The Classification of Posterior Petrous Meningiomas and Its Clinical Significance

Size: px
Start display at page:

Download "The Classification of Posterior Petrous Meningiomas and Its Clinical Significance"

Transcription

1 The Journal of International Medical Research 2009; 37: [first published online as 37(3) 13] The Classification of Posterior Petrous Meningiomas and Its Clinical Significance FJ QU 1 *, XD ZHOU 1 *, XL WANG 2, F LI 1, XD LU 3, YG LIU 1, YH ZHONG 4, HA YANG 1 AND SL NI 1 1 Department of Neurosurgery, and 2 Department of the Digestive System, Qilu Hospital, Shandong University, Jinan, China; 3 Department of Neurosurgery, Provincial Hospital of Shandong University, Jinan, China; 4 Department of Obstetrics and Gynaecology, Shandong Jiaotong Hospital, Jinan, China This retrospective analysis of the clinical records of 42 patients was used to study the clinical significance of a classification system for posterior petrous meningiomas. According to clinical manifestations and radiological images, posterior petrous meningiomas were classified into three types: type I (cerebella type; 12 patients), tumours involved and compressed the cerebellum; type II (cranial nerve type; 16 patients), tumours involved the cranial nerves; and type III (combined type; 14 patients), tumours involved more than one structure such as the cerebellum, cranial nerves and the brain stem. All patients underwent microneurosurgery and the total resection rate was 90%. It was more difficult totally to resect type II and III tumours than type I tumours and the post-operative functional outcomes were worse. Microneurosurgical techniques and skills are critical to increase the total resection rate of posterior petrous meningiomas in order to decrease the mortality and disability rates. KEY WORDS: MENINGIOMAS; MICROSURGERY; CEREBELLOPONTINE ANGLE; CLASSIFICATION; SURGICAL OUTCOMES Introduction Posterior petrous meningiomas are defined as tumours with basal dural attachment originating on the posterior surface of the petrous bone and comprise approximately 42% of all cerebellopontine angle (CPA) meningiomas. 1 In the past, posterior petrous meningiomas were reported just as a subgroup of CPA meningiomas. The major manifestations are cranial neuropathy and *FJ Qu and XD Zhou contributed equally to this work. cerebellar dysfunction. 2 4 As neurosurgical techniques develop, surgeons require more details about the structures that are attached to the tumour that they are going to try to remove. The present study focused on posterior petrous meningiomas in order to collect more information about this important group of CPA meningiomas. The clinical manifestations, surgical difficulty and outcomes vary according to the anatomical structures that are associated with the tumours. It is, therefore, necessary 949

2 to classify and analyse the tumours with their different structural involvements in order to obtain an immediate understanding of the impact of the tumour and, consequently, the associated difficulties that might be encountered during its surgical removal. This study was, therefore, designed to investigate the clinical characteristics, surgical treatment and outcomes associated with the classification of posterior petrous meningiomas in Chinese patients. Patients and methods PATIENT POPULATION This retrospective study was conducted in the Department of Neurosurgery, Qilu Hospital of Shandong University (Jinan, China) between January 1996 and December All patients with posterior petrous meningiomas confirmed by both surgery and pathology were included in the study. Data regarding the general characteristics of the patients (age, presenting signs and symptoms, duration of symptoms, and neuroradiological evaluation), surgical management, tumour histopathology and surgery-related outcomes were obtained by reviewing the medical records. TUMOUR CLASSIFICATION Posterior petrous meningiomas were classified into three types based on their clinical manifestations and radiological images: type I (cerebella type), in which the tumour involved and compressed the cerebellum with the signs of cerebellar compression, such as gait ataxia, being the main clinical characteristics; type II (cranial nerve type), in which the tumour involved the cranial nerves and where the main symptoms were cranial nerve dysfunction; and type III (combined type), in which the tumour involved more than one structure, such as the cerebellum, cranial nerves and the brain stem, so that all of the above symptoms were clinically observed. NEURORADIOLOGICAL STUDIES Neurological studies were undertaken by plain and contrast-enhanced computerized tomography (CT) scans, and T1- and T2- weighted and contrast-enhanced magnetic resonance imaging (MRI), carried out in the Neuroradiological Department of Qilu Hospital, Shandong University. HISTOPATHOLOGICAL EXAMINATION Tumour pathology was evaluated by the Pathology Department of Qilu Hospital of Shandong University. The histopathological type of meningioma was classified based on the World Health Organization (WHO) 2000 system. 5 Results GENERAL PATIENT CHARACTERISTICS A total of 42 patients (seven men and 35 women) with posterior petrous meningiomas aged years (median 51 years) participated in the study. The duration of their initial symptoms, prior to definitive diagnosis, ranged from 10 days to 10 years. The lesion was on the left in 18 patients and on the right in 24 patients. A total of 12 patients had a type I posterior petrous meningioma, 16 patients had a type II posterior petrous meningioma and 14 patients had a type III posterior petrous meningioma. The clinical symptoms and findings on physical examination for patients, grouped according to type of posterior petrous meningioma, are shown in Tables 1 and 2. NEURORADIOLOGICAL EVALUATION All patients underwent CT scans, on which 950

3 TABLE 1: Clinical symptoms associated with a posterior petrous meningioma in patients grouped according to the type of tumour (type I, II and III) Type I Type II Type III Total Clinical symptom (n = 12) (n = 16) (n = 14) (n = 42) Headache 9 (75%) 8 (50%) 10 (71%) 27 (64%) Hearing loss 0 (0%) 9 (56%) 6 (43%) 15 (36%) Gait disturbance 10 (83%) 0 (0%) 5 (36%) 15 (36%) Dizziness 6 (50%) 4 (25%) 5 (36%) 15 (36%) Tinnitus 0 (0%) 7 (44%) 3 (21%) 10 (24%) Facial numbness 0 (0%) 9 (56%) 3 (21%) 12 (29%) Extremity weakness 0 (0%) 0 (0%) 4 (29%) 4 (10%) Facial pain 0 (0%) 2 (13%) 1 (7%) 3 (7%) Decreased visual acuity 0 (0%) 1 (6%) 1 (7%) 2 (5%) Diplopia 0 (0%) 1 (6%) 1 (7%) 2 (5%) Values are n (%). Type I, cerebella type; type II, cranial nerve type; type III combined type. the tumours appeared as isointense or hyperintense well-circumscribed masses on plain CT and as homogeneously enhanced masses on contrast-enhanced CT. A total of 32 cases underwent magnetic resonance imaging (MRI), on which tumours were hypointense to isointense on T1-weighted sequences (Fig. 1A) and isointense to hyperintense on T2-weighted sequences. Tumours were homogeneously enhanced on contrast-enhanced MRI images (Fig. 1B). SURGICAL MANAGEMENT AND COMPLICATIONS A total of 37 patients underwent microneurosurgery via the suboccipital retrosigmoid approach and the other five patients were treated via the presigmoid TABLE 2: Clinical findings on physical examination in patients with a posterior petrous meningioma grouped according to the type of tumour (type I, II and III) Type I Type II Type III Total Clinical finding (n = 12) (n = 16) (n = 14) (n = 42) Cranial nerve dysfunction V VII VIII IX and X Cerebellar signs Gait disturbance Nystagmus Papilloedema Values are n. Type I, cerebella type; type II, cranial nerve type; type III combined type. 951

4 A B FIGURE 1: (A) A T1-weighted magnetic resonance imaging (MRI) scan demonstrating an isointense mass with sharp edges (arrows) in the region of the posterior petrous. (B) The mass became homogeneously enhanced on the MRI scan when the patient was injected intravenously with contrast agent (arrows) approach. Generally, the primary objective was to remove the tumour base to reduce haemorrhage. Occasionally, with large tumours, it was not possible to expose the base until internal decompression had been accomplished. The base was then removed and separated from the tumour capsule. Separation of the tumour from the surrounding nerves or other structures should follow the arachnoid mater interface. Finally, the dural attachment was resected and the infiltrated bone was ground. Total resection of tumours was achieved in 38 (90%) patients and subtotal resection was achieved in four patients (Table 3). A postoperative CT scan showing total resection of a posterior petrous meningioma is shown in Fig. 2. No deaths occurred during the peri- TABLE 3: Surgical treatment and outcomes in patients with a posterior petrous meningioma grouped according to the type of tumour (type I, II and III) Tumour resection Preservation of the facial nerve Anatomical Functional Hearing Tumour type Total Subtotal preservation preservation preservation I (n = 12) 12 (100%) 0 12 (100%) 12 (100%) 12 (100%) II (n = 16) 14 (88%) 2 14 (88%) 13 (81%) 10 (63%) III (n = 14) 12 (86%) 2 12 (86%) 11 (79%) 10 (71%) Total 38 (90%) 4 38 (90%) 36 (86%) 32 (76%) Values are n (%). Type I, cerebella type; type II, cranial nerve type; type III combined type. 952

