Cerebellopontine angle meningiomas (cpam)--clinical characteristics and surgical results

About 10% of the tumourous lesions in the cerebellopontine angle are meningiomas according to the literature. Evidently, these tumours differ from the other lesions by their clinical presentation as well as by the surgical results, which will be presented in the following article.

We report on 26 patients (22 females, 4 males: age distribution 45-81 years, mean 63 years) operated on CPAM's in the last 8 years. Clinical history lasted from 2 weeks to 9 years (mean 17 months). Cerebellar symptoms were the most frequent findings (n = 22), followed by cranial nerve (V, VII, and VIII) deficits (n = 12) and signs of increased intracranial pressure (n = 7). In 3 clinically asymptomatic cases the lesion was found incidentally, and there was 1 patient with a recurrent lesion. The radiological procedures included CT-scan in 17 patients, MR-imaging in 18, MR-angiography in 2 cases and angiography in 2 cases. Hydrocephalus was demonstrated in 8 cases. Tumour size ranged from 2.8 to 7 cm (mean 4.2 cm). All patients underwent osteoclastic craniotomy with complete tumour removal. Temporary CSF-drainage was necessary in 8 cases, monitoring was done in 9 patients.

Postoperative follow-up period ranged from 3 months to 5 years (mean 2.5 years). After 1 month, 14 patients were discharged home and 12 were transferred into other hospitals in good condition. Improvement was achieved in 19 cases, 5 patients were equal to their preoperative situation, in one case a temporary deterioration with tetraparesis and in 1 case deterioration of hearing was found. After an average follow-up of 2.5 years, 22 patients were self-sufficient without or with minimal neurological deficits at home, 2 were moderately disabled and 2 died in the meantime due to other diseases. Among the operative complications, we observed 3 CSF-fistulas, 1 requiring surgical reexploration as well as 1 rebleeding and additionally 1 meningitis. Non-surgical complications were found in 5 patients.

Cerebellar ataxia and impairment of hearing are the clinical leading symptoms of CPAM's. At diagnosis, these tumours are impressively large, but the operative results are very favourable with low morbidity and excellent prognosis.