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Published on: May 26, 2023
Cavernous hemangiomas of the internal auditory canal and cerebellopontine angle
Michael S Oldenburg1, Matthew L Carlson, Kathryn M Van Abel
1*Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota; †Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; and ‡Departments of Anatomic Pathology, and §Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, U.S.A.
Insights
Cavernous hemangiomas (CHs) in the internal auditory canal (IAC) and cerebellopontine angle (CPA) are rare. Microsurgery offers good facial nerve outcomes and tumor control, but hearing loss is common after treatment.
Area of Science:
- Neurosurgery
- Otolaryngology
- Neurology
Background:
- Cavernous hemangiomas (CHs) are rare vascular malformations that can occur in the internal auditory canal (IAC) and cerebellopontine angle (CPA).
- These tumors can present with symptoms similar to more common conditions like vestibular schwannoma, making diagnosis challenging.
Purpose of the Study:
- To review the clinical presentation, differential diagnosis, management strategy, and outcomes of microsurgical resection for CHs in the IAC and CPA.
- To evaluate the efficacy of microsurgical resection in preserving facial nerve function and achieving tumor control.
Main Methods:
- A retrospective review of 12 patients with primary CHs of the IAC and CPA who underwent microsurgical resection between 1982 and 2012.
- Preoperative imaging, surgical approach (translabyrinthine, retrosigmoid, middle cranial fossa), extent of resection (gross total or subtotal), and postoperative outcomes were analyzed.
Main Results:
- The most common symptoms were sensorineural hearing loss, tinnitus, and vertigo. Three patients had facial paresis, and 10 had pre-existing serviceable hearing loss.
- Median tumor size was 8 mm. Eight CHs were IAC-confined, and four involved the CPA. Gross total resection was achieved in 10 patients.
- No patient with serviceable preoperative hearing retained useful hearing post-surgery. Eight of nine patients with normal preoperative facial nerve function maintained House-Brackmann grade 1 function.
Conclusions:
- Primary CHs of the IAC and CPA are rare and mimic vestibular schwannoma clinically and radiographically.
- Microsurgical resection is effective for achieving excellent facial nerve outcomes and tumor control.
- Despite successful surgery, most patients experience non-serviceable hearing, either from the tumor itself or the treatment.
Objective:
To review the clinical presentation, differential diagnosis, management strategy, and outcomes after microsurgical resection of cavernous hemangiomas (CHs) arising primarily within the internal auditory canal (IAC) and cerebellopontine angle (CPA).
Patients:
Twelve patients (10 men; aged 18-66 yr) were included from 1982 to 2012 from one of two tertiary academic referral centers.
Intervention(S):
All patients underwent preoperative imaging evaluation and subsequent microsurgical resection.
Main Outcome Measure(S):
American Academy of Otolaryngology-Head and Neck Surgery hearing class, facial nerve function, and tumor control.
Results:
The most common presenting symptoms were ipsilateral sensorineural hearing loss, nonpulsatile tinnitus, and vertigo. Three presented with facial paresis, 10 had lost serviceable hearing preoperatively. All lesions demonstrated heterogeneous enhancement with gadolinium and hyperintense signal on T2-weighted imaging. The median tumor diameter was 8 mm; eight CHs were confined to the IAC, whereas four involved the CPA. Tumors were accessed via a translabyrinthine approach in eight cases, retrosigmoid craniotomy in three cases, and a middle cranial fossa approach in one case. Ten patients received gross total resection, whereas two underwent subtotal removal. Neither patient with serviceable preoperative hearing retained useful hearing after resection. Eight of the nine patients with normal preoperative facial nerve function retained House-Brackmann grade 1 function after surgery. One patient had residual tumor treated with postoperative stereotactic radiosurgery.
Conclusions:
Primary CHs of the IAC and CPA are rare and present clinically and radiographically similar to vestibular schwannoma. Microsurgical resection provides excellent facial nerve outcomes and tumor control for most patients; however, the majority of individuals will acquire non-serviceable hearing either from disease or as a result of treatment.
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