5 FIGURE 2: Post-operative computerized tomography (CT) scan showing total resection of the tumour shown in Fig. 1. operative period. The rate of functional preservation of the facial nerve was 86% (36/42 patients), compared with 60 90% in other published reports. 3,6 8 It has been reported that the extent of tumour growth is an important factor for hearing preservation and other reports have published hearing preservation rates of 69 82%, 2,3,9 13 compared with 76% in the present series. All type I tumours were completely resected via the suboccipital retrosigmoid approach. The rate of anatomical and functional preservation of the facial nerve was 100% and the hearing preservation rate was 100% in patients with type I tumours. Among these patients, one had a transient decrease in hearing. In patients with type II tumours, 13 patients underwent resection via the suboccipital retrosigmoid approach and three patients via the presigmoid approach. A total of 14 patients with type II tumours underwent total resection and two had a subtotal resection. Three patients experienced seventh nerve paralysis and six patients suffered hearing loss. The rate of anatomical preservation of the facial nerve was 88% and functional preservation was 81% in patients with type II tumours. In patients with type III tumours, 13 underwent resection via the suboccipital retrosigmoid approach and one via the presigmoid approach. A total of 12 patients with type III tumours underwent total resection and two had a subtotal resection. Three patients experienced seventh nerve paralysis and four patients suffered hearing loss. The rate of anatomical preservation of the facial nerve was 86% and functional preservation was 79% in patients with type III tumours. Histopathological tumour classification according to the WHO 2000 classification system 5 showed that 21 tumours were fibroblastic, 12 meningothelial, five mixed, two vascular, one psammomatous and one atypical (Table 4). Besides facial and auditory nerve dysfunction, post-operative complications included leakage of cerebrospinal fluid (CSF) in one patient, post-operative fever in six patients, posterior cranial nerve deficits in three patients, intracranial haematoma in two patients, abducens nerve injury in one patient and contralateral hemiplegia in two patients as a result of removal of the part of the tumour that was tightly adhered to the brain stem (Table 4). With the exception of hemiplegia, all these complications were improved at discharge after appropriate treatment. A total of 24 of the 42 patients underwent follow-up of between 6 months and 10 years (mean 4.5 years): 18 patients recovered well, four gained independence and two type III cases lost their independence because of hemiplegia. Recurrence occurred in two of the patients with a subtotal resection who had recovered well: one type II case of the meningothelial histopathological type (recurrence after about 7 years); and one type III case of atypical histopathological 953

6 TABLE 4: Histopathological classification and post-operative complications of patients with a posterior petrous meningioma grouped according to the type of tumour (type I, II and III) Type I Type II Type III Total Classification/complication (n = 12) (n = 16) (n = 14) (n = 42) Histopathological classification a Fibroblastic Meningothelial Mixed Vascular Psammomatous Atypical Post-operative complications Leakage of cerebrospinal fluid Fever Posterior cranial nerve deficits Intracranial haematoma Abducens nerve injury Contralateral hemiplegia Values are n. Type I, cerebella type; type II, cranial nerve type; type III combined type. a Histopathological classification based on the World Health Organization 2000 system. 5 type (recurrence after about 3 years). Second surgery was performed in these patients with a good recovery. Discussion Posterior petrous meningiomas refer to those meningiomas arising from the posterior surface of the petrous bone and exclude those that originate from the CPA, such as tentorium meningiomas, petroclival meningiomas and jugular foramen meningiomas. 6 The posterior surface of the petrous bone is a region surrounded by the superior petrosal sinus, inferior petrosal sinus and sigmoid sinus. In the past, meningiomas that extended into the CPA region, regardless of the location of the base, were considered to be CPA meningiomas. 6,7,9,14 17 The most common site of CPA meningiomas is the posterior petrous bone surface, which accounts for approximately 42% of all CPA meningiomas. 1 The classification of posterior petrous meningiomas is varied because there is no standard classification system. Samii and Ammirati 18 classified posterior petrous meningiomas into two types based on their anatomical relationship with the internal auditory canal (IAC): those anterior to the IAC and those posterior to the IAC. They found the clinical manifestations were different between these two types. 18 According to the dural attachment of the meningioma, Schaller et al. 7 divided them into premeatal and retromeatal meningiomas, and showed that premeatal meningiomas have a significantly worse post-operative functional outcome than retromeatal meningiomas, although premeatal meningiomas became symptomatic earlier and had smaller sizes. Desgeorges et al. 19 classified the posterior surface of the petrous bone into three equal zones according to imaging manifestation: 954

7 zones A, M and P. A tumour was classified as an AM, MP, or AMP meningioma if the base of the meningioma extended across several zones. 19 Voss et al. 4 classified posterior petrous meningiomas into four types: retromeatal, premeatal, suprameatal and inframeatal. Bassiouni et al. 2 divided posterior petrous meningiomas into five types: retromeatal, premeatal, suprameatal, inframeatal and centred on the internal acoustic meatus, according to the site of dural attachment in relation to the petrous acusticus. These authors also stated that preoperative detailed analysis of MRI data gives the surgeon important information about the dislocation of the cranial nerves. 2 Wu et al. 3 reported on a series of 82 patients with meningiomas of the posterior petrous bone and divided them into three types according to the anatomical relationship with the posterior surface of the petrous bone with special reference to the IAC: type I, located laterally to the IAC; type II, located medially to the IAC; and type III, extensively attached to the posterior surface of the petrous bone. They demonstrated that it was more difficult radically to resect type II and III tumours than type I tumours. 3 In the present study, posterior petrous meningiomas were classified into three types, based on clinical manifestations and radiological images. Type I tumours were involved with and compressed the cerebellum, resulting in signs of cerebellar compression, such as gait ataxia. We found that satisfactory results were achieved for total resection rate and preservation rate of cranial nerves VII and VIII via the suboccipital retrosigmoid approach. All group I tumours were totally resected via the suboccipital retrosigmoid approach. Only one patient experienced a transient loss of hearing. Surgery for this type of meningioma was the easiest among the three tumour types because of the easier exposure of the tumours and less involvement of important anatomical structures. For type I tumours, early drainage of CSF from the cistern was necessary after opening the dura in order to reduce drag to brain tissue and to expose the tumour clearly although, if necessary, 250 ml of 20% mannitol can be used to lower cranial pressure before opening the dura. 2 The primary principle of surgery for type I posterior petrous meningiomas is to resect as much of the tumour as possible in order to reduce the likelihood of recurrence. Type II tumours involved the cranial nerves, so the main symptoms were cranial nerve dysfunction. These posterior petrous meningiomas present with various clinical manifestations according to the extent of the involvement of the cranial nerves. 2,3 Patients with type II tumours in the present study experienced acoustic nerve injury symptoms such as hearing loss and tinnitus, facial nerve injury, facial paralysis, distortion of commissure and prosopospasm, trigeminal nerve injury symptoms such as facial pain and numbness, and posterior cranial nerve injury symptoms such as dysphagia. It was difficult to distinguish the cranial nerves in this type of tumour because of the close relationship between the nerves and the tumour. Intra-operative nerve monitoring should be implemented in order to avoid unnecessary injury if the cranial nerves are difficult to recognize because of tumour erosion and compression. 9 Vital blood vessels, such as the anterior and posterior inferior cerebellar arteries and the superior cerebellar artery, must be separated carefully. No vessels should be amputated by electrocoagulation until it has been verified that the vessel only supplies blood to the tumour. In the present study the arachnoid mater interface between the tumour and the surrounding structures was carefully 955

