Presentación simultánea de quiste epidermoide del ángulo pontocerebeloso y colesteatoma infiltrante del oído medio. Reporte de caso y revisión de literatura / Simultaneous presentation of an epidermoid cyst of the cerebellopontine angle and infiltrating cholesteatoma of the middle ear. Case report and literature review

Introducción: los quistes epidermoides son el tercer tumor más común del ángulo pontocerebeloso (APC). Es infrecuente detectar simultáneamente un colesteatoma infiltrativo del oído medio (OM). Caso clínico: paciente de 51 años acude a urgencias por cefalea hemicraneal intensa, pulsátil secundaria a hidrocefalia aguda, requirió ventriculostomía. En la resonancia magnética nuclear (RMN) cerebral contrastada se reporta una masa en el APC sugestivo de quiste epidermoide y simultáneamente un colesteatoma infiltrativo del OM. La paciente fue intervenida primero con resección de colesteatoma del OM; en un segundo tiempo resección del quiste epidermoide del APC por vía translaberíntica. El posoperatorio la evolución clínica fue satisfactoria. Discusión: los quistes epidermoides del APC son histopatológicamente idénticos al colesteatoma del OM y pueden ser secundarios a estos. Conclusión: se debe individualizar el manejo sin descartar la posibilidad de tener las dos enfermedades de manera simultánea.

Introduction: cysts are the third most common tumor of the cerebellopontine angle (CPA). It is rare to simultaneously detect an infiltrative cholesteatoma of the middle ear (OM). Clinical case: a 51-year-old patient attended the emergency department due to intense throbbing hemicranial headache secondary to acute hydrocephalus, requiring ventriculostomy. Contrast-enhanced cerebral magnetic resonance imaging (MRI) reported a mass in the APC suggestive of an epidermoid cyst and simultaneously an infiltrative cholesteatoma of the OM. The patient underwent first surgery with resection of the OM cholesteatoma; in a second stage, resection of the epidermoid cyst of the APC through a translabyrinthine approach. The postoperative clinical evolution was satisfactory. Discussion: APC epidermoid cysts are histopathologically identical to OM cholesteatoma and may be secondary to them. Conclusion: management must be individualized without ruling out the possibility of having both diseases simultaneously.

Intracranial epidermoid cyst in a cat / Cisto epidermoide intracraniano em um gato

ABSTRACT: Epidermoid cysts, also known as epidermal and keratin cysts, or congenital cholesteatomas are benign congenital non-neoplastic tumors, rarely observed in the brain of humans and some animal species (dogs, horses, mice, and rats). Histologically, they are composed of laminated, concentrically arranged keratin surrounded by a thin layer of stratified squamous epithelium. We describe a case of intracranial epidermoid cyst in a 6-year-old mixed-breed male cat in southern Brazil. The patient presented central vestibular syndrome. Given the poor prognosis and the fact that it belonged to a shelter with many dogs and cats, the owner requested euthanasia, and a thorough post-mortem examination was conducted immediately after death. The definitive diagnosis was based on histopathological findings. To the best of our knowledge, this is the first report of an intracranial epidermoid cyst in a cat.

RESUMO: Cisto epidermoide, também denominado cisto epidermal, cisto de queratina ou colesteatoma congênito é um tumor não neoplásico, benigno e congênito raramente encontrado no encéfalo de humanos e de algumas poucas espécies animais (cães, equinos, camundongos e ratos). Histologicamente, esse tumor é composto por queratina laminada concentricamente arranjada e circundada por uma fina parede de epitélio escamoso estratificado. Descreve-se um caso de cisto epidermoide intracraniano em um gato, macho, sem raça definida, de seis anos de idade, no sul do Brasil. O paciente foi encaminhado para atendimento veterinário por apresentar sinais de síndrome vestibular central. Devido ao mau prognóstico e por pertencer a um abrigo com muitos cães e gatos, o proprietário optou pela eutanásia e o paciente foi encaminhado para a realização de necropsia. O diagnóstico definitivo foi baseado nos achados histopatológicos. Pelo conhecimento dos autores, este é o primeiro relato de um cisto epidermoide intracraniano em um gato.

