“CEREBELLOPONTINE ANGLE TUMORS IN THE SITTING POSITION: A PROSPECTIVE EVALUATION OF CLINICORADIOLOGICAL, HISTOPATHOLOGICAL CORRELATION AND SURGICAL OUTCOMES VIA THE RETROSIGMOID APPROACH”
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Keywords
Cerebellopontine angle tumors; Vestibular schwannoma; Meningioma; Epidermoid ; Retrosigmoid approach; Facial nerve preservation; Post-operative complication.
Abstract
Background:
Cerebellopontine angle (CPA) tumors represent 5–10% of all intracranial neoplasms, most commonly vestibular schwannomas, followed by meningiomas and epidermoid cysts. Advances in microsurgical and anesthetic techniques have significantly improved outcomes, shifting the focus from mere excision to functional preservation.
Objective:
To evaluate the clinico-radiological and histopathological characteristics, surgical outcomes, and prognostic factors influencing results in patients with CPA tumors.
Methods:
This prospective study included 40 patients with CPA tumors who underwent surgical treatment at the Department of Neurosurgery, G.R. Medical College, Gwalior, between January 2023 and September 2024. Clinical features, MRI findings, surgical approach, extent of resection, postoperative complications, and outcomes were analyzed. Facial nerve function was graded using the House–Brackmann scale, and hearing was assessed by pure-tone audiometry. Statistical analysis was performed using SPSS version 20.0.
Results:
The mean age was in the 3rd–5th decade, with a slight male predominance (52.5%). Sensorineural hearing loss (90%), headache (87.5%), and cerebellar signs (82.5%) were the most common symptoms. Vestibular schwannoma was the predominant histopathology (82.5%). Gross total excision was achieved in 82.5% of cases, near-total in 10%, and subtotal in 7.5%. Anatomical preservation of the facial nerve was achieved in 80.6% of patients. CSF leak occurred in 5%, meningitis in 10%, and overall mortality was 5%. Recurrence occurred in two patients (5.26%) during follow-up.
Conclusion:
Cerebellopontine angle (CPA) tumors predominantly affected middle-aged individuals with a slight male preponderance. Most patients presented with hearing loss, headache, and cerebellar symptoms, and the majority had giant lesions with non-serviceable hearing. Vestibular schwannoma was the most common histopathological type. The retrosigmoid approach in the semi-sitting position provided excellent exposure and high rates of gross total excision. Advances in microsurgical techniques have improved facial nerve preservation and functional outcomes, though facial nerve palsy remained the most frequent complication. Cerebrospinal fluid (CSF) leak and meningitis persisted as major causes of morbidity and accounted for a postoperative mortality rate of 5%.
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Dr Deepak Jaiswal
MCh Neurosugery Senior resident, Department of Neurosurgery, Gajra Raja Medical college, Gwalior, M.P.,
Dr Anand Sharma
Associate Professor, Department of Neurosurgery, Gajra Raja medical college, Gwalior, M.P,
Dr Amol Aaglave
MCh Neurosugery Senior resident, Department of Neurosurgery, Gajra Raja Medical college, Gwalior, M.P.,
Dr Avinash Sharma
Professor and Head, Department of Neurosurgery, Gajra Raja medical college, Gwalior, M.P.
Dr Jyoti Priyadarshini Shrivastava
Professor, Department of Pathology, Gajra Raja medical college, Gwalior, M.P.
Dr Avdhesh Shukla
Professor, Department of Neurosurgery, Gajra Raja medical college, Gwalior, M.P.