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Preoperative Management of CP Angle Tumor
Preoperative Management of CP Angle Tumor
CP ANGLE TUMOR.
Dr.SHABIH AYESHAH.
RESIDENT NEUROSURGERY.
PRESENTATION.
Audiometric Testing.
Electrophysiologic Testing.
CT Brain contrast with bone cuts.
MRI brain contrast
Audiometric Testing.
Pure‐tone testing: – SNHL‐ most commonly high frequency (65%).
Speech discrimination: – Scores out of proportion with pure‐tone thresholds.
Acoustic reflex thresholds: – typically elevated or absent. – If present then
reflex decay measured. – The sensitivity is 85% for detecting retrocochlear
problem.
Electrophysiologic Testing.
ABR: Most sensitive & specific audiologic test. •
In patients with VS , the ABR is partially or completely absent , or there is a
delay in latency of wave V on the affected side.
RADIOLOGICAL FINDINGS IN DIFFERENT CP ANGLE TUMORS.
VESTIBULAR SCHWANNOMA.
CT – Non‐contrast: usually isodense to brain, calcification is rare
– IV Contrast: Over 90% of non‐treated tumors enhance
homogenously.
MRI – T1W – isointense to brain, hyperintense to CSF
– T2W – hyperintense to brain, iso/hypo‐intense to CSF
– Intense enhancement of tumor on T1C
MENINGIOMA.
CT scan: -Noncontrast; slightly increased density
- IV Contrast; enhances uniformly.
-Hyperostosis of the cranial vault may also be seen.
Observation
Surgical resection
Radiotherapy (EBRT, FSRT, SRS)
OBSERVATION.
Indications.
– Advanced age
– Poor health
– Lack of symptoms
– Non progression of symptoms
– Only hearing ear
Contraindications.
– Young patient
– Healthy patient
– Symptomatic progression
– Compression of brainstem structures
MRI recommended every 6 to 12 months in patients without baseline hearing
loss and stable or slow growth rates, especially elderly patients.
30%-50% of tumors show no growth or regression on serial imaging studies
Growth rate is highest for those that grow in first year.
Progressive decrease in rate of growth if growth starts later.
No predictive relationship between growth rate and tumor size at
presentation.
Stereotactic Radiosurgery.
Indications.
– Small tumors
– Functional hearing
– Older patients (>75)
– Medically unstable patients
– Small residual lesion
Contraindications
– Tumors > 3 cm
– Prior radiotherapy
– Tumor compressing brainstem
GOALS OF GAMMA KNIFE TREATMENT:
1. Arrest tumor growth.
2. Preserve facial nerve function.
3. Preserve trigeminal nerve function.
4. Preserve hearing.
APPROACHES.
1. Retromastoid suboccipital (retrosigmoid).
2. Middle cranial fossa (transtemporal).
3. Translabyrinthine.
4. Retrolabyrinthine.