Cerebellopontine Angle Meningiomas: A Multi-Institutional Cohort Study

Objective: Cerebellopontine angle (CPA) meningiomas present unique challenges given their anatomical location and proximity to critical neurovascular structures. Postoperative complications and persistent symptoms can debilitate patients, but our ability to predict their occurrence and long-term rates of recovery remain uncharacterized. This study examines the clinical presentation, surgical management, and postoperative outcomes of CPA meningiomas.

Materials and Methods: We conducted a retrospective cohort study of CPA meningioma cases resected at Mass General Brigham (2006–2020) using descriptive statistics and univariate/multivariate logistic regression to identify predictors of progression or recurrence.

Results: The total cohort was 95 patients (median age: 59.1 years, 82.1% female sex), reflecting 2.8% of meningioma resections at our institutions across the study period. Preoperative symptoms most commonly included hearing loss (49.5%), ataxia (42.1%), and headaches (29.5%). Surgical approaches included the retrosigmoid (78.9%), transmastoid retrosigmoid (17.9%), and middle fossa (3.2%) approaches, with gross total resection (GTR) achieved in 62.1% of patients. Smaller tumor size (t = 3.17, p = 0.002) was a predictor of GTR (see [Fig. 1]). For tumors with demonstrated intracanalicular invasion, drilling into the canal was significantly associated with GTR (χ² = 21.8, p < 0.001). Specifically, the IAC was drilled in 26 patients with 88.5% of these resections achieving GTR, while 17 tumors with intracanalicular invasion did not have drilling of the IAC and achieved GTR in only 2 cases. In most cases, the cranial nerve VII/VIII complex was inferior (45.6%) or superior (19.1%) to the meningioma, with a smaller proportion being anterior (5.9%), posterior (13.2%), or other (16.2%). Postoperative hearing loss was stable or improved in the majority of patients at final clinical follow-up (see [Fig. 2]). Overall, progression or recurrence of meningioma was observed in 25.3% of patients at a median time-to-progression of 3.00 years (IQR: 2.91 years) and 1.59 years (IQR: 2.80 years) for WHO Grade 1 and Grade 2 tumors respectively. GTR (OR: 0.13, p = 0.002) and older age per year (OR: 0.94, p = 0.002) were associated with lower odds of progression or recurrence on multivariable testing.

Fig. 1 Box plot comparing maximum tumor diameter in cm across cases in which subtotal or gross total resections were achieved. Box plot reflects the median maximum diameter with edges at the first and third quartiles. Upper and lower whiskers were calculated as +/− 1.5 (IQR).

Fig. 2 Summary of reported hearing loss outcomes in 31 patients across the immediate post-operative period, first clinical follow up (median: 1.1 months), and final clinical follow-up (median: 39.4 months). Of the 47 patients presenting with preoperative hearing loss, only 31 reported data at all three chosen time-points.

Conclusion: Achieving GTR is important for CPA meningiomas to achieve optimal symptomatic control and reduced progression and recurrence rates. Further, drilling of the IAC is an important predictor of achieving GTR particularly in tumors with intracanalicular invasion.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
07 February 2025