8 separated with blunt manipulation and minimal electrocoagulation was used to avoid thermal injury to the cranial nerves. Type III tumours involved more than one structure, such as the cerebellum, the cranial nerves and the brainstem, resulting in a range of the symptoms observed with type I and II tumours. The surgeon should analyse MRI scans carefully prior to operating to observe the relationship between the tumour and the brainstem. 20 The primary principle of surgery for type III tumours is to preserve nerve function and then resect as much of the tumour as possible. If the tumour is densely adherent to vital blood vessels, nerves or the brainstem and hard to resect completely, it is considered optimal to leave a small margin of tumour behind and implement postoperative adjuvant radiotherapy or γ-knife therapy to control tumour recurrence effectively. 21,22 The primary objective in resecting posterior petrous meningiomas is to remove the tumour base to stop the blood supply and reduce haemorrhage. Sometimes, because of the large size of these tumours and the complicated associations that they make with the surrounding anatomical structures, it is not easy to separate the tumour base until internal decompression has been performed repeatedly and the tumour resected little by little. 23 The tumour base can then be separated from the surrounding structures and removed. The dural attachment of tumour to the posterior surface of the petrous bone should be handled as soon as possible to reduce haemorrhage and keep the surgical field clear. The following factors may determine surgical outcome: patient age; tumour size, location and texture; the extent to which the tumour envelops blood vessels and nerves; and the degree of invasion into the brainstem. 3 It is clear that, in the present study, total resection was more difficult in type II and III tumours compared with the type I tumours. Post-operative nerve function impairment was also more evident in type II and III tumours compared with type I tumours. The primary principle of surgery for type I tumours is to resect as much of the tumour as possible in order to reduce the likelihood of recurrence. The invading dura was electrocoagulated or resected and infiltrating bone was ground. For type II and III tumours, in order to protect the function of the cranial nerves or brain stem, subtotal resection is acceptable. The primary principle of surgery for type II and III tumours is to preserve nerve function and then resect as much of the tumour as possible. Minimal residual tumour was left behind in four patients in the present study because the tumour adhered to important structures: in two patients it tightly adhered to cranial nerves VII and VIII; and in two patients to the brainstem. Post-operative adjuvant radiotherapy or γ-knife therapy was needed for the residual tumours and achieved satisfactory results. 24,25 In conclusion, the present study suggests that it is easy to classify posterior petrous meningiomas using the classification system that we describe. Clinical presentations, surgical approach, surgical outcomes and prognoses vary greatly among the three tumour types. It is more difficult for type II and III tumours to be resected than type I tumours and the post-operative functional outcomes were worse. In the majority of patients, the tumours were resected totally and safely via the retrosigmoid approach. Microsurgical techniques and skills are critical to increase the total resection rate of posterior petrous meningiomas and to decrease mortality and disability rates. Acknowledgement This study was supported by a grant 956

9 (2006GG ) from the Programme of the Shandong Science and Technology Committee. Conflicts of interest The authors had no conflicts of interest to declare in relation to this paper. Received for publication 5 January 2009 Accepted subject to revision 19 January 2009 Revised accepted 27 April 2009 Copyright 2009 Field House Publishing LLP References 1 Castellano F, Ruggiero G: Meningiomas of the posterior fossa. Acta Radiol 1953; 104: Bassiouni H, Hunold A, Asgari S, et al: Meningiomas of the posterior petrous bone: functional outcome after microsurgery. J Neurosurg 2004; 100: Wu ZB, Yu CJ, Guan SS: Posterior petrous meningiomas: 82 cases. J Neurosurg 2005; 102: Voss NF, Vrionis FD, Heilman CB, et al: Meningiomas of cerebellopontine angle. Surg Neurol 2000; 53: Louis DN, Scheithauer BW, Budka H, et al: Meningiomas. In: World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of the Nervous System (Kleihues P, Cavenee WK, eds). Lyon: IARC Press, 2000; pp Batra PS, Dutra JC, Wiet RJ: Auditory and facial function following surgery for cerebellopontine angle meningiomas. Arch Otolaryngol Head Neck Surg 2002; 128: Schaller B, Merlo A, Gratzl O, et al: Premeatal and retromeatal cerebellopontine angle meningioma: two distinct clinical entities. Acta Neurochir (Wein) 1999; 141: Rosser F, Nakamura M, Dormiani M, et al: Meningiomas of the cerebellopontine angle with extension into the internal auditory canal. J Neurosurg 2005; 102: 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: Grey PL, Baguley DM, Moffat DA, et al: Audiovestibular results after surgery for cerebellopontine angle meningiomas. Am J Otol 1996; 17: Yasargil MG, Mortara RW, Curcic M: Meningiomas of the basal posterior cranial fossa. Adv Tech Stand Neurosurg 1980; 7: Matthies C, Carvalho G, Tatagiba M, et al: Meningiomas of the cerebellopontine angle. Acta Neurochir Suppl 1996; 65: Nassif PS, Shelton C, Arriaga M: Hearing preservation following surgical removal of meningiomas affecting the temporal bone. Laryngoscope 1992; 102: Daspit CP, Spetzler RF, Pappas CT: Combined approach for lesions involving the cerebellopontine angle and skull base: experience with 20 cases preliminary report. Otolaryngol Head Neck Surg 1991; 105: Giannotta SL, Pulec JL, Goodkin R: Translabyrinthine removal of cerebellopontine angle meningiomas. Neurosurgery 1985; 17: Granick MS, Martuza RL, Parker SW, et al: Cerebellopontine angle meningiomas: clinical manifestations and diagnosis. Ann Otol Rhinol Laryngol 1985; 94: Sekhar LN, Jannetta PJ: Cerebellopontine angle meningiomas: microsurgical excision and follow-up results. J Neurosurg 1984; 60: Samii M, Ammirati M: Cerebellopontine angle meningiomas. In: Meningiomas (Al-Mefty O, ed). New York: Raven Press, 1991; pp Desgeorges M, Sterkers O, Poncet JL, et al: Surgery for meningioma of the posterior skull base. 135 cases. Choice of approach and results. Neurochirurgie 1995; 41: [in French]. 20 Uede T, Wanibuchi M, Nonaka T, et al: Distinctions of petroclival meningioma with perifocal edema on adjacent brain stem. No Shinkei Geka 1996; 24: Jung HW, Yoo H, Paek SH, et al: Long-term outcome and growth rate of subtotally resected petroclival meningiomas: experience with 38 cases. Neurosurgery 2000; 46: Lee JY, Niranjan A, McInerney J, et al: Stereotactic radiosurgery providing long-term tumor control of cavernous sinus meningiomas. J Neurosurgery 2002; 97: Samii M, Draf W: Surgery of Skull Base: an Interdisciplinary Approach. Berlin: Springer, 1989; pp IwaI Y, Yamanaka K, Yasui T, et al: Gamma knife surgery for skull base meningiomas: the effectiveness of low-dose treatment. Surg Neurol 1999; 52: Goldsmith BJ, Wara WM, Wilson CB, et al: Postoperative irradiation for subtotally resected meningiomas. A retrospective analysis of 140 patients treated from 1967 to J Neurosurg 1994; 80: Author s address for correspondence Dr Yuguang Liu Department of Neurosurgery, Qilu Hospital, Shandong University, Jinan , China. qufj2000@mail.sdu.edu.cn 957

Impact of Gamma Knife Radiosurgery on the neurosurgical management of skull-base lesions: The Combined Approach

Impact of Gamma Knife Radiosurgery on the neurosurgical management of skull-base lesions: The Combined Approach Radiosurgery as part of the neurosurgical armamentarium: Educational Symposium November 24 th 2011 Impact of Gamma Knife Radiosurgery on the neurosurgical management of skull-base lesions: The Combined

More information

Original Article Surgical Management of Tentorial Meningiomas: Analysis of 14 Cases Experience

Original Article Surgical Management of Tentorial Meningiomas: Analysis of 14 Cases Experience Egyptian Journal of Neurosurgery Volume 29 / No. 1 / January - March 2014 39-44 Original Article Surgical Management of Tentorial Meningiomas: Analysis of 14 Cases Experience Ahmed M Zaater*, Mohamed I

More information

Dr. T. Venkat Kishan Asst. Prof Department of Radiodiagnosis

Dr. T. Venkat Kishan Asst. Prof Department of Radiodiagnosis Dr. T. Venkat Kishan Asst. Prof Department of Radiodiagnosis Schwannomas (also called neurinomas or neurilemmomas) constitute the most common primary cranial nerve tumors. They are benign slow-growing