Melanocitoma meníngeo del ángulo pontocerebeloso: claves imagenológicas para su abordaje / Cerebellopontine meningeal melanocytoma: keys for imaging diagnostic approach

Resumen: Las lesiones del ángulo pontocerebeloso (APC) representan el 6 al 10% de las neoplasias intracraneales, siendo los schwannomas vestibulares y meningiomas los más comunes. Sin embargo, hasta el 15% pueden ser otras lesiones, entre ellas las derivadas a partir de restos de células melanocíticas presentes en las leptomeninges. El diagnóstico diferencial de las patologías tumorales del APC es extenso, siempre teniendo en cuenta las lesiones más comunes. Sin embargo, cuando las características radiológicas no son las esperadas, el enfoque debe orientarse hacia las lesiones inusuales, poniendo en contexto las diferentes estirpes celulares que pueden dar origen a las neoplasias en esta localización, como las neoplasias melanocíticas. Se presenta el caso de un masculino de 74 años con síndrome cerebeloso de tórpida evolución, al cual se le realiza RM de cerebro contrastada, identificando una lesión de base dural en el APC izquierdo, con hiperintensidad de señal en T1 e hipointensidad en T2, atípico para las lesiones más comunes en esta región, que sugiere su contenido melanocítico.

Abstract: Cerebellopontine angle tumors (CPA) represent approximately 6 to 10% of intracranial tumors. Vestibular Schwannomas and meningiomas are the most common, however up to 15% can be of other origin, including from melanocytes derived from the neural crest. The differential diagnosis of CPA pathologies is extensive, always taking into account the most common ones. However, if the radiological characteristics are not the expected, the approach should be directed towards unusual lesions, putting into context the different cell lines that can give rise to the neoplasm at this location, such as melanotic neoplasms. We present a case of a 74-year-old male, who presented with a cerebellar syndrome. Due to an atypical clinical evolution, a contrast enhanced head MRI was performed, revealing a dural based tumor on the left CPA, which was hyperintense on T1 and hypointense on T2 weighted sequences, which is not expected from the common lesions at this region and suggested it's melanotic content.

Study of Sigmoid Sinus Variations in the Temporal Bone by Micro Dissection and its Classification - A Cadaveric Study

Abstract Introduction Sigmoid sinus (SS) variations have been classified variously in the literature. These classifications suffer from some form of shortcoming from a clinical point of view for their application. Objective We propose a clinically relevant classification of the SS in relation to the posterior semicircular canal (PSCC) and to the exposure of the presigmoid dural plate. The positioning of the SS was analyzed with reference to the volume of themastoid and to the level of mastoid pneumatization. Methods A total of 94 formalin-preserved human cadaveric temporal bones were microdissected to carry out a complete mastoidectomy. The SS, the presigmoid dural plate, and the PSCCwere exposed, and the position of the former was analyzed in relation to the latter two in order to classify the position of the SS into three grades. Results GradeI hadthebest exposureof the presigmoid dura andof the PSCC,while grade III had the poorest exposure of the presigmoid dura and of the PSCC. Grade I SS was associated with good pneumatization and highermastoid volumescompared with grades II and III. Conclusions The SS exhibits considerable anatomic variability. A favorable positioning of the SS is associated with a large mastoid volume and pneumatization. A careful preoperative study of the imaging may help in understanding the positioning of the SS and the safety of various transmastoid approaches.

