Nonvestibular Schwannoma Tumors in the Cerebellopontine Angle: A Structured Approach and Management Guidelines

ABSTRACT

The most common cerebellopontine angle (CPA) tumor is a vestibular schwannoma, but one in five CPA tumors are not vestibular schwannomas. These tumors may require different management strategies. Compared with vestibular schwannomas, symptoms and signs from cranial nerve VIII are less frequent: other cranial nerve and cerebellar symptoms and signs predominate in patients with these less common CPA tumors. Computed tomography and magnetic resonance imaging often show features leading to the correct diagnosis. Treatment most often includes surgery, but a policy of observation or subtotal resection is often wiser. This review provides a structured approach to the diagnosis of nonvestibular schwannoma CPA lesions and also management guidelines.

Cerebellopontine angle - epidermoids - meningiomas - tumors - management guidelines

REFERENCES

• 1 Moffat D A, Ballagh R H. Rare tumours of the cerebellopontine angle.  Clin Oncol (R Coll Radiol). 1995;  7 28-41
• 2 Bonneville F, Sarrazin J L, Marsot-Dupuch K et al.. Unusual lesions of the cerebellopontine angle: a segmental approach.  Radiographics. 2001;  21 419-438
• 3 Lalwani A K. Meningiomas, epidermoids, and other nonacoustic tumors of the cerebellopontine angle.  Otolaryngol Clin North Am. 1992;  25 707-728
• 4 Grey P L, Moffat D A, Hardy D G. Surgical results in unusual cerebellopontine angle tumours.  Clin Otolaryngol. 1996;  21 237-243
• 5 Brunori A, Scarano P, Chiappetta F. Non-acoustic neuroma tumor (NANT) of the cerebello-pontine angle: a 15-year experience.  J Neurosurg Sci. 1997;  41 159-168
• 6 Thomsen J, Terkildsen K, Tos M. Acoustic neuromas: progression of hearing impairment and function of the eighth cranial nerve.  Am J Otol. 1983;  5 20-33
• 7 Mallucci C L, Ward V, Carney A S, O'Donoghue G M, Robertson I. Clinical features and outcomes in patients with non-acoustic cerebellopontine angle tumours.  J Neurol Neurosurg Psychiatry. 1999;  66 768-771
• 8 Martuza R L, Parker S W, Nadol Jr J B, Davis K R, Ojemann R G. Diagnosis of cerebellopontine angle tumors.  Clin Neurosurg. 1985;  32 177-213
• 9 Nager G T, Masica D N. Meningiomas of the cerebello-pontine angle and their relation to the temporal bone.  Laryngoscope. 1970;  80 863-895
• 10 Symon L, Pell M, Singh L. Surgical management of posterior cranial fossa meningiomas.  Br J Neurosurg. 1993;  7 599-609
• 11 Glasscock M E, Minor L B, McMenomey S O. Meningiomas of the cerebellopontine angle. In: Jackler R, Brackmann D Neurotology. St. Louis; Mosby 1994: 795-823
• 12 Voss N F, Vrionis F D, Heilman C B, Robertson J H. Meningiomas of the cerebellopontine angle.  Surg Neurol. 2000;  53 439-446
• 13 Granick M S, Martuza R L, Parker S W, Ojemann R G, Montgomery W W. Cerebellopontine angle meningiomas: clinical manifestations and diagnosis.  Ann Otol Rhinol Laryngol. 1985;  94 34-38
• 14 Laird F J, Harner S G, Laws Jr E R, Reese D F. Meningiomas of the cerebellopontine angle.  Otolaryngol Head Neck Surg. 1985;  93 163-167
• 15 Kondziolka D, Lunsford L D, Coffey R J, Flickinger J C. Stereotactic radiosurgery of meningiomas.  J Neurosurg. 1991;  74 552-559
• 16 Kumar P P, Patil A A, Syh H W, Chu W K, Reeves M A. Role of brachytherapy in the management of the skull base meningioma: treatment of skull base meningiomas.  Cancer. 1993;  71 3726-3731
• 17 de la Cruz A, Doyle K J. Epidermoids of the cerebellopontine angle. In: Jackler RK, Brackmann D Neurotology. St. Louis; Mosby 1994: 823-833
• 18 Bartels L J, Arrington J R. Rare tumors of the cerebellopontine angle. In: Jackler RK, Brackmann D Neurotology. St. Louis; Mosby 1994: 835-861
• 19 Samii M, Tatagiba M, Piquer J, Carvalho G A. Surgical treatment of epidermoid cysts of the cerebellopontine angle.  J Neurosurg. 1996;  84 14-19
• 20 Mohanty A, Venkatrama S K, Rao B R, Chandramouli B A, Jayakumar P N, Das B S. Experience with cerebellopontine angle epidermoids.  Neurosurgery. 1997;  40 24-29
• 21 de Souza C E, Sperling N M, da Costa S S, Yoon T H, Abdel H M, de Souza R A. Congenital cholesteatomas of the cerebellopontine angle.  Am J Otol. 1989;  10 358-363
• 22 Dutt S N, Mirza S, Chavda S V, Irving R M. Radiologic differentiation of intracranial epidermoids from arachnoid cysts.  Otol Neurotol. 2002;  23 84-92
• 23 Talacchi A, Sala F, Alessandrini F, Turazzi S, Bricolo A. Assessment and surgical management of posterior fossa epidermoid tumors: report of 28 cases.  Neurosurgery. 1998;  42 242-251
• 24 Zimmermann M, Kellermann S, Gerlach R, Seifert V. Cerebellopontine angle lipoma: case report and review of the literature.  Acta Neurochir (Wien). 1999;  141 1347-1351
• 25 Bigelow D C, Eisen M D, Smith P G et al.. Lipomas of the internal auditory canal and cerebellopontine angle.  Laryngoscope. 1998;  108 1459-1469
• 26 Jallo G I, Woo H H, Meshki C, Epstein F J, Wisoff J H. Arachnoid cysts of the cerebellopontine angle: diagnosis and surgery.  Neurosurgery. 1997;  40 31-37
• 27 Samii M, Carvalho G A, Schuhmann M U, Matthies C. Arachnoid cysts of the posterior fossa.  Surg Neurol. 1999;  51 376-382
• 28 Kieserman S, Linstrom C, McCormick S, Petschenik A J. Choroid plexus papilloma of the cerebellopontine angle.  Am J Otol. 1996;  17 119-122
• 29 van Swieten J C, Thomeer R T, Vielvoye G J, Bots G T. Choroid plexus papilloma in the posterior fossa.  Surg Neurol. 1987;  28 129-134
• 30 House J L, Burt M R. Primary CNS tumors presenting as cerebellopontine angle tumors.  Am J Otol. 1985;  (suppl) 147-153
• 31 Nishimura T, Uchida Y, Fukuoka M, Ono Y, Kurisaka M, Mori K. Cerebellopontine angle lymphoma: a case report and review of the literature.  Surg Neurol. 1998;  50 480-485