More information

SPECIAL PAPER IN CELEBRATION OF PROF. YANG'S 50 YEARS CAREER IN MEDICINE

SPECIAL PAPER IN CELEBRATION OF PROF. YANG'S 50 YEARS CAREER IN MEDICINE JOURNAL OF OTOLOGY SPECIAL PAPER IN CELEBRATION OF PROF. YANG'S 50 YEARS CAREER IN MEDICINE ADVANCES IN SURGICAL TREATMENT OF ACOUSTIC NEUROMA HAN Dongyi,CAI Chaochan Acoustic Neuroma (AN) arises from

More information

Surgery of petroclival meningiomas. Recent surgical results and outcomes

Surgery of petroclival meningiomas. Recent surgical results and outcomes Romanian Neurosurgery (2015) XXIX (XXII) 1: 27-37 27 Surgery of petroclival meningiomas. Recent surgical results and outcomes Mugurel Radoi 1, Florin Stefanescu 1, Ram Vakilnejad 2, Lidia Gheorghitescu

More information

CASE REPORTS. Surgical Treatment of Cerebellopontine Angle Trigeminal Schwannoma Via a Retrosigmoid Intradural Approach: A Case Report

CASE REPORTS. Surgical Treatment of Cerebellopontine Angle Trigeminal Schwannoma Via a Retrosigmoid Intradural Approach: A Case Report CASE REPORTS Surgical Treatment of Cerebellopontine Angle Trigeminal Schwannoma Via a Retrosigmoid Intradural Approach: A Case Report Cédric Porret MD.,Christian Dubreuil MD. From the Otoneurosurgery Department,

More information

Otolaryngologist s Perspective of Stereotactic Radiosurgery

Otolaryngologist s Perspective of Stereotactic Radiosurgery Otolaryngologist s Perspective of Stereotactic Radiosurgery Douglas E. Mattox, M.D. 25 th Alexandria International Combined ORL Conference April 18-20, 2007 Acoustic Neuroma Benign tumor of the schwann

More information

Cerebellopontine angle (CPA) meningiomas are a. Stereotactic radiosurgery for cerebellopontine angle meningiomas. Clinical article

Cerebellopontine angle (CPA) meningiomas are a. Stereotactic radiosurgery for cerebellopontine angle meningiomas. Clinical article J Neurosurg 120:708 715, 2014 AANS, 2014 Stereotactic radiosurgery for cerebellopontine angle meningiomas Clinical article Seong-Hyun Park, M.D., Ph.D., 1,3,4 Hideyuki Kano, M.D., Ph.D., 1,3 Ajay Niranjan,

More information

Acoustic Neuroma. Presenting Signs and Symptoms of an Acoustic Neuroma:

Acoustic Neuroma. Presenting Signs and Symptoms of an Acoustic Neuroma: Acoustic Neuroma An acoustic neuroma is a benign tumor which arises from the nerves behind the inner ear and which may affect hearing and balance. The incidence of symptomatic acoustic neuroma is estimated

More information

Hemorrhagic vestibular schwannoma: an unusual clinical entity Case report

Hemorrhagic vestibular schwannoma: an unusual clinical entity Case report Neurosurg Focus 5 (3):Article 9, 1998 Hemorrhagic vestibular schwannoma: an unusual clinical entity Case report Dean Chou, M.D., Prakash Sampath, M.D., and Henry Brem, M.D. Departments of Neurological

More information

Submitted: Revised: Published:

Submitted: Revised: Published: ORIGINAL ARTICLE ASIAN JOURNAL OF MEDICAL SCIENCES A study assessing the post operative outcome in patients of acoustic schwannoma operated through retrosigmoid approach at tertiary care institutions-

More information

Internal Auditory Canal Involvement of Acoustic Neuromas: Surgical Correlates to Magnetic Resonance Imaging Findings

Internal Auditory Canal Involvement of Acoustic Neuromas: Surgical Correlates to Magnetic Resonance Imaging Findings Otology & Neurotology 22:92 96 200, Otology & Neurotology, Inc. Internal Auditory Canal Involvement of Acoustic Neuromas: Surgical Correlates to Magnetic Resonance Imaging Findings * Samuel H. Selesnick,

More information

Temporal Lobe Cystic Collection and Associated Oedema: A Rare Complication of Translabyrinthine Resection of Vestibular Schwannoma

Temporal Lobe Cystic Collection and Associated Oedema: A Rare Complication of Translabyrinthine Resection of Vestibular Schwannoma Open Access Case Report DOI: 10.7759/cureus.2217 Temporal Lobe Cystic Collection and Associated Oedema: A Rare Complication of Translabyrinthine Resection of Vestibular Schwannoma Abdurrahman Raeiq 1 1.

More information

Spatial Relationship between Vestibular Schwannoma and Facial Nerve on Three-dimensional T2-weighted Fast Spin-echo MR Images

Spatial Relationship between Vestibular Schwannoma and Facial Nerve on Three-dimensional T2-weighted Fast Spin-echo MR Images AJNR Am J Neuroradiol 21:810 816, May 2000 Spatial Relationship between Vestibular Schwannoma and Facial Nerve on Three-dimensional T2-weighted Fast Spin-echo MR Images Sabine Sartoretti-Schefer, Spyros

More information

External carotid blood supply to acoustic neurinomas

External carotid blood supply to acoustic neurinomas External carotid blood supply to acoustic neurinomas Report of two cases HARVEY L. LEVINE, M.D., ERNEST J. FERmS, M.D., AND EDWARD L. SPATZ, M.D. Departments of Radiology, Neurology, and Neurosurgery,

More information

Case Report Multiple Intracranial Meningiomas: A Review of the Literature and a Case Report

Case Report Multiple Intracranial Meningiomas: A Review of the Literature and a Case Report Case Reports in Surgery Volume 2013, Article ID 131962, 4 pages http://dx.doi.org/10.1155/2013/131962 Case Report Multiple Intracranial Meningiomas: A Review of the Literature and a Case Report F. Koech,

More information

Revision Surgery for Vestibular Schwannomas

Revision Surgery for Vestibular Schwannomas 528 Original Article Kevin A. Peng 1 Brian S. Chen 3 Mark B. Lorenz 2 Gregory P. Lekovic 1 Marc S. Schwartz 1 William H. Slattery 1 Eric P. Wilkinson 1 1 House Clinic, Los Angeles, California, United States

More information

MANAGEMENT OF ACOUSTIC NEUROMA. Mr Nigel Mendoza Consultant Neurosurgeon West London Neurosciences Centre Charing Cross Hospital

MANAGEMENT OF ACOUSTIC NEUROMA. Mr Nigel Mendoza Consultant Neurosurgeon West London Neurosciences Centre Charing Cross Hospital MANAGEMENT OF ACOUSTIC NEUROMA Mr Nigel Mendoza Consultant Neurosurgeon West London Neurosciences Centre Charing Cross Hospital Acoustic Neuroma Vestibular Schwannoma Benign tumour that arises from the

More information

DIRECT SURGERY FOR INTRA-AXIAL

DIRECT SURGERY FOR INTRA-AXIAL Kitakanto Med. J. (S1) : 23 `28, 1998 23 DIRECT SURGERY FOR INTRA-AXIAL BRAINSTEM LESIONS Kazuhiko Kyoshima, Susumu Oikawa, Shigeaki Kobayashi Department of Neurosurgery, Shinshu University School of Medicine,

More information

With advances in microsurgical techniques and the. Staged resection of large vestibular schwannomas. Clinical article

With advances in microsurgical techniques and the. Staged resection of large vestibular schwannomas. Clinical article J Neurosurg 116:1126 1133, 2012 Staged resection of large vestibular schwannomas Clinical article Ahmed M. Raslan, M.D., 1 James K. Liu, M.D., 3 Sean O. McMenomey, M.D., 1,2 and Johnny B. Delashaw Jr.,

More information

Results of Surgery of Cerebellopontine angle Tumors

Results of Surgery of Cerebellopontine angle Tumors Original Article Iranian Journal of Otorhinolaryngology, Vol. 27(1), Serial No.78, Jan 2015 Abstract Results of Surgery of Cerebellopontine angle Tumors Faramarz Memari 1, * Fatemeh Hassannia 1, Seyed