Trigeminal Neuralgia Caused by Cerebellopontine Angle Tumors: Surgical Series

Introduction Cerebellopontine angle (CPA) tumors represent an important cause of persistent and refractory trigeminal neuralgia (TN). It is believed that between 1 and 9.9% of the cases of patients presenting with TN painful manifestation are caused by space-occupying lesions. Objective The objective of the present study is to describe the clinical and surgical experience of the operative management of patients presenting with secondary type TN associated with CPA tumors. Method An observational investigation was conducted with data collection from patients with secondary type TN associated with CPA tumors who were treated with surgical resection of the space-occupying lesion and decompression of the trigeminal nerve from January 2013 to November 2016 in 2 different centers in the western region of the state of São Paulo, Brazil. Results We operated on 11 consecutive cases in which TN was associated with CPA during the period of analysis. Seven (63.6%) patients were female, and 4 (36.4%) were male. Seven (63.6%) patients presented with right-side symptoms, and 4 (36.4%) presented with left-side symptoms. After 2 years of follow-up, we observed that 8 (72.7%) patients showed a complete improvement of the symptoms, with an excellent outcome, and that 3 (27.3%) patients showed an incomplete improvement, with a good outcome. No patient reported partial improvement or poor outcome after the follow-up. There was no operative mortality. Conclusion Cerebellopontine angle tumors represent an important cause of TNandmust be included in the differential diagnosis of patients presenting with refractory and persistent symptoms. Surgical treatment with total resection of the expansive lesion and effective decompression of the trigeminal nerve are essential steps to control the symptoms.

Isolated Trigeminal Neuralgia Presented Due to Cerebellopontine Angle Epidermoid Cyst

Trigeminal neuralgia (TN) is a paroxysmal shock like pain restricted to the innervations of the areas of one or more trigeminal branches. The pathogenesis of TN is uncertain and typically is idiopathic, but it may be due to a structural lesion. Various etiologies such as vascular anomaly, tumor, infectious agents, and multiple sclerosis have been implicated as possible causes. Here we report two young patients diagnosed with trigeminal neuralgia secondary to epidermoid cyst at the cerebellopontine angle.

Extra-axial medulloblastoma in cerebellopontine angle: A report of two cases and literature review / 吉林大学学报(医学版)

Objective: To investigate the clinical features of extra-axial medulloblastoma (MB) in the cerebellopontine angle (CPA) area and analyze the imaging features and clinical prognosis, and to provide the reference for its clinical diagnosis and treatment. Methods: The clinical data of two patients diagnosed as extra-axial MB in CPA area were collected; the literature review was performed, and the clinical characteristics, diagnostic and treatment methods were analyzed. Results: Two patients were admitted to the hospital due to headache accompanied by hearing loss. The magnetic resonance imaging (MRI) results indicated a mass in the CPA area. All the two patients were treated with the cerebellopontine angle tumor resection. The operation of the two patients was successful, and the tumor located outside the axis seen in the operation, which was confirmed as MB by postoperative pathology. No recurrence or metastasis of tumor was found 15 months after follow-up. Conclusion: The possibility of MB should be considered before operation for the occupying lesions in the extra-axial CPA area. The active operation can improve the prognosis and prolong the survival of the patients.

Application of individualized nutritional intervention based on screening of dysphagia in postoperative patients with cerebellopontine angle occupying lesion / 中国实用护理杂志

Objective@#To explore the effect of individualized nutrition intervention mode based on dysphagia screening in postoperative patients with cerebellopontine angle occupying lesion.@*Methods@#By developing nurses training, selecting special screening and evaluation tools, developing screening methods and individualized nutrition intervention measures and meal spectrum, making screening and intervention flow chart, and starting to be implemented in postoperative patients with cerebellopontine angle occupying lesion in July 2017. Forty-six patients with cerebellopontine angle occupying lesion in the previous year were reviewed as the control group, who were given routine treatment and nursing; One year after implementation, Another 48 patients were set as the experimental group, and were given individualized nutritional care based on screening of dysphagia.@*Results@#The incidence rate of dominant aspiration(0), pneumonia (4.17%, 2/48) and diarrhea (2.08%,1/48) in the experimental group was lower than 4.35% (2/46), 21.74% (10/46), 19.57% (9/46) in the control group, especially the difference of incidence rate of pneumonia and diarrhea was statistically significant (pneumonia: χ2=0.010, P=0.013; diarrhea: χ2=0.006, P=0.007). The retention rate of gastric tube in the experimental group (31.30%, 18/48) was lower than that in the control group (58.70%, 27/46), the difference was statistically significant (χ2=7.158, P=0.007). Average retention time of gastric tube in the experimental group (4.47±1.13) d was less than that in the control group (5.11±0.70) d, the difference was statistically significant (t=2.296, P=0,027). The hospitalization time in the experimental group (8.69±1.36) d were less than those in the control group (12.57±2.95) d, the difference was statistically significant (t=8.248, P=0,000). The nutritional status of 7 days after operation of the experimental group was better than that of the control group, the differenc e was statistically significant (albumin: t=4.888, P<0.01; prealbumin: t=5.188, P<0.01; hemoglobin: t=4.039, P<0.01). The knowledge and skills of swallowing of general nurses improved significantly after the work, in particular, the accuracy of screening tests for Wa Tian drinking water increased from 5/8 to 20/20. The difference was statistically significant (χ2=8.148, P=0.017).@*Conclusions@#Individualized nutrition intervention based on screening for dysphagia can improve the clinical outcome of patients, improve the comprehensive ability of nurses and achieve a win-win situation of nurse - patient.

