Abstract

Objective: The purpose of the current study is to investigate a large series of surgical and non-surgical outcomes of CPATS at a single institution.

Methods: The authors performed a retrospective analysis of 321 patients from September 2014 to July 2018 who had undergone surgical and non-surgical or both approaches. Pure tone audiometry was done to assess the degree of hearing loss. The relationships between tumor size and either surgical and non-surgical approach, extent of resection, complication rate, need of re-operation, KPS were analyzed. The impact of surgical approach and tumor size on pre-post-operative HBS, KPS at discharge, and histopathology report was analyzed.

Results: Acoustic neuroma accounts for 65.1% with predominance of Female > Male. CPATs were categorized by largest diameter: < 15 mm in 95 cases, 16 - 30 mm in 152 and > 30 mm in 74 cases with majority 83.17% in CPA region in relation to extension. Sensorineural hearing loss (44.54%) was the most common symptoms which accounts 60.28% in acoustic neuroma. Among 321 cases, 202 cases underwent SORSA, 5 STA, 1 by EA-RMRSA and 113 by GKRS approach. GTR was achieved in 175 (84.13%), STR 18 (8.65%) and PTR 15 (7.21%) P < 0.05 giving rise to n = 29 patients treated with surgery plus GKRS P-value (0.001) at a median of 2.5 months. Among, n = 18 recurrence, GTR 16 and STR 2 were treated with GKRS in 6 patients P < 0.05, at a median of 45 (average: 36 - 72) months and 12 patients with surgery at a median of 84 (average: 36 - 216) months P < 0.05. Hearing loss (50%) was most common complication followed by facial palsy and hydrocephalus. According to HBS, tumor > 3 cm shows 24.51% and overall 89.90% facial nerve Grade I-II outcome post-operatively. Microsurgery showed preservation of hearing with (91.58%, 98/107 and not preserved in (8.41%, 9/107) patients presenting with useful hearing preoperatively while those who had hearing loss preoperatively, post-operatively (7.76%, 7/102) gained with hearing and hearing could not be gained in (93.13%, 95/102) patients. Also, Post-GKRS showed hearing loss in 37.16% with preservation of hearing in (98.61%, 71/72) and not preserved in (1.38%, 1/72) who had useful hearing Pre-GKRS while hearing was not preserved in (100%, 41 cases) who presented with Pre-GKRS hearing loss with no evidence of facial palsy. 17 patients underwent VPN shunt due to hydrocephalus. CSF leakage presents in 1.44% and were managed conservatively. The median KPS at discharge was 80 P < 0.05. Death related to surgery occurred in one patient which was due to intracranial hemorrhage and pleural effusion.

Conclusion: Although microsurgery provides long term cure, incomplete resection due to microsurgical approach, small and recurrent tumors can be managed conservatively by GKRS with possible preservation of hearing and facial nerve in relation to microsurgery.

Keywords: Cerebellopontine Angle Tumors; Suboccipital Retro-Sigmoid Approach; House Brackmann Score

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Citation

Citation: Rutong Yu., et al. “Cerebellopontine Angle Tumors: Surgical and Non-Surgical Outcomes in a Cohort 321 Cases”. Acta Scientific Neurology 3.6 (2020): 59-74.

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Copyright: © 2020 Rutong Yu., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.