Primary Epidermoid Tumors of the Cerebellopontine Angle

A Review of 47 Cases

Robert J. Yawn, Neil S. Patel, Colin L. Driscoll, Michael J. Link, David S. Haynes, George B. Wanna, Reid C. Thompson, Matthew L. Carlson

Research output: Contribution to journalReview article

5 Citations (Scopus)

Abstract

Objective: To analyze disease presentation, treatment, and clinical course of a consecutive series of patients with primary cerebellopontine angle (CPA) epidermoids. Patients: Forty-seven consecutive patients with previously untreated CPA epidermoids. Intervention(s): Observation and microsurgery. Main Outcome Measures: Disease- and treatment-associated morbidity, recurrence. Results: Forty-seven patients (mean age 39 years; 53% women) were analyzed and the average duration of follow-up was 42 months. The most common presenting symptom was headache (27; 57%); 13 (28%) exhibited preoperative asymmetric sensorineural hearing loss, 3 (6%) facial nerve paresis, and 3 (6%) hemifacial spasm. Thirteen patients (28%) were initially observed over a mean interval of 56 months; however, five experienced disease progression requiring operation. Thirty-nine patients (83%) underwent surgical resection; 18 (46%) received gross total, 5 (13%) near total, and 16 (41%) aggressive subtotal resection. Three patients (8%) recurred at a median of 53 months; two after subtotal and one after gross total resection. Ninety-three percent of patients with useful hearing maintained serviceable hearing following treatment and one patient (3%) experienced mild long-term postoperative facial nerve paresis (HB II/VI). All patients with preoperative facial nerve paresis recovered normal function postoperatively. There were no episodes of stroke or death. Conclusions: Surgical intervention is effective in alleviating symptoms of cranial neuropathy and brainstem compression from CPA epidermoids. Gross total resection is preferred; however, aggressive subtotal removal should be considered with adherent or extensive disease as reoperation rates are low, even in the setting of aggressive subtotal resection. Conservative observation with serial imaging is a viable initial strategy in asymptomatic or minimally symptomatic patients.

Original languageEnglish (US)
Pages (from-to)951-955
Number of pages5
JournalOtology and Neurotology
Volume37
Issue number7
DOIs
StatePublished - Aug 1 2016

Fingerprint

Acoustic Neuroma
Cerebellopontine Angle
Facial Paralysis
Facial Nerve
Hearing
Observation
Hemifacial Spasm
Cranial Nerve Diseases
Microsurgery
Sensorineural Hearing Loss
Reoperation
Brain Stem
Headache
Disease Progression
Therapeutics
Stroke
Outcome Assessment (Health Care)
Morbidity

Keywords

  • Cerebellopontine angle
  • Cranial base
  • Epidermoid
  • Internal auditory canal
  • Microsurgery
  • Neurotology
  • Skull base

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Sensory Systems
  • Clinical Neurology

Cite this

Yawn, R. J., Patel, N. S., Driscoll, C. L., Link, M. J., Haynes, D. S., Wanna, G. B., ... Carlson, M. L. (2016). Primary Epidermoid Tumors of the Cerebellopontine Angle: A Review of 47 Cases. Otology and Neurotology, 37(7), 951-955. https://doi.org/10.1097/MAO.0000000000001085

Primary Epidermoid Tumors of the Cerebellopontine Angle : A Review of 47 Cases. / Yawn, Robert J.; Patel, Neil S.; Driscoll, Colin L.; Link, Michael J.; Haynes, David S.; Wanna, George B.; Thompson, Reid C.; Carlson, Matthew L.

In: Otology and Neurotology, Vol. 37, No. 7, 01.08.2016, p. 951-955.