Application of individualized nutritional intervention based on screening of dysphagia in postoperative patients with cerebellopontine angle occupying lesion / 中国实用护理杂志

Objective To explore the effect of individualized nutrition intervention mode based on dysphagia screening in postoperative patients with cerebellopontine angle occupying lesion. Methods By developing nurses training, selecting special screening and evaluation tools, developing screening methods and individualized nutrition intervention measures and meal spectrum, making screening and intervention flow chart, and starting to be implemented in postoperative patients with cerebellopontine angle occupying lesion in July 2017. Forty-six patients with cerebellopontine angle occupying lesion in the previous year were reviewed as the control group, who were given routine treatment and nursing; One year after implementation, Another 48 patients were set as the experimental group, and were given individualized nutritional care based on screening of dysphagia. Results The incidence rate of dominant aspiration(0), pneumonia (4.17% , 2/48) and diarrhea (2.08% ,1/48) in the experimental group was lower than 4.35% (2/46), 21.74% (10/46), 19.57% (9/46) in the control group, especially the difference of incidence rate of pneumonia and diarrhea was statistically significant (pneumonia: χ2=0.010, P=0.013; diarrhea: χ2=0.006, P=0.007). The retention rate of gastric tube in the experimental group (31.30%, 18/48) was lower than that in the control group (58.70%, 27/46), the difference was statistically significant (χ2=7.158, P=0.007). Average retention time of gastric tube in the experimental group (4.47± 1.13) d was less than that in the control group (5.11±0.70) d, the difference was statistically significant (t=2.296, P=0,027). The hospitalization time in the experimental group (8.69±1.36) d were less than those in the control group (12.57 ± 2.95) d, the difference was statistically significant (t=8.248, P=0,000). The nutritional status of 7 days after operation of the experimental group was better than that of the control group, the differenc e was statistically significant (albumin: t=4.888, P<0.01; prealbumin: t=5.188, P<0.01; hemoglobin: t=4.039, P<0.01). The knowledge and skills of swallowing of general nurses improved significantly after the work, in particular, the accuracy of screening tests for Wa Tian drinking water increased from 5/8 to 20/20. The difference was statistically significant (χ2=8.148, P=0.017). Conclusions Individualized nutrition intervention based on screening for dysphagia can improve the clinical outcome of patients, improve the comprehensive ability of nurses and achieve a win-win situation of nurse-patient.

Contralateral blink reflex abnormality in right trigeminal neuralgia: A case report

@#Trigeminal neuralgia can be a manifestation of contralateral cerebellopontine angle tumor. We report here a 34 year old female patient who presented with right sided facial pain in first and second divison of right trigeminal nerve but her blink reflex was abnormal on the left side. Her brain MRI revealed a left cerebellopontine angle tumor displacing the pons as well as the basilar artery. The distortion and displacement of brainstem and the basilar artery contribute to the genesis of the trigeminal neuralgia contralaterally

Una propuesta de clasificación del complejo arteria cerebelosa anteroinferior ­ arteria subarcuata basada en el desarrollo embriológico / A proposed classification of the anteroinferior cerebellar artery - subarcuate artery complex based on embryological development

