Hearing Preservation after Stereotactic Radiosurgery for Bilateral Cerebellopontine Angle Meningiomas

Abstract

Background: Preservation of cranial nerve function is critical in the management of patients with cerebellopontine angle (CPA) tumors.

Case Report: A 51-year-old woman with tinnitus and dizziness was discovered to have bilateral CPA dural-based masses extending into the internal auditory canals (IAC). Pre-operatively, the patient had normal hearing on the right (SRT, 5 dB; SDS 100% at 30 dB) and left (SRT, 10 dB; SDS 90% at 40 dB). The patient underwent two Leksell Gamma Knife^® (Elekta Instruments, Norcross, GA) radiosurgeries initially for the larger left-sided tumor, then one year later for the right. The margin dose for each tumor was 14 Gy. Six years after the first radiosurgery, the tumors have not progressed and she has retained normal hearing and facial function bilaterally.

Conclusion: Preservation of cranial nerve function is generally possible after stereotactic radiosurgery of CPA meningiomas.

Key words

hearing preservation - meningioma - cerebellopontine angle tumors - stereotactic radiosurgery

References

• 1 Brackmann DE, Bartels LJ. Rare tumors of the cerebellopontine angle.  Otolaryngol Head Neck Surg. 180;  88 555-559
• 2 Laird FJ, Harner SG, Laws Jr ER. et al . Meningiomas of the cerebellopontine angle.  Otolaryngol Head Neck Surg. 1985;  93 163-167
• 3 Langman AW, Jackler RK, Althaus SR. Meningioma of the internal auditory canal.  Am J Otol. 1990;  11 201-204
• 4 Moffat DA, Ballagh RH. Rare tumours of the cerebellopontine angle.  Clin Oncol (R Coll Radiol). 1995;  7 28-41
• 5 Thomsen J. Cerebellopontine angle tumours, other than acoustic neuromas. A report on 34 cases. A presentation of 7 bilateral acoustic neuromas.  Acta Otolaryngol. 1976;  82 106-111
• 6 Batra PS, Dutra JC, Wiet RJ. Auditory and facial nerve function following surgery for cerebellopontine angle meningiomas.  Arch Otolaryngol Head Neck Surg. 2002;  128 369-374
• 7 Grey PL, Baguley DM, Moffat DA. et al . Audiovestibular results after surgery for cerebellopontine angle meningiomas.  Am J Otol. 1996;  17 634-638
• 8 Matthies C, Carvalho G, Tatagiba M. et al . Meningiomas of the cerebellopontine angle.  Acta Neurochir Suppl. 1996;  65 86-91
• 9 Nakamura M, Roser F, Dormiani M. et al . Facial and cochlear nerve function after surgery of cerebellopontine angle meningiomas.  Neurosurgery. 2005;  57 77-90 ; discussion 77-90 
• 10 Roser F, Nakamura M, Dormiani M. et al . Meningiomas of the cerebellopontine angle with extension into the internal auditory canal.  J Neurosurg. 2005;  102 17-23
• 12 Schaller B, Heilbronner R, Pfaltz CR. et al . Preoperative and postoperative auditory and facial nerve function in cerebellopontine angle meningiomas.  Otolaryngol Head Neck Surg. 1995;  112 228-234
• 13 Voss NF, Vrionis FD, Heilman CB. et al . Meningiomas of the cerebellopontine angle.  Surgical Neurol. 2000;  53 439-446 ; discussion 446-437 
• 14 Simpson D. The recurrence of intracranial meningiomas after surgical treatment.  J Neurol Neurosurg Psychiatry. 1957;  20 22-39
• 15 Pollock BE, Stafford SL, Utter A. et al . Stereotactic radiosurgery provides equivalent tumor control to a Simpson Grade 1 resection for patients with small- to medium-sized meningiomas.  Int J Radiat Oncol Biol Phys. 2003;  55 1000-1005
• 16 Klink DF, Miller NR, Williams J. Preservation of residual vision 2 years after stereotactic radiosurgery for a presumed optic nerve sheath meningioma.  J Neuroophthalmol. 1998;  18 117-120
• 17 Kondziolka D, Mathieu D, Lunsford LD. et al . Radiosurgery as definitive management of intracranial meningiomas.  Neurosurgery. 2008;  62 53-58 ; discussion 58-60 
• 18 Pollock BE, Stafford SL. Results of stereotactic radiosurgery for patients with imaging defined cavernous sinus meningiomas.  Int J Radiat Oncol Biol Phys. 2005;  62 1427-1431
• 19 Eustacchio S, Trummer M, Fuchs I. et al . Preservation of cranial nerve function following Gamma Knife radiosurgery for benign skull base meningiomas: experience in 121 patients with follow-up of 5 to 9.8 years.  Acta Neurochir Suppl. 2002;  84 71-76
• 20 Pollock BE, Link MJ, Foote RL. et al . Radiosurgery as primary management for meningiomas extending into the internal auditory canal.  Stereotact Funct Neurosurg. 2004;  82 98-103
• 11 Kida Y, Kobayashi T, Tanaka T. et al . Radiosurgery for bilateral neurinomas associated with neurofibromatosis type 2.  Surgical Neurol. 2000;  53 383-389 discussion 389-390 
• 21 Mathieu D, Kondziolka D, Flickinger JC. et al . Stereotactic radiosurgery for vestibular schwannomas in patients with neurofibromatosis type 2: an analysis of tumor control, complications, and hearing preservation rates.  Neurosurgery. 2007;  60 460-468 ; discussion 468-470 
• 22 Roche PH, Regis J, Pellet W. et al . Neurofibromatosis type 2. Preliminary results of gamma knife radiosurgery of vestibular schwannomas].  Neuro-Chirurgie. 2000;  46 339-353 ; discussion 354 
• 23 Rowe JG, Radatz MW, Walton L. et al . Clinical experience with gamma knife stereotactic radiosurgery in the management of vestibular schwannomas secondary to type 2 neurofibromatosis.  J Neurol Neurosurg Psychiatry. 2003;  74 1288-1293
• 24 Subach BR, Kondziolka D, Lunsford LD. et al . Stereotactic radiosurgery in the management of acoustic neuromas associated with neurofibromatosis Type 2.  J Neurosurg. 1999;  90 815-822
• 25 Samii M, Matthies C, Tatagiba M. Management of vestibular schwannomas (acoustic neuromas): auditory and facial nerve function after resection of 120 vestibular schwannomas in patients with neurofibromatosis 2.  Neurosurg. 1997;  40 696-705 ; discussion 705-696 

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