A case series of 38 cases

1. Presentation, Treatment and Outcome of
Cerebellopontine Angle Tumors: A Series of 38 Cases
Dr. Syed Shahreor Razzaque
Dr. Md Rafiqul Islam
Dr. Kanij Fatema
Dr. Moinul Islam Murad
Dr. Md Rashidul Hasan
Dr. Md Omar Faruk

2. Introduction
• Approximately 10% of all intracranial tumors are in triangular space
bounded antero-medially by pons, postero-medially by cerebellum
and laterally by petrous part of temporal bone named
cerebellopontine angle (CPA) region.
• Although most of the CPA tumors are benign, they pose a challenge
because of the complex anatomy and important neurovascular
structures that traverse this space.

3. Complex Anatomy

4. Continued….

5. Neuroma from
other Cranial
Nerves
Metastases
Ectodermal
Inclusion
Tumor
Meningioma
(5-10%)
Vestibular
Schwannoma
(80-90%)
Extension of-
Glioma, Pituitary
Adenoma,
Craniopharyngioma
Cholesterol
Granuloma
Lipoma
Aneurysm (PICA,
AICA, Vertebro-
basilar)
Arachnoid Cyst
Common
CPA
Tumors
Common CPA Tumors

6. 1.Hearing preservation
2.Usually for <2.5cm
tumor
3.Chance of temporal
lobe damage
4.Chance of facial nerve
injury
MIDDLE FOSSA
APPROACH
TRANSLABYRINTHINE
APPROACH
RETROSIGMOID
APPROACH
COMBINED
APPROACH
Approaches for CPA Tumors
1.Sacrifices hearing
2.Higher rate of CSF leak
3.Higher preservation of
facial nerve
4.No cerebellum
retraction
1.Hearing preservation
2.Versatile & familiar to
most neurosurgeons
3.Cerebellar retraction
for >4cm tumors
4.More chance of
headache
1.For very large tumors
extending into multiple
compartments
2.Single or multi-staged
3.May use microscope
and endoscope or both

7. ANALYSIS
SAMPLE SIZE
DURATION
PLACE OF STUDY
STUDY TYPE
Prospective
type of
analysis.
Dhaka Medical
College &
Hospital and a
private
hospital of
Dhaka city.
From March,
2018 to May,
2022.
Total 38
patients were
enrolled. All
were
approached
through
retromastoid
retrosigmoid
suboccipital
corridor.
Patient profiles,
clinical features,
radiological
characteristics,
degree of
resection,
postoperative
complications,
facial nerve
status and need
of CSF diversion
were analyzed.
Materials and Methods

8. 2 (5.3%)
7 (18.4%)
9 (23.7%)
12 (31.6%)
8 (21.1%)
10-20 21-30 31-40 41-50 >50
Frequency
of
Patients
Age Group in Years
Age Distribution

9. Sex Distribution
16 (42.1%)
22 (57.9%)
Distribution of Patients according to Sex
Male Female

10. 47.4%
18
42%
16 31.6%
12
31.6%
12 21.1%
8
10.5%
4
10.5%
4
Sensorineural
Hearing Loss
Features of
Raised ICP
Cerebellar Signs Tinnitus Facial Palsy
Trigeminal
Neuralgia
Clinical Presentation
Motor
Deficit

11. 75.0%
15.8%
5.3%
5.3%
2.6%
Vestibular Schwannoma (29)
Arachnoid Cyst(2)
CPA Meningioma (6)
Epidermoid (2)
Distribution of Tumor
Trigeminal Schwannoma(1)

12. [CELLRANGE
]
13.2%
[CELLRANGE
]
39.5%
[CELLRANGE
]
47.4%
<1.5 cm 1.5-3 cm >3 cm
Distribution of Tumor according to Size

13. Resection Rate
Gross Total Resection
39% (15)
Subtotal Resection
61% (23)
DISTRIBUTION OF PATIENTS ACCORDING TO RESECTION RATE

14. Radiological Features
Solid
14, 36.8%
Cystic
5, 13.2%
Mixed
19, 50.0%
CLASSIFICATION OF TUMOR ACCORDING TO RADILOGICAL FEATURES

15. 16
42.1%
6
15.8%
5
13.2%
2
5.3%
4
10.5%
0
5
10
15
20
25
30
35
Facial Nerve Palsy CSF Leak Meningitis Other Nerve Palsy Mortality
Postoperative Complications

16. 30
5
3
0
14
17
7
0
0
5
10
15
20
25
30
35
Grade I Grade II-III Grade IV-V Grade VI
PreOP
PostOP
Status of Facial Nerve

17. Need of Pre/Postoperative CSF Diversion
12
32%
26
68%
Underwent VP Shunt No Procedure

18. Case 1
• Mrs. Fatema, 38yrs old lady presented with
• Headache
• Vomiting &
• Progressive hearing loss in right ear

19. Preoperative Evaluation

20. Preoperative Images

21. Preoperative Images

22. Peroperative Images

23. Postoperative CT Scan

24. Histopathology

25. Outcome
Permission was taken from the patient

26. Case 2
• Mr. Fazlur Rahman, 55yrs old male presented with
• Headache
• Occasional vomiting &
• Imbalance

27. Preoperative MRI

28. Preoperative MRI

29. Peroperative Images

30. Postoperative CT Scan

31. Outcome
Permission was taken from the patient

32. Case 3
• Mr. Sentu Miah, 40yrs old male presented with
• Headache
• Right sided facial numbness &
• Progressive hearing loss in right ear
Permission was taken from the patient

33. Preoperative MRI

34. Preoperative MRI

35. Peroperative Images

36. Postoperative CT Scan

37. Outcome
Permission was taken from the patient

38. Case 4
• Mrs. Sabura, 59 yrs old lady presented with
• Left sided progressive hearing loss &
• Left sided tinnitus

39. Preoperative MRI

40. Preoperative MRI

41. Peroperative Images

42. Continued….

43. Peroperative Video

44. Case 5
• Mr. Shahjahan Al, 40 yrs old male presented with
• Headache and blurring of vision,
• Progressive hearing loss in right ear &
• Numbness in right side of face
Permission was taken from the patient

45. Preoperative MRI

46. Preoperative MRI

47. Peroperative Images

48. Continued….

49. Postoperative CT Scan

50. Outcome
Permission was taken from the patient

51. Case 6
• Mrs. Taslima Begum, 58 yrs old lady presented with
• Imbalance
• Blurring of vision &
• Right sided weakness

52. Preoperative MRI

53. Preoperative MRI

54. Peroperative Video

55. Postoperative CT Scan

56. Postoperative CT Scan

57. Outcome

58. Conclusion
• In our country, most of the patients usually present at a delayed stage with
large to giant tumors often with gross HCP & deteriorated neurological
condition contributing to large no. of VP shunts in our series.
• Facial nerve preservation should be given more emphasis than GTR in
these challenging tumors.
• Adequate craniotomy/craniectomy according to involved compartment,
sometimes exposure of transverse sinus give wide corridor for proper
visualization.