More information

The New England Journal of Medicine LONG-TERM OUTCOMES AFTER RADIOSURGERY FOR ACOUSTIC NEUROMAS

The New England Journal of Medicine LONG-TERM OUTCOMES AFTER RADIOSURGERY FOR ACOUSTIC NEUROMAS LONG-TERM OUTCOMES AFTER RADIOSURGERY FOR ACOUSTIC NEUROMAS DOUGLAS KONDZIOLKA, M.D., L. DADE LUNSFORD, M.D., MARK R. MCLAUGHLIN, M.D., AND JOHN C. FLICKINGER, M.D. ABSTRACT Background Stereotactic radiosurgery

More information

Meningioma tumor. Meningiomas are named according to their location (Fig. 1) and cause various symptoms: > 1

Meningioma tumor. Meningiomas are named according to their location (Fig. 1) and cause various symptoms: > 1 Meningioma tumor Overview A meningioma is a type of tumor that grows from the protective membranes, called meninges, which surround the brain and spinal cord. Most meningiomas are benign (not cancer) and

More information

25/06/2010. Scaricato da 1

25/06/2010. Scaricato da   1 Approcci chirurgici al Clivus DIPARTIMENTO DI NEUROCHIRURGIA SECONDA UNIVERSITÀ DI NAPOLI Prof. Aldo Moraci Surgical Anatomy of the Clivus Scaricato da www.sunhope.it 1 Midsagittal Section of the Skull

More information

Antonio De la Cruz, MD 27th Alexandria International Combined ORL Congress Alexandria, Egypt April 8, 2009

Antonio De la Cruz, MD 27th Alexandria International Combined ORL Congress Alexandria, Egypt April 8, 2009 ACOUSTIC NEUROMA TREATMENT OPTIONS 2009 27 th Alexandria International Combined ORL Congress Alexandria, Egypt April 10, 2009 AntonioDelaCruz Cruz, MD House Ear Institute Los Angeles, California Antonio

More information

Corresponding author - Dr.Krishnakumar M

Corresponding author - Dr.Krishnakumar M Chettinad Health City Medical Journal Original Article Karthikeyan KV*, Krishnakumar M**, Ramesh VG***, Siddarth G****, Jayendrapalan**** * Senior Consultant, Department of Neurosurgery, Chettinad Superspeciality

More information

Paraganglioma of the Skull Base. Ross Zeitlin, MD Medical College of Wisconsin Milwaukee, WI

Paraganglioma of the Skull Base. Ross Zeitlin, MD Medical College of Wisconsin Milwaukee, WI Paraganglioma of the Skull Base Ross Zeitlin, MD Medical College of Wisconsin Milwaukee, WI Case Presentation 63-year-old female presents with right-sided progressive conductive hearing loss for several

More information

Title. Author(s) Takahashi, Haruo. Issue Date Right.

Title. Author(s) Takahashi, Haruo. Issue Date Right. NAOSITE: Nagasaki University's Ac Title Author(s) Citation A case with posterior fossa epiderm symptoms caused by insufficiency of usefulness of free DICOM image view Takasaki, Kenji; Kumagami, Hidetaka

More information

Microsurgery for ruptured cerebellar arteriovenous malformations

Microsurgery for ruptured cerebellar arteriovenous malformations European Review for Medical and Pharmacological Sciences Microsurgery for ruptured cerebellar arteriovenous malformations S.-F. GONG 1,2, X.-B. WANG 1,3, Y.-Q. LIAO 1,2, T.-P. JIANG 1,2, J.-B. HE 1,2,

More information

Unilateral Vestibular Schwannomas in Childhood without Evidence of Neurofibromatosis: Experience of 10 Patients at a Single Institute

Unilateral Vestibular Schwannomas in Childhood without Evidence of Neurofibromatosis: Experience of 10 Patients at a Single Institute DOI: 10.5137/1019-5149.JTN.16283-15.1 Received: 06.10.2015 / Accepted: 28.12.2015 Published Online: 27.05.2016 Original Investigation Unilateral Vestibular Schwannomas in Childhood without Evidence of

More information

Evaluation of Variation in the Course of the Facial Nerve, Nerve Adhesion to Tumors, and Postoperative Facial Palsy in Acoustic Neuroma

Evaluation of Variation in the Course of the Facial Nerve, Nerve Adhesion to Tumors, and Postoperative Facial Palsy in Acoustic Neuroma Original Article 39 Evaluation of Variation in the Course of the Facial Nerve, Nerve Adhesion to Tumors, and Postoperative Facial Palsy in Acoustic Neuroma Tetsuro Sameshima 1 Akio Morita 1 Rokuya Tanikawa

More information

Postoperative Nerve Injury and Recurrence in Surgical Treatment of Head and Neck Schwannomas

Postoperative Nerve Injury and Recurrence in Surgical Treatment of Head and Neck Schwannomas Postoperative Nerve Injury and Recurrence in Surgical Treatment of Head and Neck Schwannomas SHU-HSIEN CHEN 1, PEI-YIEN TSAI 2, YEN-HUI 3 TSAI * AND CHIH-YING LIN 4 1 Institute of Health Industry Management

More information

Radiologic Evaluation of Petrous Apex Masses. Pavan Kavali, MS-IV Morehouse School of Medicine November 16, 2009

Radiologic Evaluation of Petrous Apex Masses. Pavan Kavali, MS-IV Morehouse School of Medicine November 16, 2009 Radiologic Evaluation of Petrous Apex Masses Pavan Kavali, MS-IV Morehouse School of Medicine November 16, 2009 Roadmap Petrous Apex Anatomy Patient D.S.: Clinical Presentation Differential diagnosis of

More information

Petroclival meningiomas resected via a combined transpetrosal approach: surgical outcomes in 60 cases and a new scoring system for clinical evaluation

Petroclival meningiomas resected via a combined transpetrosal approach: surgical outcomes in 60 cases and a new scoring system for clinical evaluation clinical article J Neurosurg 122:373 380, 2015 Petroclival meningiomas resected via a combined transpetrosal approach: surgical outcomes in 60 cases and a new scoring system for clinical evaluation Hiroki

More information

PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES

PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES CENTRAL NERVOUS SYSTEM MENINGIOMA CNS Site Group Meningioma Author: Dr. Norm Laperriere Date: February 20, 2018 1. INTRODUCTION 3 2. PREVENTION

More information

Primary Jugular Foramen Meningioma: Imaging Appearance and Differentiating Features

Primary Jugular Foramen Meningioma: Imaging Appearance and Differentiating Features ndré J. Macdonald 1 Karen L. Salzman 1 H. Ric Harnsberger 1 Erik Gilbert 2 lough Shelton 2 Received May 16, 2003; accepted after revision ugust 12, 2003. 1 Department of Diagnostic Radiology, University

More information

1 Tentorial Meningiomas Francesco Signorelli

1 Tentorial Meningiomas Francesco Signorelli Meta data Explanation Please review proofs carefully for typographical and factual errors only; mark corrections in the file using the discretion. Please read your chapter carefully to confirm that no

More information

Editorial Manager(tm) for Neurosurgery Manuscript Draft. Manuscript Number:

Editorial Manager(tm) for Neurosurgery Manuscript Draft. Manuscript Number: Editorial Manager(tm) for Neurosurgery Manuscript Draft Manuscript Number: Title: Evaluation of variation in the course of the facial nerve, nerve adhesion to tumors, and postoperative facial palsy in

More information

Removal of vestibular schwannoma and facial nerve preservation using small suboccipital retrosigmoid craniotomy

Removal of vestibular schwannoma and facial nerve preservation using small suboccipital retrosigmoid craniotomy 274 Original article Removal of vestibular schwannoma and facial nerve preservation using small suboccipital retrosigmoid craniotomy CHEN Ling, CHEN Li-hua, LING Feng, LIU Yun-sheng, Madjid Samii and Amir

More information

Rapid recurrence of a malignant meningioma: case report

Rapid recurrence of a malignant meningioma: case report Romanian Neurosurgery Volume XXXI Number 2 2017 April-June Article Rapid recurrence of a malignant meningioma: case report Oguz Baran, Sima Sayyahmeli, Taner Tanriverdi, Pamir Erdincler TURKEY DOI: 10.1515/romneu-2017-0027