Introducción: El recorrido del "loop subarcuato" de la arteria cerebelosa anteroinferior (ACAI) presenta múltiples variaciones que condicionan además su principal eferencia, la arteria subarcuata (ASA). El espectro de variaciones de este complejo ha sido referido en la literatura de forma inconexa y desorganizada. Material y Métodos: Se propuso una clasificación sistematizada de las variantes del complejo ACAI-ASA, basada en la interacción del hueso petroso y la ACAI en el periodo embrionario. La misma fue aplicada en una serie de pacientes estudiados mediante secuencia CISS (constructive interference in steady state) de resonancia magnética para categorizar las relaciones presentes en el ángulo pontocerebeloso (APC). Resultados: Se evaluaron 84 pacientes, incluyendo 161 APC. Todos los grados propuestos fueron identificados en la serie evaluada. Las proporciones encontradas en la gradación propuesta se mantuvieron en el rango de las publicaciones aisladas. Conclusión: La clasificación propuesta para el complejo ACAI-ASA permitió distinguir y objetivar consistentemente el espectro de variaciones.

Introduction: The pathway of the anterior inferior cerebellar artery's (AICA) "subarcuate loop" can vary extensively. This variability also affects its main branch, the subarcuate artery (SAA). The spectrum of variations observed with this combination of vessels is inadequately described in the literature. Methods and Materials: A systematized classification system for AICA-SAA complex variants was proposed, based upon interactions between the petrosal bone and the AICA in embryos. This classification scheme then was applied to a series of patients assessed by magnetic resonance CISS (constructive interference in steady state) sequences, to categorize the cerebellopontine angle (CPA) relationships. Results: Eighty-four patients were evaluated, encompassing 161 CPA. All the proposed grades were identified in the evaluated series. The proportions found with the proposed gradation system were within the range of previous publications. Conclusions: The AICA-SAA complex classification system that we proposed allowed for consistently distinguishing and objectifying the spectrum of variations seen in the subarcuate loop.

Intratumoral Bleeding in a Vestibular Schwannoma

Vestibular schwannomas (VSs) account for 70% of all tumors of the cerebellopontine angle (CPA). Their clinical presentation is often insidious, with progressive hearing loss and involvement of other cranial nerves. Spontaneous hemorrhage in those tumors is very unusual, and generally presents with acute clinical features such as nausea, vomiting, headache and altered consciousness, usually with marked dysfunction of the cranial nerve involved, and with new deficits of neighboring cranial nerves. Asymptomatic patients are extremely rare. We present a case report of an incidental VS with asymptomatic bleeding, which evolved to death after surgery.

Schwannomas vestibulares (SVs) são responsáveis por cerca de 70% de todos os tumores do ângulo pontocerebelar. Sua apresentação costuma ser insidiosa, com perda auditiva progressiva e envolvimento de outros nervos cranianos. Hemorragia espontânea nesses tumores é incomum, e geralmente apresenta-se agudamente, com náusea, vômitos, cefaleia e alterações de consciência, normalmente com disfunção importante dos nervos cranianos envolvidos e com novos déficits dos nervos próximos. Pacientes assintomáticos são extremamente raros. Apresentamos um relato de caso de um SV incidental com sangramento assintomático que evoluiu para o óbito após cirurgia.

The effects of early neck isometrics exercise on neck discomfort in patients underwent cerebellopontine angle surgeries / 中华护理杂志

Objective To evaluate the effects of early neck isometrics exercise on relieving neck discomfort in patients after cerebellopontine angle surgeries.Methods The non-synchronous control study was conducted.The control group(40 patients recruited from March to June,2017) received routine nursing,while the intervention group (40 patients recruited from July to November,2017) performed early neck isometrics exercise in addition to routine nursing.Neck discomfort degree,neck rotation range,and Barthel score were measured and compared between two groups on Day 1,Day 3,Day 5,and Day 7 after surgeries.Results The intervention group had a high level of participation and no adverse events occurred.Neck discomfort degree of the intervention group was significantly lower than that of the control group on Day 1,Day 3,and Day 5(P＜0.05).Neck rotation range of the intervention group was improved on Day 1 and Day 3 compared with the control group(P＜0.05).Barthel score of the intervention group on Day 3,Day 5 and Day 7 was significantly better than that of the control group(P＜0.05).Conclusion Early neck isometrics exercise in patients underwent cerebellopontine angle surgeries is safe and feasible,which can alleviate discomfort of neck,and improve patients' early postoperative experience and quality of life.

