Acta Scientific Neurology (ASNE) (ISSN: 2582-1121)

Research Article Volume 3 Issue 6

Cerebellopontine Angle Tumors: Surgical and Non-Surgical Outcomes in a Cohort 321 Cases

Sunil Rauniyar1, Jia Gu2, Lei Wang2, Zhigang Shen2, Qingming Meng2, Shao Xie2 and Rutong Yu1,2*

1The Graduate School, Xuzhou Medical University, Jiangsu, China
2Department of Neurosurgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China

*Corresponding Author: Rutong Yu, Professor, Department of Neurosurgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China.

Received: May 04, 2020; Published: May 31, 2020

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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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References

  1. Samii M and Gerganov V. “Surgery of Cerebellopontine Lesions”. Springer-Verlag Berlin Heidelberg (2013).
  2. Springborg JB., et al. “Nonvestibular schwannoma tumors in the cerebellopontine angle: a structured approach and management guidelines”. Skull Base 18.4 (2008): 217-227.
  3. Barnes L. “Surgical Pathology of the Head and Neck in forma healthcare” (2009). 
  4. Yilmaz C., et al. “Rare lesions of the cerebellopontine angle”. Turkish Neurosurgery 20.3 (2010): 390-397.
  5. Machinis TG., et al. “History of acoustic neurinoma surgery”. Neurosurgical Focus 18.4 (2005): e9.
  6. Patel N., et al. “Diagnostic and surgical challenges in resection of cerebellar angle tumors and acoustic neuromas”. Surgical Neurology International 3 (2012): 17.
  7. Alam S KA., et al. “The surgical management of trigeminal schwannomas”. The ORION Medical Journal 32.2 (2009): 659-662.
  8. Van de Langenberg R., et al. “Management of large vestibular schwannoma. Part I. Planned subtotal resection followed by Gamma Knife surgery: radiological and clinical aspects”. Journal of Neurosurgery 115.5 (2011): 875-884.
  9. Bir SC., et al. “Long-term outcome of gamma knife radiosurgery for vestibular schwannoma”. Journal of Neurological Surgery Part B: Skull Base 75.4 (2014): 273-278.
  10. Harati A., et al. “Clinical features, microsurgical treatment, and outcome of vestibular schwannoma with brainstem compression”. Surgical Neurology International 8 (2017): 45.
  11. D'Amico RS., et al. “Efficacy and outcomes of facial nerve-sparing treatment approach to cerebellopontine angle meningiomas”. Journal of Neurosurgery 127.6 (2017): 1231-1241.
  12. Joarder M., et al. “Surgical Outcomes of Cerebellopontine Angle Tumors in 34 Cases”. Pulse 8 (2015).
  13. He X., et al. “Surgical Management and Outcome Experience of 53 Cerebellopontine Angle Meningiomas”. Cureus 9.8 (2017): e1538.
  14. Iwai Y., et al. “Surgery combined with radiosurgery of large acoustic neuromas”. Surgical Neurology International 59.4 (2003): 283-289.
  15. L Leksell. “Cerebral radiosurgery I Gammathalanotomy in two cases of intractable pain”. Acta Chirurgica Scandinavica 134.8 (1968): 585.
  16. Lin EP and Crane BT. “The Management and Imaging of Vestibular Schwannomas”. American Journal of Neuroradiology 38.11 (2017): 2034-2043.
  17. Dale D., et al. “Gamma knife radiosurgery for cerebellopontine angle meningiomas: a multicenter study”. Journal of Neurosurgery 75.4 (2014): 398-408.
  18. Boari N., et al. “Gamma Knife radiosurgery for vestibular schwannoma: clinical results at long-term follow-up in a series of 379 patients”. Journal of Neurosurgery 121.2 (2014): 123-142.
  19. Wong RX., et al. “Local experience with radiosurgery for vestibular schwannomas and recommendations for management”. Singapore Medical Journal 59.11 (2018): 590-596.
  20. Kreil W., et al. “Long term experience of gamma knife radiosurgery for benign skull base meningiomas”. Journal of Neurology, Neurosurgery, and Psychiatry 76.10 (2005): 1425-1430.
  21. Conti A., et al. “Post-Treatment Edema after Meningioma Radiosurgery is a Predictable Complication”. Cureus 8.5 (2016): e605.
  22. Muzevic D., et al. “Stereotactic radiotherapy for vestibular schwannoma”. The Cochrane Database of Systematic Reviews 12.12 (2014): CD009897.
  23. Régis J., et al. “Wait-and-see strategy compared with proactive Gamma Knife surgery in patients with intracanalicular vestibular schwannomas: clinical article”. Journal of Neurosurgery 119.6 (2013): 105.
  24. Lunsford LD., et al. “Radiosurgery of vestibular schwannomas: summary of experience in 829 cases”. Journal of Neurosurgery 102 (2005):195-199.