More information

NON MALIGNANT BRAIN TUMOURS Facilitator. Ros Taylor Advanced Neurosurgical Nurse Practitioner Southmead Hospital Bristol

NON MALIGNANT BRAIN TUMOURS Facilitator. Ros Taylor Advanced Neurosurgical Nurse Practitioner Southmead Hospital Bristol NON MALIGNANT BRAIN TUMOURS Facilitator Ros Taylor Advanced Neurosurgical Nurse Practitioner Southmead Hospital Bristol Neurosurgery What will be covered? Meningioma Vestibular schwannoma (acoustic neuroma)

More information

Cerebellopontine Angle Masses June 2004

Cerebellopontine Angle Masses June 2004 TITLE: Cerebellopontine Angle Masses SOURCE: Grand Rounds Presentation, UTMB, Dept. of Otolaryngology DATE: June 2, 2004 RESIDENT PHYSICIAN: Alan L. Cowan, MD FACULTY ADVISOR: Arun Gadre, MD SERIES EDITORS:

More information

ACOUSTIC NEUROMAS. University of Florida ENT Clinic Patrick J. Antonelli, MD Matthew R. O Malley, MD

ACOUSTIC NEUROMAS. University of Florida ENT Clinic Patrick J. Antonelli, MD Matthew R. O Malley, MD ACOUSTIC NEUROMAS University of Florida ENT Clinic Patrick J. Antonelli, MD Matthew R. O Malley, MD Rev. 10.31.2011 ACOUSTIC TUMORS Acoustic tumors are non-malignant fibrous growths, originating from the

More information

Pure Intracavernous Sinus Epidermoid Cyst: Diffusion-Weighted (DW) and Constructive Interference in Steady State (CISS) Images 1

Pure Intracavernous Sinus Epidermoid Cyst: Diffusion-Weighted (DW) and Constructive Interference in Steady State (CISS) Images 1 Pure Intracavernous Sinus Epidermoid Cyst: Diffusion-Weighted (DW) and Constructive Interference in Steady State (CISS) Images 1 Suk Jin Park, M.D., In Kyu Yu, M.D., Min Sun Kim, M.D., Hyeon Mi Yoo, M.D.,

More information

Temporal Bone Carcinoma: Results of Surgery for Primary and Secondary Malignancies

Temporal Bone Carcinoma: Results of Surgery for Primary and Secondary Malignancies ORIGINAL ARTICLE Temporal Bone Carcinoma: Results of Surgery for Primary and Secondary Malignancies Milan Stankovic, M.D. From the Department of Otorhinolaryngology, Medical Faculty Nis, Serbia. Correspondence:

More information

RADIOLOGY TEACHING CONFERENCE

RADIOLOGY TEACHING CONFERENCE RADIOLOGY TEACHING CONFERENCE John Athas, MD Monica Tadros, MD Columbia University, College of Physicians & Surgeons Department of Otolaryngology- Head & Neck Surgery September 27, 2007 CT SCAN IMAGING

More information

Imaging Findings in Schwannomas of the Jugular Foramen

Imaging Findings in Schwannomas of the Jugular Foramen AJNR Am J Neuroradiol 21:1139 1144, June/July 2000 Imaging Findings in Schwannomas of the Jugular Foramen O. Petter Eldevik, Trygve O. Gabrielsen, and Eva A. Jacobsen BACKGROUND AND PURPOSE: Tumors of

More information

S urgical removal is the sole treatment for large acoustic

S urgical removal is the sole treatment for large acoustic 453 PAPER Removal of large acoustic neurinomas (vestibular schwannomas) by the retrosigmoid approach with no mortality and minimal morbidity I Yamakami, Y Uchino, E Kobayashi, A Yamaura, N Oka... See end

More information

Application of three-dimensional angiography in elderly patients with meningioma

Application of three-dimensional angiography in elderly patients with meningioma Application of three-dimensional angiography in elderly patients with meningioma Poster No.: C-0123 Congress: ECR 2012 Type: Scientific Paper Authors: X. Han, J. Chen, K. Shi; Haikou/CN Keywords: Neuroradiology

More information

Unit 18: Cranial Cavity and Contents

Unit 18: Cranial Cavity and Contents Unit 18: Cranial Cavity and Contents Dissection Instructions: The calvaria is to be removed without damage to the dura mater which is attached to the inner surface of the calvaria. Cut through the outer

More information

Selected radiosurgery cases from the Rotating Gamma Institute Debrecen, Hungary

Selected radiosurgery cases from the Rotating Gamma Institute Debrecen, Hungary Selected radiosurgery cases from the Rotating Gamma Institute Debrecen, Hungary László Bognár M.D., Ph.D., József G. Dobai M.D., Gábor Csiky and Imre Fedorcsák M.D., Ph.D. Department of Neurosurgery, Medical

More information

Year 2003 Paper two: Questions supplied by Tricia

Year 2003 Paper two: Questions supplied by Tricia question 43 A 42-year-old man presents with a two-year history of increasing right facial numbness. He has a history of intermittent unsteadiness, mild hearing loss and vertigo but has otherwise been well.

More information

List the tumours that may arise in CPA:

List the tumours that may arise in CPA: List the tumours that may arise in CPA: 1. Vestibular schwannoma: 75-90% 2. Meningioma: 5-10% 3. Epidermoid 5% 4. Cholesteatoma: 5% 5. Other schwannomas 2-5%: trigeminal is the most common (0.3% of intracranial

More information

Injury to the facial nerve is a common complication. Efficacy of facial nerve sparing approach in patients with vestibular schwannomas

Injury to the facial nerve is a common complication. Efficacy of facial nerve sparing approach in patients with vestibular schwannomas See the corresponding editorial in this issue, pp 915 916. J Neurosurg 115:917 923, 2011 Efficacy of facial nerve sparing approach in patients with vestibular schwannomas Clinical article Raqeeb Haque,

More information

Postoperative LINAC-Based Stereotactic Radiotherapy for Grade I Intracranial Meningioma in Subtype Classification

Postoperative LINAC-Based Stereotactic Radiotherapy for Grade I Intracranial Meningioma in Subtype Classification Postoperative LINAC-Based Stereotactic Radiotherapy for Grade I Intracranial Meningioma in Subtype Classification Peerapong Lueangapapong MD*, Mantana Dhanachai MD**, Ake Hansasuta MD* * Division of Neurosurgery,

More information

Recently, GKS has been regarded as a major therapeutic. Nervus intermedius dysfunction following Gamma Knife surgery for vestibular schwannoma

Recently, GKS has been regarded as a major therapeutic. Nervus intermedius dysfunction following Gamma Knife surgery for vestibular schwannoma J Neurosurg 118:566 570, 2013 AANS, 2013 Nervus intermedius dysfunction following Gamma Knife surgery for vestibular schwannoma Clinical article Seong-Hyun Park, M.D., 1 Kyu-Yup Lee, M.D., 2 and Sung-Kyoo

More information

Stereotactic radiosurgery in the management of acoustic neuromas associated with neurofibromatosis Type 2

Stereotactic radiosurgery in the management of acoustic neuromas associated with neurofibromatosis Type 2 Stereotactic radiosurgery in the management of acoustic neuromas associated with neurofibromatosis Type 2 Brian R. Subach, M.D., Douglas Kondziolka, M.D., M. Sc., F.R.C.S.(C), L. Dade Lunsford, M.D., F.A.C.S.,

More information

LONG-TERM FOLLOW-UP OF ACOUSTIC SCHWANNOMA RADIOSURGERY WITH MARGINAL TUMOR DOSES OF 12 TO 13 Gy

LONG-TERM FOLLOW-UP OF ACOUSTIC SCHWANNOMA RADIOSURGERY WITH MARGINAL TUMOR DOSES OF 12 TO 13 Gy doi:10.1016/j.ijrobp.2007.01.001 Int. J. Radiation Oncology Biol. Phys., Vol. 68, No. 3, pp. 845 851, 2007 Copyright 2007 Elsevier Inc. Printed in the USA. All rights reserved 0360-3016/07/$ see front

More information

A lthough more than 90% of intracranial meningiomas are

A lthough more than 90% of intracranial meningiomas are 226 PAPER Complications after gamma knife radiosurgery for benign meningiomas J H Chang, J W Chang, J Y Choi, Y G Park, S S Chung... See end of article for authors affiliations... Correspondence to: Professor