MRI in Cerebellopontine angle and internal auditory canal lesions

Background: A large variety of inflammatory and neoplastic lesions are known to occur within internal auditory canal and cerebellopontine angle Imaging techniques are now available to guide the search for the underlying cause of most patient complaints The advent of MRI has revolutionized the medical diagnostic imaging because it allowed tissue characterization of many lesions High resolution MRI scan is highly sensitive in detecting lesions of internal auditory canal and cerebellopontine angle More recently, diffusion imaging is playing a substantial role in evaluation of CPA masses High ADC values of solid vestibular schwannomas were in conformity with increased diffusion rates, indicating the presence of increased amounts of extracellular water (a relatively loose tissue in tumor matrix) This study was undertaken with purpose to present MRI findings in cases of CPA and IAC lesions and to assess the impact of MRI on the diagnosis management and follow up, after treatment, of these lesions with an attempt to compare MRI findings with operative and H/P findings in the cases where surgery was done Materials and methods: The present study was conducted in Post Graduate Department of Radiodiagnosis, Government Medical College, Srinagar on patients presenting with otoneurological signs and symptoms suggestive of CP angle and IAC lesions referred for MR imaging by various departments of GMC Hospital Srinagar during the one year period of study Results: Majority of lesions found in this study were tumors (33 lesions), next common in our series were inflammatory lesions and vascular lesions (4 each case) Among all lesions and tumors most common MR diagnosis in our study was acoustic neuroma 20 of 41 lesions (4878%) and 20of 33 tumors (6060%) respectively Next common among tumors was meningiomas 3 out of 33 cases (909%) Conclusion: The results of the present study concluded that, MRI has particular advantages over CT for study of internal auditory canal and cerebellopontine lesions because it is non-ionizing Aijaz Ahmad Hakeem, Irshad Mohiuddin MRI in Cerebellopontine angle and internal auditory canal lesions IAIM, 2018; 5(12): 40-50 Page 41 investigation, better soft tissue contrast and resolution, multiplanar capability permits more reliable distinction of lesions, better identification of structures involved by lesions, tissue characterization of lesions and absence of beam hardening artifacts makes MR imaging superior ion evaluating the lesions in CP angle and IAC The radiological features of various lesions are often sufficiently distinctive to permit a specific diagnosis to be made MR imaging due to its multiplanar capability helps in knowing the exact site and extent of these lesions MRI shows inflammatory and vascular lesions with exquisite detail and is better for detection of such lesions as compared to CT MRI allows a confident perspective pathologic diagnosis to be made (Using FSE T2 weighted images, diffusion imaging, SE images, thin section post gadolinium scans) and this predictive value far exceeded the CT

Schwannoma gigante del ángulo pontocerebeloso / Giant Schwannoma of the cerebellopontine angle

Los Schwannomas del acústico son tumores benignos de crecimiento lento de la división superior del nervio vestibular, con una incidencia de 1,9 por cada 100.000 habitantes. En la actualidad, la tecnología de la neuroimagen en conjunto con la exploración audiológica clínica e instrumentada permiten el diagnóstico en estadios tempranos e incluso como hallazgo clínico, por tal motivo solo el 6 % a nivel mundial se cataloga como tumor grande al momento del diagnóstico. Se presenta el caso de una mujer de 16 años con cefalea, mareo, vómito, hipoacusia, parálisis facial y diadococinesia, por lo que se realizaron estudios de neuroimagen en los que se evidenció masa ocupativa a nivel ángulo pontocerebeloso; por las dimensiones se cataloga según la clasificación de Koss como estadio IV. Se confirmó diagnóstico mediante estudio histopatológico.

Acoustic schwannomas are benign tumors of slow growth in the top division of the vestibular nerve, with an incidence of 1.9 per 100,000 inhabitants. Currently, imaging technology together with the clinical examination audiological and implemented allow diagnosis at an early stage and even as a clinical finding, on that ground only 6 % worldwide are categorized as large tumor at diagnosis. For a woman of 16 with headache, dizziness , vomiting , hearing loss, facial paralysis and diadochokinesia occurs, so neuroimaging studies in which a space- occupying mass level cerebellopontine angle were made evident ; by the dimensions it is classified as classified as stage IV Koss . Diagnosis was confirmed by histopathology.

