Issue N# 2 - 2005
Management of cerebellopontine angle meningiomas and the posterior part of the temporal bone. Report on 44 cases
Authors : C. Le Garlantezec, V. Franco Vidal, J. Guerin, J.-P. Bébéar, D. Liguoro, V. Darrouzet (Bordeaux)
Ref. : Rev Laryngol Otol Rhinol. 2005;126,2:81-89.
Article published in french
Downloadable PDF document french
Objectives: To review and study the management of CPA meningiomas through the experience of an otoneurosurgical team. Material and Methods: Fourty-two patients (44 meningiomas) were considered. Seventy-seven per cent of tumors (34 cases) were operated on; 6 tumors (14.6%) were exclusively irradiated using fractionated radiation therapy (FRT) and four only surveyed (9,8%). Results: transpetrosal approaches were exclusively used. These were translabyrinthine (TLA) in 47%, widened retrolabyrinthine (WRLA) in 41% of cases, transcochlear approach (TCA) in three cases and a middle fossa in one. A transtentorial approach was combined in 35% of cases (8 TLA , 4 WRLA). Surgical removal was incomplete in 11,8% of cases; in 3 cases growing tumor was treated by FRT, included one case of anaplasic tumor. Postoperative complications were: 1 meningitis, 1 wound abscess, 2 hydrocephalus (6%) and 4 CSF fistulas (12%). No complications have been observed during the last 7 years (21 cases). House and Brackmann Grade 1 or 2 facial function was obtained in 59% of cases (but 10 patients had a preoperative facial nerve paresis). A normal or subnormal AAO-HNS Class A-B Hearing could be preserved in 57% of WRLA. Radiation therapy allowed tumor shrinkage in all cases. In 3 cases this regression was of more than 50%. Conclusion: Surgery is the gold standard in treating CPA meningiomas. Transpetrosal approaches and particularly WRLA pure or combined to a transtentorial approach are for us the best way to remove these tumors in preserving hearing and facial nerve function. When hearing is poor or when tumor extension to the clivus or the premeatal area is consistent a TLA is either planned preoperatively or obtained from a WRLA.
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