More information

Perforating branches from ovending arteries in hemifacial spasm: anatomical correlation with vertebrobasilar configuration

Perforating branches from ovending arteries in hemifacial spasm: anatomical correlation with vertebrobasilar configuration J Neurol Neurosurg Psychiatry 1999;67:73 77 73 Department of Neurosurgery, Nagoya University School of Medicine, Nagoya, Japan T Nagatani S Inao Y Suzuki J Yoshida Correspondence to: Dr T Nagatani, Department

More information

diagnostic and therapeutic aspects

diagnostic and therapeutic aspects e181 Case Report Glossopharyngeal schwannoma: diagnostic and therapeutic aspects Agrawal A, Pandit L, Bhandary S, Makannavar J H, Srikrishna U ABSTRACT Among posterior fossa tumours, schwannomas arising

More information

Operative management of trigeminal neuromas: an analysis of a surgical experience with 55 cases

Operative management of trigeminal neuromas: an analysis of a surgical experience with 55 cases Acta Neurochir (2014) 156:1105 1114 DOI 10.1007/s00701-014-2051-7 CLINICAL ARTICLE - BRAIN TUMORS Operative management of trigeminal neuromas: an analysis of a surgical experience with 55 cases Li-feng

More information

Schwannoma of the intermediate nerve

Schwannoma of the intermediate nerve J Neurosurg 109:144 148, 2008 Schwannoma of the intermediate nerve Case report CHRISTIAN SCHELLER, M.D., 1 JENS RACHINGER, M.D., 1 JULIAN PRELL, M.D., 1 MALTE KORNHUBER, M.D., 2 AND CHRISTIAN STRAUSS,

More information

Neurosurgery 72[ONS Suppl 2]:ons103 ons115, 2013

Neurosurgery 72[ONS Suppl 2]:ons103 ons115, 2013 TUMOR Operative Nuances Contemporary Surgical Management of Vestibular Schwannomas: Analysis of Complications and Lessons Learned Over the Past Decade Yoichi Nonaka, MD, PhD* Takanori Fukushima, MD, DMSc*

More information

Comparison of Growth Patterns of Acoustic Neuromas With and Without Radiosurgery

Comparison of Growth Patterns of Acoustic Neuromas With and Without Radiosurgery Otology & Neurotology 27:705 Y 712 Ó 2006, Otology & Neurotology, Inc. Comparison of Growth Patterns of Acoustic Neuromas With and Without Radiosurgery *Alex Battaglia, Bill Mastrodimos, and *Roberto Cueva

More information

Update on Pediatric Brain Tumors

Update on Pediatric Brain Tumors Update on Pediatric Brain Tumors David I. Sandberg, M.D. Director of Pediatric Neurosurgery & Associate Professor Dr. Marnie Rose Professorship in Pediatric Neurosurgery Pre-talk Questions for Audience

More information

Clinical analysis of preoperative embolization combined with Kawase approach in patients with petroclival meningioma.

Clinical analysis of preoperative embolization combined with Kawase approach in patients with petroclival meningioma. Biomedical Research 2018; 29 (6): 1128-1132 ISSN 0970-938X www.biomedres.info Clinical analysis of preoperative embolization combined with Kawase approach in patients with petroclival meningioma. Wei Tao

More information

Introduction to Neurosurgical Subspecialties:

Introduction to Neurosurgical Subspecialties: Introduction to Neurosurgical Subspecialties: Tumor and Skull Base Neurosurgery Brian L. Hoh, MD 1 and Gregory J. Zipfel, MD 2 1 University of Florida, 2 Washington University Tumor / Skull Base Neurosurgery

More information

Ve s t i b u l a r schwannomas are benign tumors that. Sporadic unilateral vestibular schwannoma in the pediatric population.

Ve s t i b u l a r schwannomas are benign tumors that. Sporadic unilateral vestibular schwannoma in the pediatric population. J Neurosurg Pediatrics 4:000 000, 4:125 129, 2009 Sporadic unilateral vestibular schwannoma in the pediatric population Clinical article Br i a n P. Wa l c o t t, M.D., 1,2 Ga n e s h Si va r a ja n, B.S.,

More information

Dynamic MRI of meningiomas and schwannomas: is differential diagnosis possible?

Dynamic MRI of meningiomas and schwannomas: is differential diagnosis possible? Neuroradiology (1997) 39: 633 638 Springer-Verlag 1997 DIAGNOSTIC NEURORADIOLOGY I. Ikushima Y. Korogi J. Kuratsu T. Hirai S. Hamatake M. Takahashi Y. Ushio Dynamic MRI of meningiomas and schwannomas:

More information

Solitary paraganglioma of the hypoglossal nerve: A case report with magnetic resonance imaging findings

Solitary paraganglioma of the hypoglossal nerve: A case report with magnetic resonance imaging findings ISSN 1507-6164 DOI: 10.12659/AJCR.889509 Received: 2013.06.30 Accepted: 2013.07.16 Published: 2013.10.18 : A case report with magnetic resonance imaging findings Authors Contribution: Study Design A Data

More information

Major Anatomic Components of the Orbit

Major Anatomic Components of the Orbit Major Anatomic Components of the Orbit 1. Osseous Framework 2. Globe 3. Optic nerve and sheath 4. Extraocular muscles Bony Orbit Seven Bones Frontal bone Zygomatic bone Maxillary bone Ethmoid bone Sphenoid

More information

ABSTRACT INTRODUCTION

ABSTRACT INTRODUCTION /, 2017, Vol. 8, (No. 27), pp: 44819-44823 After microvascular decompression to treat trigeminal neuralgia, both immediate pain relief and recurrence rates are higher in patients with arterial compression

More information

Skull Base Course. Dissection with fresh temporal bones and half heads

Skull Base Course. Dissection with fresh temporal bones and half heads Skull Base Course Dissection with fresh temporal bones and half heads 711 November 2016 Gruppo Otologico Via Emmanueli 42 Piacenza 29122 t +39 0523 754 362 fax +39 0523 453 708 www.gruppootologico.com

More information

Neurovascular elements of the PCF

Neurovascular elements of the PCF Level I: Neurovascular elements of the PCF Trigeminal and Abducent Superior cerebellar artery and vein Dandy s vein Level II: Facial and Cochleovestibular AICA and internal auditory artery, veins Level

More information

Case Report Malignant Transformation Six Months after Removal of Intracranial Epidermoid Cyst: A Case Report

Case Report Malignant Transformation Six Months after Removal of Intracranial Epidermoid Cyst: A Case Report Case Reports in Neurological Medicine Volume 2011, Article ID 525289, 4 pages doi:10.1155/2011/525289 Case Report Malignant Transformation Six Months after Removal of Intracranial Epidermoid Cyst: A Case

More information

Case Report Squamous Cell Carcinoma of the External Auditory Canal: ACaseReport

Case Report Squamous Cell Carcinoma of the External Auditory Canal: ACaseReport Case Reports in Otolaryngology Volume 2011, Article ID 615210, 4 pages doi:10.1155/2011/615210 Case Report Squamous Cell Carcinoma of the External Auditory Canal: ACaseReport Harry Boamah, 1 Glenn Knight,

More information

Intraoperative monitoring of foramen occipitalis magnum meningiomas surgery significantly improves the preservation of neurological functions

Intraoperative monitoring of foramen occipitalis magnum meningiomas surgery significantly improves the preservation of neurological functions Activitas Nervosa Superior Rediviva Volume 57 No. 3 2015 This paper has been published under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) allowing to download

More information

The translabyrinthine approach has been

The translabyrinthine approach has been OPERATIVE NUANCES TRANSLABYRINTHINE APPROACH FOR ACOUSTIC NEUROMA John Diaz Day, M.D. Department of Neurosurgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, and Allegheny General

More information

pissn: eissn: A El Naggar et al. Alexandria Bulletin 247

pissn: eissn: A El Naggar et al. Alexandria Bulletin 247 A El Naggar et al. Alexandria Bulletin 247 SKULL BASE SURGERY OF NON VESTIBULAR SCHWANNOMAS OF THE POSTERIOR CRANIAL FOSSA Alaa El Naggar MD, 1 Ahmad farhood MD, 1 Osama Abdel Aziz MD, 1 Fathy Abdel Baky

More information

S tereotactic radiosurgery, whether delivered by a gamma

S tereotactic radiosurgery, whether delivered by a gamma 1536 PAPER Gamma knife stereotactic radiosurgery for unilateral acoustic neuromas J G Rowe, M W R Radatz, L Walton, A Hampshire, S Seaman, A A Kemeny... See end of article for authors affiliations... Correspondence

More information

Case Report Intracranial Capillary Hemangioma in the Posterior Fossa of an Adult Male

Case Report Intracranial Capillary Hemangioma in the Posterior Fossa of an Adult Male Case Reports in Radiology Volume 2016, Article ID 6434623, 4 pages http://dx.doi.org/10.1155/2016/6434623 Case Report Intracranial Capillary Hemangioma in the Posterior Fossa of an Adult Male Jordan Nepute,

More information

Meningiomas of the clivus have been traditionally

Meningiomas of the clivus have been traditionally PETROCLIVAL MENINGIOMA AN ATTEMPT TO DEFINE THE ROLE OF SKULL BASE APPROACHES IN THEIR SURGICAL MANAGEMENT Aldo Spallone, M.D.,t Uvais B. Makhmudov, M.D.,* Dulat 1. Mukhamedjanov, M.D.,* and Vassilij A.

