Answers:
Which of the following approaches to a CPA tumor is hearing ablative?
A) Retrosigmoid
B) Middle Fossa
C) Translabyrinthine
D) They can all be hearing preserving as long as care is taken not to damage vital hearing structures
E) They are all hearing ablative
MC Questions:
What percentage of CPA tumors are not vestibular schwannomas?
A) 5%
B) 20%
C) 50%
D) 80%
E) 95%
A) Retrosigmoid
B) Middle Fossa
C) Translabyrinthine
D) They can all be hearing preserving as long as care is taken not to damage vital hearing structures
E) They are all hearing ablative
The translabyrinthine approach is hearing ablative whereas the retrosigmoid and middle fossa approaches can keep hearing intact.
When is observation an adequate management strategy for vestibular schwannomas?
Observation is reasonable in older patients or in pts where the tumor does not appear to be growing significantly.
What percentage of CPA tumors are not vestibular schwannomas?
A) 5%
B) 20%
C) 50%
D) 80%
E) 95%
Free Response Question:
What factors should prompt testing for NF2 in a patient who presents w/ a CPA tumor?
Quick Facts:
Treatment of CPA meningiomas
-can observe or use stereotactic radiotherapy if pt has limited life expectancy or not surgical candidate, otherwise treat w/ surgery.
-ideal surgery consists of total meningioma removal and excision of surrounding dura w/ drilling of underlying bone.
-Surgical approach depends on location of tumor and pts hearing.
-Meningiomas medial to the IAC are more common.
-arise along inferior petrosal sinus and involve petrous apex, lateral clivus and meckel cave.
-Meningiomas lateral to IAC involve the sigmoid sinus, jugular bulb and superior petrosal sinus.
-Approach these via retrosigmoidal approach as facial nerve is often displaced anteriorly so a retro sigmoid approach does not place the nerve between the surgeon dn the tumor. Also allows for hearing preservation.
-Limited intracanalicular meningiomas can be managed by middle cranial fossa approach to preserve hearing or translabyrinthine if pt has poor/no hearing.
-If meningioma invades cochlear or extends to clivus or meckle cave than transcochlear approach is warranted.
-60% of CPA meningiomas involve middle fossa and may need craniotomy of combine middle/posterior fossae.
Prognosis
-Total tumor removal achieved in 70-85% of cases.
-Non total removal often due to adherence to brainstem or cavernous sinus involvement.
-Long term recurrence is 10-30% if all removed, 50% if some left behind.
-Hearing preservation is ~70% (more than schwannomas)
What factors should prompt testing for NF2 in a patient who presents w/ a CPA tumor?
Quick Facts:
Treatment of CPA meningiomas
-can observe or use stereotactic radiotherapy if pt has limited life expectancy or not surgical candidate, otherwise treat w/ surgery.
-ideal surgery consists of total meningioma removal and excision of surrounding dura w/ drilling of underlying bone.
-Surgical approach depends on location of tumor and pts hearing.
-Meningiomas medial to the IAC are more common.
-arise along inferior petrosal sinus and involve petrous apex, lateral clivus and meckel cave.
-Meningiomas lateral to IAC involve the sigmoid sinus, jugular bulb and superior petrosal sinus.
-Approach these via retrosigmoidal approach as facial nerve is often displaced anteriorly so a retro sigmoid approach does not place the nerve between the surgeon dn the tumor. Also allows for hearing preservation.
-Limited intracanalicular meningiomas can be managed by middle cranial fossa approach to preserve hearing or translabyrinthine if pt has poor/no hearing.
-If meningioma invades cochlear or extends to clivus or meckle cave than transcochlear approach is warranted.
-60% of CPA meningiomas involve middle fossa and may need craniotomy of combine middle/posterior fossae.
Prognosis
-Total tumor removal achieved in 70-85% of cases.
-Non total removal often due to adherence to brainstem or cavernous sinus involvement.
-Long term recurrence is 10-30% if all removed, 50% if some left behind.
-Hearing preservation is ~70% (more than schwannomas)
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