Clinical analysis of non-acoustic lesions in internal auditory canal and cerebellopontine angle / 中国耳鼻咽喉头颈外科

OBJECTIVE To analyse the diagnosis of non-acoustic lesions in internal auditory canal(IAC) and cerebellopontine angle(CPA),and discuss the effects of imaging examinationon differential diagnosis.METHODS A retrospective study was carried out in 185 patients with non-acoustic lesions of IAC and CPA from January 2001 to December 2016,in which lower cranial schwannoma,facial nerve tumor,meningioma,cholesteatoma,malignant tumor,trigeminal schwannoma,cavernous hemangioma,arachnoid cyst,lipoma were diagnosed in 65,55,25,9,9,8,6,5 and 3 patients,respectively.All patients were performed surgeries,and preoperative diagnosis and surgical approach were decided according to clinical manifestation,CT and MRI findings.Postoperative diagnosis were confirmed by pathological examination.RESULTS Total removal of lesion was achieved in 185 patients [96 men and 89 women,11-77 years old,mean age (46.4±25.6) years] and mean follow-up time was (5.1 ±3.2) years.Postoperative complication was leakage of cerebrospinal (4 patients,2.2％).4 patients with malignancy were dead and 1 patient with cholesteatoma was found recurrent during the follow-up.All kinds of non-acoustic lesions in IAC and CPA had its characteristic imaging findings.Preoperative diagnostic accuracy rate was 93.5％(173/185).CONCLUSION Accurate preoperative diagnosis has great significance in developing treatment strategy for IAC and CPA lesions;Preoperative diagnosis should be achieved according to clinical manifestation,CT and MRI findings,which can significantly improve the accuracy rate of diagnosis.

Retrolabyrinthine approach for cerebellopontine angle region surgeries / 中国耳鼻咽喉头颈外科

OBJECTIVE To evaluate the application ofretrolabyrinthine approach in cerebellopontine angel(CPA) region surgeries.METHODS A total of 42 patients underwent microscopic-endoscopic cooperative surgeries for CPA lesions via retrolabytinthine approach were reviewed.They were hospitalized from January 1st 2011 to January 1st 2016 in our institution.The microscopic-endoscopic technique was applied in all surgeries.RESULTS Complete removal was obtained in all tumor resections and satisfactory symptom-relief was achieved in all microvascular decompressions and neurectomies.In cases with acoustic neuroma and cholesteatoma,useful hearing (AAO-HNS classes A,B and C) was obtained in 66.7％(6/9) patients.No facial paralysis and postoperative complications such as cerebrospinal fluid leakage occurred during follow-up.In cranial nerve rhizopathies cases,complete relief was achieved in all patients.No facial paralysis and other lower cranial nerve dysfunction occurred.CONCLUSION With the preservation of labyrinthine structures,the microscopic-endoscopic cooperative surgeries for CPA lesions via retrolabytinthine approach could increase the hearing preservation level without facial nerve injury.Retrolabyrinthine approach is a good option for cranial nerve rhizopathies and tumors smaller than 15 mm in diameter without involvement of the fundus of internal auditory canal in the CPA region.

A combination use of endoscope and microscope in cerebral pontine angle surgery / 中华耳鼻咽喉头颈外科杂志