More information

Skullbase Lesions. Skullbase Surgery Open vs endoscopic. Choice Of Surgical Approaches 12/28/2015. Skullbase Surgery: Evolution

Skullbase Lesions. Skullbase Surgery Open vs endoscopic. Choice Of Surgical Approaches 12/28/2015. Skullbase Surgery: Evolution Skullbase Lesions Skullbase Surgery Open vs endoscopic Prof Asim Mahmood,FRCS,FACS,FICS,FAANS, Professor of Neurosurgery Henry Ford Hospital Detroit, MI, USA Anterior Cranial Fossa Subfrontal meningioma

More information

Acoustic Neuroma (vestibular schwannoma)

Acoustic Neuroma (vestibular schwannoma) 1 2 Acoustic Neuroma (vestibular schwannoma) Overview An acoustic neuroma is a tumor that grows from the nerves responsible for balance and hearing. These tumors grow from the sheath covering the vestibulocochlear

More information

Surgical Anatomy of the Temporal Bone and Measurements of the Skull Base for Transpetrosal Approaches

Surgical Anatomy of the Temporal Bone and Measurements of the Skull Base for Transpetrosal Approaches Okajimas Folia Anat. Jpn., 75(1): 33-40, May, 1998 Surgical Anatomy of the Temporal Bone and Measurements of the Skull Base for Transpetrosal Approaches Mustafa BOZBUGA, Adnan OZTURK, Zafer ARI, Kayihan

More information

The dura is sensitive to stretching, which produces the sensation of headache.

The dura is sensitive to stretching, which produces the sensation of headache. Dural Nerve Supply Branches of the trigeminal, vagus, and first three cervical nerves and branches from the sympathetic system pass to the dura. Numerous sensory endings are in the dura. The dura is sensitive

More information

What cranial nerves can we monitor?

What cranial nerves can we monitor? What cranial nerves can we monitor? Laura Hemmer, M.D. SNACC Neuromonitoring Subcommittee Linda Aglio, M.D., M.S. Laura Hemmer, M.D. Antoun Koht, M.D. David L. Schreibman, M.D. What cranial nerve (CN)

More information

What Is an Arteriovenous malformation (AVM)?

What Is an Arteriovenous malformation (AVM)? American Society of Neuroradiology What Is an Arteriovenous malformation (AVM)? From the Cerebrovascular Imaging and Intervention Committee of the American Heart Association Cardiovascular Council Randall

More information

137 Hands-on Course in LATERAL SKULL BASE SURGERY

137 Hands-on Course in LATERAL SKULL BASE SURGERY October 23 rd, 2017 137 Hands-on Course in LATERAL SKULL BASE SURGERY October 23 rd -27 th 2017 GRUPPO OTOLOGICO Piacenza Rome Italy CASE #1 Left IAC tumor Age 59 years Sex Female History - Mild left-sided

More information

Clinical features of intracranial vestibular schwannomas

Clinical features of intracranial vestibular schwannomas ONCOLOGY LETTERS 5: 57-62, 2013 Clinical features of intracranial vestibular schwannomas XIANG HUANG *, JIAN XU *, MING XU, LIANG FU ZHOU, RONG ZHANG, LIQIN LANG, QIWU XU, PING ZHONG, MINGYU CHEN, YING

More information

Acoustic Neuroma (vestibular schwannoma) basic level

Acoustic Neuroma (vestibular schwannoma) basic level Acoustic Neuroma (vestibular schwannoma) basic level Overview An acoustic neuroma is a tumor that grows from the nerves responsible for balance and hearing. More accurately called vestibular schwannoma,

More information

Cranial Cavity REFERENCES: OBJECTIVES OSTEOLOGY. Stephen A. Gudas, PT, PhD

Cranial Cavity REFERENCES: OBJECTIVES OSTEOLOGY. Stephen A. Gudas, PT, PhD Stephen A. Gudas, PT, PhD Cranial Cavity REFERENCES: Moore and Agur, Essential Clinical Anatomy (ECA), 3rd ed., pp. 496 498; 500 507; 512 514 Grant s Atlas 12 th ed., Figs 7.6; 7.19 7.30. Grant s Dissector

More information

Vertebrobasilar Insufficiency

Vertebrobasilar Insufficiency Equilibrium Res Vol. (3) Vertebrobasilar Insufficiency Toshiaki Yamanaka Department of Otolaryngology-Head and Neck Surgery, Nara Medical University School of Medicine Vertebrobasilar insufficiency (VBI)

More information

Brain ميهاربا لض اف دمح ا د The Meninges 1- Dura Mater of the Brain endosteal layer does not extend meningeal layer falx cerebri tentorium cerebelli

Brain ميهاربا لض اف دمح ا د The Meninges 1- Dura Mater of the Brain endosteal layer does not extend meningeal layer falx cerebri tentorium cerebelli .احمد د فاضل ابراهيم Lecture 15 Brain The Meninges Three protective membranes or meninges surround the brain in the skull: the dura mater, the arachnoid mater, and the pia mater 1- Dura Mater of the Brain

More information

Alessandra Gorgulho, MD, MSc

Alessandra Gorgulho, MD, MSc Manejo do Meningioma que compromete o seio cavernoso: quando eu irradio Alessandra Gorgulho, MD, MSc Chefe Clínico-Científica Centro HCor de Neurociências Professora Visitante, Departamento de Neurocirurgia,

More information

Skull-2. Norma Basalis Interna. Dr. Heba Kalbouneh Assistant Professor of Anatomy and Histology

Skull-2. Norma Basalis Interna. Dr. Heba Kalbouneh Assistant Professor of Anatomy and Histology Skull-2 Norma Basalis Interna Dr. Heba Kalbouneh Assistant Professor of Anatomy and Histology Norma basalis interna Base of the skull- superior view The interior of the base of the skull is divided into

More information

CHONDROSARCOMAS OF THE TEMPORAL BONE PRESENTATION AND MANAGEMENT

CHONDROSARCOMAS OF THE TEMPORAL BONE PRESENTATION AND MANAGEMENT CHONDROSARCOMAS OF THE TEMPORAL BONE PRESENTATION AND MANAGEMENT Authors Mr Mallappa Raghu FRCS, Clinical Research Fellow Mr Ioannis Moumoulidis MRCS, Clinical Research Fellow Mr Ranit De, FRCS (ORL-HNS),

More information

Surgical Treatment of Olfactory Groove Meningioma

Surgical Treatment of Olfactory Groove Meningioma Med. J. Cairo Univ., VoL 81, No. 1, March: 133-137, 2013 www.medicaljournalofcairouniversity.com Surgical Treatment of Olfactory Groove Meningioma AHMED ELSAWAF, M.D., Ph.D. The Department of Neurosurgery,

More information

Neuro Vascular Relationship between Superior Cerebellar Artery and Trigeminal Nerve

Neuro Vascular Relationship between Superior Cerebellar Artery and Trigeminal Nerve Neuro Vascular Relationship between Superior Cerebellar Artery and Trigeminal Nerve Pages with reference to book, From 140 To 143 Nawab Mohammad Khan, Mohammad Afzal Khan, Fazal Karim Aasi ( Department

More information