Research output: Contribution to journalReview article

Yawn, RJ, Patel, NS, Driscoll, CL, Link, MJ, Haynes, DS, Wanna, GB, Thompson, RC & Carlson, ML 2016, 'Primary Epidermoid Tumors of the Cerebellopontine Angle: A Review of 47 Cases', Otology and Neurotology, vol. 37, no. 7, pp. 951-955. https://doi.org/10.1097/MAO.0000000000001085
Yawn RJ, Patel NS, Driscoll CL, Link MJ, Haynes DS, Wanna GB et al. Primary Epidermoid Tumors of the Cerebellopontine Angle: A Review of 47 Cases. Otology and Neurotology. 2016 Aug 1;37(7):951-955. https://doi.org/10.1097/MAO.0000000000001085
Yawn, Robert J. ; Patel, Neil S. ; Driscoll, Colin L. ; Link, Michael J. ; Haynes, David S. ; Wanna, George B. ; Thompson, Reid C. ; Carlson, Matthew L. / Primary Epidermoid Tumors of the Cerebellopontine Angle : A Review of 47 Cases. In: Otology and Neurotology. 2016 ; Vol. 37, No. 7. pp. 951-955.
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abstract = "Objective: To analyze disease presentation, treatment, and clinical course of a consecutive series of patients with primary cerebellopontine angle (CPA) epidermoids. Patients: Forty-seven consecutive patients with previously untreated CPA epidermoids. Intervention(s): Observation and microsurgery. Main Outcome Measures: Disease- and treatment-associated morbidity, recurrence. Results: Forty-seven patients (mean age 39 years; 53{\%} women) were analyzed and the average duration of follow-up was 42 months. The most common presenting symptom was headache (27; 57{\%}); 13 (28{\%}) exhibited preoperative asymmetric sensorineural hearing loss, 3 (6{\%}) facial nerve paresis, and 3 (6{\%}) hemifacial spasm. Thirteen patients (28{\%}) were initially observed over a mean interval of 56 months; however, five experienced disease progression requiring operation. Thirty-nine patients (83{\%}) underwent surgical resection; 18 (46{\%}) received gross total, 5 (13{\%}) near total, and 16 (41{\%}) aggressive subtotal resection. Three patients (8{\%}) recurred at a median of 53 months; two after subtotal and one after gross total resection. Ninety-three percent of patients with useful hearing maintained serviceable hearing following treatment and one patient (3{\%}) experienced mild long-term postoperative facial nerve paresis (HB II/VI). All patients with preoperative facial nerve paresis recovered normal function postoperatively. There were no episodes of stroke or death. Conclusions: Surgical intervention is effective in alleviating symptoms of cranial neuropathy and brainstem compression from CPA epidermoids. Gross total resection is preferred; however, aggressive subtotal removal should be considered with adherent or extensive disease as reoperation rates are low, even in the setting of aggressive subtotal resection. Conservative observation with serial imaging is a viable initial strategy in asymptomatic or minimally symptomatic patients.",
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AU - Link, Michael J.

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N2 - Objective: To analyze disease presentation, treatment, and clinical course of a consecutive series of patients with primary cerebellopontine angle (CPA) epidermoids. Patients: Forty-seven consecutive patients with previously untreated CPA epidermoids. Intervention(s): Observation and microsurgery. Main Outcome Measures: Disease- and treatment-associated morbidity, recurrence. Results: Forty-seven patients (mean age 39 years; 53% women) were analyzed and the average duration of follow-up was 42 months. The most common presenting symptom was headache (27; 57%); 13 (28%) exhibited preoperative asymmetric sensorineural hearing loss, 3 (6%) facial nerve paresis, and 3 (6%) hemifacial spasm. Thirteen patients (28%) were initially observed over a mean interval of 56 months; however, five experienced disease progression requiring operation. Thirty-nine patients (83%) underwent surgical resection; 18 (46%) received gross total, 5 (13%) near total, and 16 (41%) aggressive subtotal resection. Three patients (8%) recurred at a median of 53 months; two after subtotal and one after gross total resection. Ninety-three percent of patients with useful hearing maintained serviceable hearing following treatment and one patient (3%) experienced mild long-term postoperative facial nerve paresis (HB II/VI). All patients with preoperative facial nerve paresis recovered normal function postoperatively. There were no episodes of stroke or death. Conclusions: Surgical intervention is effective in alleviating symptoms of cranial neuropathy and brainstem compression from CPA epidermoids. Gross total resection is preferred; however, aggressive subtotal removal should be considered with adherent or extensive disease as reoperation rates are low, even in the setting of aggressive subtotal resection. Conservative observation with serial imaging is a viable initial strategy in asymptomatic or minimally symptomatic patients.

AB - Objective: To analyze disease presentation, treatment, and clinical course of a consecutive series of patients with primary cerebellopontine angle (CPA) epidermoids. Patients: Forty-seven consecutive patients with previously untreated CPA epidermoids. Intervention(s): Observation and microsurgery. Main Outcome Measures: Disease- and treatment-associated morbidity, recurrence. Results: Forty-seven patients (mean age 39 years; 53% women) were analyzed and the average duration of follow-up was 42 months. The most common presenting symptom was headache (27; 57%); 13 (28%) exhibited preoperative asymmetric sensorineural hearing loss, 3 (6%) facial nerve paresis, and 3 (6%) hemifacial spasm. Thirteen patients (28%) were initially observed over a mean interval of 56 months; however, five experienced disease progression requiring operation. Thirty-nine patients (83%) underwent surgical resection; 18 (46%) received gross total, 5 (13%) near total, and 16 (41%) aggressive subtotal resection. Three patients (8%) recurred at a median of 53 months; two after subtotal and one after gross total resection. Ninety-three percent of patients with useful hearing maintained serviceable hearing following treatment and one patient (3%) experienced mild long-term postoperative facial nerve paresis (HB II/VI). All patients with preoperative facial nerve paresis recovered normal function postoperatively. There were no episodes of stroke or death. Conclusions: Surgical intervention is effective in alleviating symptoms of cranial neuropathy and brainstem compression from CPA epidermoids. Gross total resection is preferred; however, aggressive subtotal removal should be considered with adherent or extensive disease as reoperation rates are low, even in the setting of aggressive subtotal resection. Conservative observation with serial imaging is a viable initial strategy in asymptomatic or minimally symptomatic patients.

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KW - Neurotology

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