Giant cerebellopontine Angle Tumor Surgery: Experience of a Tertiary Care Center in Lahore, Pakistan
Objectives: In this case series, we report our experience of microsurgical resection of large and giant CPA tumors at the Department of Neurosurgery, Punjab Institute of Neurosciences (PINS).
Materials and Methods: This was a retrospective case series of 328 patients (mean age, 40 years) with large and giant CPA tumors (predominantly vestibular schwannomas) who underwent surgical removal using a retro sigmoid approach over 4 years.
Results: In the study, there were 58% (190) females while 42% (138) were males. 60% (197) of the tumors were right – sided and 40% (131) left – sided. Hearing loss was the main presenting complaint with 73% of the patients having non-serviceable hearing. There were 14 (4.3%) deaths reported during the retrospective analytic study. There were 3 cases of postoperative hemorrhage, and 11 patients expired due to post-operative wound infection. There were 13 cases diagnosed as having post-operative bacterial meningitis. Gross total tumor excision was achieved in 98% of patients based on postoperative imaging. There were 26 cases (8%) with postoperative CSF leakage that was managed with LP drain (5 patients) and in the rest VP shunt was done. Facial nerve function was graded according to the House Brackmann system. It was recorded in all patients following surgery: There were 16% patients with HB grade IV and 216 (66%) patients with HB grade III facial palsy.
Conclusion: Suboccipital Retrosigmoid approach is ideal for dealing with giant CPA tumors. Complication rates in our series were comparable with other reported literature.
2. Moosa S, Ding D. Role of stereotactic radiosurgery in the management of Cerebellopontine angle tumors. Austin J Radiat. Oncol& Cancer, 2015; 1 (1): 1004.
3. Broomfield SJ, O’Donoghue GM. Self-reported symptoms and patient experience: a British Acoustic Neuroma Association survey. British Journal of Neurosurgery, 2016 May 3; 30 (3): 294-301.
4. Kentala E, Pyykkö I. Clinical picture of vestibular schwannoma. Auris Nasus Larynx. 2001 Jan. 1; 28 (1): 15-22.
5. Iwai Y, Yamanaka K, Ishiguro T. Surgery combined with radiosurgery of large acoustic neuromas. Surgical Neurology, 2003 Apr. 1; 59 (4): 283-9.
6. Memari F, Hassannia F, Abtahi SH. Surgical outcomes of cerebellopontine angle tumors in 50 cases. Iranian Journal of Otorhinolaryngology, 2015 Jan; 27 (78): 29.
7. Mazzoni A, Biroli F, Foresti C, Signorelli A, Sortino C, ZanolettiE. Hearing preservation surgery in acoustic neuroma. Slow progress and new strategies. Acta Otorhinolaryngol Ital. 2011; 31: 76–84.22.
8. Samii M, Matthies C. Management of 1000 vestibular schwannomas (acoustic neuromas): surgical management and results with an emphasis on complications and how to avoid them. Neurosurgery, 1997; 40 (1): 11–21, Discussion 21-
9. Falcioni M, Fois P, Taibah A, Sanna M. Facial nerve functionafter vestibular schwannoma surgery. J Neurosurg. 2011; 115: 820–6.29.
10. Awan MS, Qureshi HU, Sheikh AA, Ali MM. Vestibular schwannomas: clinical presentation, management and outcome. JPMA. The Journal of the Pakistan Medical Association, 2001; 51 (2): 63.
11. Samii M, Matthies C. Management of 1000 vestibular schwannomas (acoustic neuromas): surgical management and results with an emphasis on complications and how to avoid them. Neurosurgery, 1997 Jan. 1; 40 (1): 11-23.
12. Rauniyar S, Gu J, Wang L, Shen Z, Meng Q. Cerebellopontine Angle Tumors: Surgical and Non-Surgical Outcomes in a Cohort 321 Cases. Acta Scientific Neurology, 2020 Jun; 3 (6): (ISSN: 2582-1121).
13. Starnoni D, Giammattei L, Cossu G, Link MJ, Roche PH, Chacko AG, Ohata K, Samii M, Suri A, Bruneau M, Cornelius JF. Surgical management for large vestibular schwannomas: a systematic review, meta-analysis, and consensus statement on behalf of the EANS skull base section. Acta Neurochirurgica. 2020 Jul. 29: 1-23.
14. Nakamura M, Roser F, Dormiani M, Matthies C, Vorkapic P, Samii M. Facial and cochlear nerve function after surgery of cerebellopontine angle meningiomas. Neurosurgery, 2005 Jul. 1; 57 (1): 77-90.
15. Samii M, Gerganov VM, Samii A. Functional outcome after complete surgical removal of giant vestibular schwannomas. Journal of Neurosurgery, 2010 Apr. 1; 112 (4): 860-7.
16. Joarder MA, Karim AB, Sujon SI, Akhter N, Waheed-uz-Zaman M, Joseph V, Jahangir SM, Chandy MJ. Surgical outcomes of cerebellopontine angle tumors in 34 cases. Pulse, 2015; 8 (1): 8-
17. Ebersold MJ, Harner SG, Beatty CW, Harper CM, Quast LM. Current results of the retrosigmoid approach to acoustic neurinoma. Journal of Neurosurgery, 1992 Jun. 1; 76 (6): 901-9.
18. Lanman TH, Brackmann DE, Hitselberger WE, Subin B. Report of 190 consecutive cases of large acoustic tumors (vestibular schwannoma) removed via the translabyrinthine approach. Journal of Neurosurgery, 1999 Apr. 1; 90 (4): 617-23.
19. Slattery III WH, Francis S, House KC. Perioperative
morbidity of acoustic neuroma surgery. Otology &Neurotology, 2001 Nov. 1; 22 (6): 895-902.
20. Brennan JW, Rowed DW, Nedzelski JM, Chen JM. Cerebrospinal fluid leak after acoustic neuroma surgery: influence of tumor size and surgical approach on incidence and response to treatment. Journal of Neurosurgery, 2001 Feb. 1; 94 (2): 217-
21. Becker SS, Jackler RK, Pitts LH. Cerebrospinal fluid leak after acoustic neuroma surgery: a comparison of the translabyrinthine, middle fossa, and retrosigmoid approaches. Otology & Neurotology, 2003 Jan. 1; 24 (1): 107-12.
Copyright (c) 2022 Pakistan Journal Of Neurological Surgery
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.