- 19 Al-Mefty O, Smith RR. Clival and petroclival meningioma. In: Al-Mefty O, editor. Meningiomas. New York: Raven Press; 1991. p. 517-37.
- 20 Kawase T, Shiobara R, Toya S. Anterior transpetrosal-transtentorial approach for sphenopetroclival meningiomas: Surgical method and results in 10 patients. Neurosurgery 1991;28:869-75.
- 21 Bricolo AP, Turazzi S, Talacchi A, Cristofori L. Microsurgical removal of petroclival meningiomas: A report of 33 patients. Neurosurgery 1992;31:813-28.
- 22 Spetzler RF, Daspit CP, Pappas CT. The combined supra- and infratentorial approach for lesions of the petrous and clival regions: Experience with 46 cases. J Neurosurg 1992;76:588-99.
- 23 Jung HW, Yoo H, Paek SH, Choi KS. Long-term outcome and growth rate of subtotally resected petroclival meningiomas: Experience with 38 cases. Neurosurgery 2000;46:567-74.
- 24 Little KM, Friedman AH, Sampson JH, Wanibuchi M, Fukushima T. Surgical management of petroclival meningiomas: Defining resection goals based on risk of neurological morbidity and tumor recurrence rates in 137 patients. Neurosurgery 2005;56:546-59.
- 25 Mathiesen T, Gerlich A, Kihlström L, Svensson M, Bagger-Sjöbäck D. Effects of using combined transpetrosal surgical approaches to treat petroclival meningiomas. Neurosurgery 2007;60:982-91.
- 26 Natarajan SK, Sekhar LN, Schessel D, Morita A. Petroclival meningiomas: Multimodality treatment and outcomes at long-term follow-up. Neurosurgery 2007;60:965-79.
- 27 Bambakidis NC, Kakarla UK, Kim LJ, Nakaji P, Porter RW, Daspit CP, et al. Evolution of surgical approaches in the treatment of petroclival meningiomas: A retrospective review. Neurosurgery 2007;61:202-9.
- 28 Kano H, Awan NR, Flannery TJ, Iyer A, Flickinger JC, Lunsford LD, et al. Stereotactic radiosurgery for patients with trigeminal neuralgia associated with petroclival meningiomas. Stereotact Funct Neurosurg 2011;89:17-24.
- 29 De la Cruz A, Doyle KJ. Epidermoids of the cerebellopontine angle. In: Jackler RK, Brackmann D, editors. Neurotology. St. Louis: Mosby; 1994. p. 823-33.
- 30 Bartels LJ, Arrington JR. Rare tumors of the cerebellopontine angle. In: Jackler RK, Brackmann D, editors. Neurotology. St. Louis: Mosby; 1994. p. 835-61.
- 31 Greenberg M, editor. Handbook of Neurosurgery. 7th ed. New York: Thieme; 2010.
- 32 Springborg JB, Poulsgaard L, Thomsen J. Nonvestibular schwannoma tumors in the cerebellopontine angle: A structured approach and management guidelines. Skull Base 2008;18:217-27.
- 33 Feng R, Gu X, Hu J, Lang L, Bi H, Guo J, et al. Surgical treatment and radiotherapy of epidermoid cyst with malignant transformation in cerebellopontine angle. Int J Clin Exp Med 2014;7:312-5.
- 34 Gopalakrishnan CV, Ansari KA, Nair S, Menon G. Long term outcome in surgically treated posterior fossa epidermoids. Clin Neurol Neurosurg 2014;117:93-9.
- 35 Samii M, Tatagiba M, Piquer J, Carvalho GA. Surgical treatment of epidermoid cysts of the cerebellopontine angle. J Neurosurg 1996;84:14-9.
- 36 Mohanty A, Venkatrama SK, Rao BR, Chandramouli BA, Jayakumar PN, Das BS, et al. Experience with cerebellopontine angle epidermoids. Neurosurgery 1997;40:24-9.
- 37 de Souza CE, Sperling NM, da Costa SS, Yoon TH, Abdel Hamid M, de Souza RA, et al. Congenital cholesteatomas of the cerebellopontine angle. Am J Otol 1989;10:358-63.
- 38 Dutt SN, Mirza S, Chavda SV, Irving RM. Radiologic differentiation of intracranial epidermoids from arachnoid cysts. Otol Neurotol 2002;23:84-92.
- 39 Talacchi A, Sala F, Alessandrini F, Turazzi S, Bricolo A. Assessment and surgical management of posterior fossa epidermoid tumors: Report of 28 cases. Neurosurgery 1998;42:242-51.
- 40 Misra BK, Purandare HR, Ved RS, Bagdia AA, Mare PB. Current treatment strategy in the management of vestibular schwannoma. Neurol India 2009;57:257-63.
- 41 Misra BK. Neurological Society of India guest lecture: Optimally invasive skull base surgery. Clin Neurosurg 2010;57:79-90.
- 42 Miller JP, Semaan M, Einstein D, Megerian CA, Maciunas RJ. Staged gamma knife radiosurgery after tailored surgical resection: A novel treatment paradigm for glomus jugulare tumors. Stereotact Funct Neurosurg 2009;87:31-6.
- 43 Nevoux J, Nowak C, Vellin JF, Lepajolec C, Sterkers O, Richard S, et al. Management of endolymphatic sac tumors: Sporadic cases and von Hippel-Lindau disease. Otol Neurotol 2014;35:899-904.
- 44 Carlson ML, Thom JJ, Driscoll CL, Haynes DS, Neff BA, Link MJ, et al. Management of primary and recurrent endolymphatic sac tumors. Otol Neurotol 2013;34:939-43.
- 45 Balasubramaniam S, Deshpande RB, Misra BK. Gamma knife radiosurgery in jugular foramen endolymphatic sac adenocarcinoma. J Clin Neurosci 2009;16:710-1.
- 46 Kim HJ, Hagan M, Butman JA, Baggenstos M, Brewer C, Zalewski C, et al. Surgical resection of endolymphatic sac tumors in von Hippel-Lindau disease: Findings, results, and indications. Laryngoscope 2013;123:477-83.
- 47 Friedmann DR, Grobelny B, Golfinos JG, Roland JT Jr. Nonschwannoma tumors of the cerebellopontine angle. Otolaryngol Clin North Am 2015;48:461-75.
- 48 Kieserman S, Linstrom C, McCormick S, Petschenik AJ. Choroid plexus papilloma of the cerebellopontine angle. Am J Otol 1996;17:119-22.
- 49 van Swieten JC, Thomeer RT, Vielvoye GJ, Bots GT. Choroid plexus papilloma in the posterior fossa. Surg Neurol 1987;28:129-34.
- 50 Talacchi A, De Micheli E, Lombardo C, Turazzi S, Bricolo A. Choroid plexus papilloma of the cerebellopontine angle: A twelve patient series. Surg Neurol 1999;51:621-9.
- 51 Jeibmann A, Wrede B, Peters O, Wolff JE, Paulus W, Hasselblatt M, et al. Malignant progression in choroid plexus papillomas. J Neurosurg Pediatr 2007;107:199-202.