Objective@#To evaluate the application of combination use of microscope and endoscope in cerebral pontine angle (CPA) surgery.@*Methods@#A total of 72 patients undergone lateral skull base surgeries via endoscope under microscopic control from January 2006 to January 2015 was reviewed respectively. The patients including 35 males and 37 females were composed of 22 cases of vestibular swannnomas, 45 cases of cranial neuropathy and 5 cases of CPA chelesteatoma. Twenty cases of vestibular swannnomas, 15 cases of cranial neuropathy and 2 cases of CPA chelesteatoma undergone the surgery via retrosigmoid approach, while other cases undergone the surgery via retrolabyrinthine approach. Surgical procedures were accomplished under the control of microscope and different angular endoscope with imaging fusion. The surgical results were evaluated according to subjective and objective criteria, and all patients were followed up for 15 years.@*Results@#The symptoms was disappeared in the cranial neuropathy patients, without facial paralysis, complication of other nerves or hearing loss. Twenty-two patients with vestibular schwannomas got total tumor removal without facial palsy or neurological deficits; useful hearing was preserved in 16 of 22 patients (72.7%), and no tumor recurrence was found during 1-5 years follow-up. There was also no facial palsy or other complications in 5 cases of CPA chelesteatoma, which gained completely surgical removal; useful hearing was preserved in 3 of 5 cases of these patients and no recurrence was occurred during 1-1.5 years follow-up.@*Conclusions@#A combination use of endoscope and microscope could combine advantages and avoid disadvantages of two techniques. It can provide better exposure with minimal invasion in CPA surgery, and is especially applicable in surgery for cranial neuropathy, vestibular schwannoma and CPA cholesteatoma, which should be performed through retrosigmoid approach and retrolabyrinthine approach.

Primary Glioblastoma of the Cerebellopontine Angle: Case Report and Review of the Literature

Glioblastoma multiforme (GBM) is located most frequently in the cerebral hemispheres. Glioblastoma presenting as an extraaxial mass of cerebellopontine angle (CPA) is very rare in adults. We report a rare case of GBM arising in the CPA. The patient was a 71-year-old female, who complained of progressive gait disturbance and poor memory. Initial magnetic resonance imaging (MRI) revealed a 1.4×1.3 cm mass in the left CPA, with broad base to the petrous bone, showing homogenous enhancement. Follow-up MRI showed a rapid increase in size of mass (2.7×2.2 cm) with a necrotic portion. A stereotactic biopsy was done under the guidance of navigation system, and the histopathologic diagnosis was GBM, World Heath Organization grade IV. Further surgical resection was not performed considering her general condition, and the patient underwent concurrent chemotherapy with radiation therapy. Although rare, the possibility of glioblastoma should be included in the differential diagnosis of atypical CPA tumor.

Experiencia en el tratamiento de los meningiomas del ángulo pontocerebeloso del Sanatorio Allende / Experience in the treatment of meningiomas of the pontocerebellar angle of the Allende Sanatorium

Objetivo: Presentar nuestra experiencia en el tratamiento de meningiomas del ángulo pontocerebeloso, desde 1972 a 2013. Material y Método: Se realizó un trabajo retrospectivo y descriptivo. Se incluyeron 8 casos de pacientes con meningiomas de ángulo pontocerebeloso, cuyas edades oscilaron entre 41 y 68 años; 7 de ellos fueron mujeres. Resultados: Se realizaron 8 cirugías de exéresis tumoral. En un paciente se realizó, además, radioterapia por presentar recurrencia. En 5 casos la resección fue total (Simpson 1 o 2) y en 3 fue parcial. Los primeros se localizaban todos a nivel posterior del complejo VII-VIII. Hubo un caso de muerte postquirúrgica por sepsis secundaria a un absceso de la cavidad operatoria. Conclusión: En los meningiomas de ángulo pontocerebeloso, principalmente en aquellos ubicados por detrás del conducto auditivo interno, la exéresis completa es posible y constituye un tratamiento capaz de controlar la enfermedad. La radioterapia sería una opción a considerar en un número limitado de enfermos.

Objective: To present our experience in the treatment of cerebellopontine angle (CPA) meningiomas from 1972 to 2013. Materials and Methods: A descriptive, retrospective study was performed involving eight patients (7 females) with a cerebellopontine angle meningioma, whose ages ranged from 41 to 68 years. Results: Tumor resection was performed in all eight patients, with one patient requiring subsequent radiotherapy for tumor recurrence. In five patients, resection was complete (Simpson 1 or 2), while only partial resection was achieved in three. The former lesions were all posterior to the VII-VIII complex. There was one death from post-surgical sepsis secondary to an abscess in the surgical cavity. Conclusions: With meningiomas of the CPA, and especially those located behind the internal auditory canal, complete excision is possible and treatment can control the disease. Radiotherapy is an option to consider in a limited number of patients.