Cerebellopontine angle meningiomas: Postoperative outcomes in a modern cohort

Vijay Agarwal, Ranjith Babu, Jordan Grier, Owoicho Adogwa, Adam Back, Allan H. Friedman, Takanori Fukushima, Cory Adamson

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Object. Tumors of the cerebellopontine angle (CPA) have always proven difficult for neurosurgeons to optimally manage. Studies investigating the natural history and treatment of vestibular schwannomas have dominated the literature in this regard. Distinguishing meningiomas from schwannomas in this location carries particular importance as each tumor type has certain prognostic and surgical considerations. In this study, the authors have characterized the outcomes of 34 patients surgically treated for CPA meningiomas and have investigated various factors that may affect postoperative neurological function. Methods. The medical records of patients with CPA meningiomas who underwent surgery from 2005 to 2013 at the Duke University Health System were reviewed. Various patient, clinical, and tumor data were gathered from the medical records including patient demographics, pre- and postoperative neurological examinations, duration of symptoms, procedural details, tumor pathology and size, and treatment characteristics. Differences in continuous variables were then analyzed using the Student t-test while categorical variables were evaluated using the chi-square test. Results. A total of 34 patients underwent surgical treatment for CPA meningiomas during the 8-year period. Jugular foramen invasion was seen in 17.6% of tumors, with nearly half (41.2%) extending into the internal acoustic canal. The most common presenting symptom was hearing loss (58.8%), followed by headache (52.9%) and facial numbness/pain (50.0%). The most common cranial nerve (CN) affected was CN X (11.8%), followed by CNs VI and VII (5.9%). Postoperatively, no patients experienced a decrease in hearing, with only 5.9% of patients experiencing facial nerve palsies. Patients with tumors larger than 3 cm had a significantly higher incidence of permanent CN deficits than those with smaller tumors (45.5% vs 5.9%, respectively; p = 0.011). Also, tumor extension into the jugular foramen was associated with the occurrence of lower CN deficits, none of which occurred in tumors without jugular foramen invasion. Internal acoustic canal tumor extension was not seen to be associated with postoperative complications or CN deficits. Conclusions. Meningiomas of the CPA are challenging lesions to treat surgically. However, the risk of facial palsy and hearing loss is significantly lower when compared with vestibular schwannomas. Novel methods for preoperative differentiation are needed to appropriately counsel patients on surgical risks. Also, due to the significant potential for neurological deficits, further studies are needed to investigate the utility of radiotherapy for these lesions.

Original languageEnglish (US)
Article numberE10
JournalNeurosurgical focus
Volume35
Issue number6
DOIs
StatePublished - Dec 1 2013
Externally publishedYes

Fingerprint

Cerebellopontine Angle
Meningioma
Acoustic Neuroma
Cranial Nerves
Neoplasms
Neck
Facial Paralysis
Hearing Loss
Medical Records
Facial Pain
Vagus Nerve
Hypesthesia
Neurilemmoma
Facial Nerve
Neurologic Examination
Chi-Square Distribution
Natural History
Acoustics
Hearing
Headache

Keywords

  • Cerebellopontine angle
  • Complications
  • Meningioma
  • Outcomes
  • Resection

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Agarwal, V., Babu, R., Grier, J., Adogwa, O., Back, A., Friedman, A. H., ... Adamson, C. (2013). Cerebellopontine angle meningiomas: Postoperative outcomes in a modern cohort. Neurosurgical focus, 35(6), [E10]. https://doi.org/10.3171/2013.10.FOCUS13367

Cerebellopontine angle meningiomas : Postoperative outcomes in a modern cohort. / Agarwal, Vijay; Babu, Ranjith; Grier, Jordan; Adogwa, Owoicho; Back, Adam; Friedman, Allan H.; Fukushima, Takanori; Adamson, Cory.

In: Neurosurgical focus, Vol. 35, No. 6, E10, 01.12.2013.