  25. Moosa SDD. “Role of Stereotactic Radiosurgery in the Management of Cerebellopontine Angle Tumors”. Austin Journal of Radiation Oncology and Cancer 1.1 (2015): 1004.
  26. Mahboubi H., et al. “CyberKnife for Treatment of Vestibular Schwannoma: A Meta-analysis”. Otolaryngology–Head and Neck Surgery 157.1 (2017): 7-15.
  27. Troude L., et al. “Adjunctive Gamma Knife Surgery or Wait and Scan Policy After Optimal Resection of Large Vestibular Schwannomas: Clinical and Radiologic Outcomes”. World Neurosurgery 118 (2018): e895-e905.
  28. Gardner G and Robertson JH. “Hearing Preservation in Unilateral Acoustic Neuroma Surgery”. Journal of Annals of Otology, Rhinology and Laryngology 97.1 (1988): 55-66.
  29. Silverstein H., et al. “Hearing preservation after acoustic neuroma surgery using intraoperative direct eighth cranial nerve monitoring”. Journal of American Journal of Otolaryngology 3 (1985): 99.
  30. Eisenhauer EA., et al. “New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1)”. European Journal of Cancer 45.2 (2009): 228-247.
  31. Vince DN. “Suboccipital Surgery for Acoustic Neuroma”. Mayfield Brain and Spine (2018).
  32. G Raja Sekhar Kennedy J. “A Study of the Incidence of Cerebellopontine Angle Tumors and their Management in a Tertiary Care Hospital”. Journal of Evidence based Medicine and Healthcare 2.17 (2015): 2517-2524.
  33. Zahid S., et al. “Frequency and clinical presentation of cerebellopontine angle tumors: An experience in Department of Neurosurgery Lady Reading Hospital Peshawar”. Journal of Postgraduate Medical Institute 30.3 (2016): 226-229.
  34. Lazard DS., et al. “Early complications and symptoms of cerebellopontine angle tumor surgery: a prospective analysis”. European Archives of Oto-Rhino-Laryngology 268.11 (2011): 1575-1582.
  35. Poshataev VK., et al. “ [Endoscopic assistance in surgery of cerebellopontine angle tumors]”. Zh Vopr Neirokhir Im N N Burdenko 78.4 (2014): 42-49.
  36. Heman-Ackah SE., et al. “Retrosigmoid approach to cerebellopontine angle tumor resection: Surgical modifications”. The Laryngoscope 122.11 (2012): 2519-2523.
  37. Memari F., et al. “Surgical Outcomes of Cerebellopontine angle Tumors in 50 Cases”. Iranian Journal of Otorhinolaryngology 27.78 (2015): 29-34.
  38. Mohammed Jawad MS. “Cerebellopontine Angle Tumors; Tumor Size and Surgical Outcome”. Open access Journal of Neurology and Neurosurgery 3.4 (2017).
  39. Shi-ming Y., et al. “Endoscope-Assisted Cerebellopontine Angle Surgery”. Journal of Otology 4.1 (2009): 44-49.
  40. Pinna MH., et al. “Vestibular schwannoma: 825 cases from a 25-year experience”. International Archives of Otorhinolaryngology 16.4 (2012): 466-475.
  41. Jain VK., et al. “Surgery of vestibular schwannomas: an institutional experience”. Neurol India 53.1 (2005): 41-55.
  42. Nakatomi H., et al. “Long-term risk of recurrence and regrowth after gross-total and subtotal resection of sporadic vestibular schwannoma”. Journal of Neurosurgery (2017): 1-7.
  43. Matthies C and Samii M. “Management of 1000 vestibular schwannomas (acoustic neuromas): Clinical presentation”. Journal of Neurosurgery 40.1 (1997): 11-21.
  44. Nedzelski JM and Tator CH. “Surgical management of cerebellopontine angle tumors”. Journal of Otolaryngology 9.2 (1980):105.
  45. Myrseth E., et al. “Vestibular schwannomas: clinical results and quality of life after microsurgery or gamma knife radiosurgery”. Neurosurgery 56.5 (2005): 927-935.
  46. Pollock B., et al. “Patient outcomes after vestibular schwannoma management: a prospective comparison of microsurgical resection and stereotactic radiosurgery”. Journal of Neurosurgery 59.1 (2006): 77.
  47. Daniel R., et al. “Optimally Invasive Skull Base Surgery for Large Benign Tumors”. Nova Science Publishers, Inc (2013).
  48. Ramina R., et al. “Surgical management of trigeminal schwannomas”. Neurosurgical Focus 25.6 (2008).
  49. Zhang Z., et al. “Removal of Large or Giant Sporadic Vestibular Schwannomas via Translabyrinthine Approach: A Report of 115 Cases”. International Journal of Otorhinolaryngology 74.5 (2012): 271-277.
  50. Peng Z., et al. “Functional outcome and postoperative complications after the microsurgical removal of large vestibular schwannomas via the retrosigmoid approach: a meta-analysis”. Journal of Neurosurgical Review 37.1 (2014): 15-21.
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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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