Research output: Contribution to journalArticle

Agarwal, V, Babu, R, Grier, J, Adogwa, O, Back, A, Friedman, AH, Fukushima, T & Adamson, C 2013, 'Cerebellopontine angle meningiomas: Postoperative outcomes in a modern cohort', Neurosurgical focus, vol. 35, no. 6, E10. https://doi.org/10.3171/2013.10.FOCUS13367
Agarwal, Vijay ; Babu, Ranjith ; Grier, Jordan ; Adogwa, Owoicho ; Back, Adam ; Friedman, Allan H. ; Fukushima, Takanori ; Adamson, Cory. / Cerebellopontine angle meningiomas : Postoperative outcomes in a modern cohort. In: Neurosurgical focus. 2013 ; Vol. 35, No. 6.
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abstract = "Object. Tumors of the cerebellopontine angle (CPA) have always proven difficult for neurosurgeons to optimally manage. Studies investigating the natural history and treatment of vestibular schwannomas have dominated the literature in this regard. Distinguishing meningiomas from schwannomas in this location carries particular importance as each tumor type has certain prognostic and surgical considerations. In this study, the authors have characterized the outcomes of 34 patients surgically treated for CPA meningiomas and have investigated various factors that may affect postoperative neurological function. Methods. The medical records of patients with CPA meningiomas who underwent surgery from 2005 to 2013 at the Duke University Health System were reviewed. Various patient, clinical, and tumor data were gathered from the medical records including patient demographics, pre- and postoperative neurological examinations, duration of symptoms, procedural details, tumor pathology and size, and treatment characteristics. Differences in continuous variables were then analyzed using the Student t-test while categorical variables were evaluated using the chi-square test. Results. A total of 34 patients underwent surgical treatment for CPA meningiomas during the 8-year period. Jugular foramen invasion was seen in 17.6{\%} of tumors, with nearly half (41.2{\%}) extending into the internal acoustic canal. The most common presenting symptom was hearing loss (58.8{\%}), followed by headache (52.9{\%}) and facial numbness/pain (50.0{\%}). The most common cranial nerve (CN) affected was CN X (11.8{\%}), followed by CNs VI and VII (5.9{\%}). Postoperatively, no patients experienced a decrease in hearing, with only 5.9{\%} of patients experiencing facial nerve palsies. Patients with tumors larger than 3 cm had a significantly higher incidence of permanent CN deficits than those with smaller tumors (45.5{\%} vs 5.9{\%}, respectively; p = 0.011). Also, tumor extension into the jugular foramen was associated with the occurrence of lower CN deficits, none of which occurred in tumors without jugular foramen invasion. Internal acoustic canal tumor extension was not seen to be associated with postoperative complications or CN deficits. Conclusions. Meningiomas of the CPA are challenging lesions to treat surgically. However, the risk of facial palsy and hearing loss is significantly lower when compared with vestibular schwannomas. Novel methods for preoperative differentiation are needed to appropriately counsel patients on surgical risks. Also, due to the significant potential for neurological deficits, further studies are needed to investigate the utility of radiotherapy for these lesions.",
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N2 - Object. Tumors of the cerebellopontine angle (CPA) have always proven difficult for neurosurgeons to optimally manage. Studies investigating the natural history and treatment of vestibular schwannomas have dominated the literature in this regard. Distinguishing meningiomas from schwannomas in this location carries particular importance as each tumor type has certain prognostic and surgical considerations. In this study, the authors have characterized the outcomes of 34 patients surgically treated for CPA meningiomas and have investigated various factors that may affect postoperative neurological function. Methods. The medical records of patients with CPA meningiomas who underwent surgery from 2005 to 2013 at the Duke University Health System were reviewed. Various patient, clinical, and tumor data were gathered from the medical records including patient demographics, pre- and postoperative neurological examinations, duration of symptoms, procedural details, tumor pathology and size, and treatment characteristics. Differences in continuous variables were then analyzed using the Student t-test while categorical variables were evaluated using the chi-square test. Results. A total of 34 patients underwent surgical treatment for CPA meningiomas during the 8-year period. Jugular foramen invasion was seen in 17.6% of tumors, with nearly half (41.2%) extending into the internal acoustic canal. The most common presenting symptom was hearing loss (58.8%), followed by headache (52.9%) and facial numbness/pain (50.0%). The most common cranial nerve (CN) affected was CN X (11.8%), followed by CNs VI and VII (5.9%). Postoperatively, no patients experienced a decrease in hearing, with only 5.9% of patients experiencing facial nerve palsies. Patients with tumors larger than 3 cm had a significantly higher incidence of permanent CN deficits than those with smaller tumors (45.5% vs 5.9%, respectively; p = 0.011). Also, tumor extension into the jugular foramen was associated with the occurrence of lower CN deficits, none of which occurred in tumors without jugular foramen invasion. Internal acoustic canal tumor extension was not seen to be associated with postoperative complications or CN deficits. Conclusions. Meningiomas of the CPA are challenging lesions to treat surgically. However, the risk of facial palsy and hearing loss is significantly lower when compared with vestibular schwannomas. Novel methods for preoperative differentiation are needed to appropriately counsel patients on surgical risks. Also, due to the significant potential for neurological deficits, further studies are needed to investigate the utility of radiotherapy for these lesions.

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