Early-Career Surgical Practice for Cerebellopontine Angle Tumors in the Era of Radiosurgery

Abstract

We analyzed the outcomes of patients with large cerebellopontine angle (CPA) tumors treated by a skull-base team in which two surgeons (one neurosurgeon and one otological surgeon) were in the beginning of their careers (<40 years old). Data of patients operated on between April 2012 and March 2016 were reviewed. All factors related to surgical training were considered. Thirty-one patients had vestibular schwannomas, while 26 had meningiomas. Mean tumor diameter was 30.6 mm (range, 23-49 mm) for schwannomas and 35 mm (range, 22-51 mm) for meningiomas. Satisfactory postoperative facial nerve function (House-Brackmann's grade I or II) was achieved in 20 (64.5%) schwannoma patients and 21 (80.7%) meningioma patients. Gross total and near-total resections (residual tumor < 5 mm) were achieved in 21 (67.7%) and 9 (29%) schwannoma patients, respectively. Gross total resection (Simpson's grade II) was achieved in 18 (69.2%) meningioma patients. In both groups, the retrosigmoid approach was the most common approach. Regarding surgical training of the two younger surgeons, during the residency period, they attended high-volume centers for CPA tumors. Application of microsurgical techniques was systematically applied from the beginning of their personal series in every intracranial pathology case. During the first 2 years of the series, they were supervised by more experienced surgeons and followed a stepwise sharing of increasingly difficult surgical phases; by comparing results of this period with the last 2 years of the series, where they acquired a complete autonomy, no relevant difference was detected. Our results suggest that young surgeons may achieve good results even at the beginning of their careers, if specific conditions related to training and mentorship are met.

Small Cerebellopontine Angle Meningioma—Surgical Experience of 162 Patients and Literature Review

“…They are characterized by the deep tumor location, narrow surgical field, and proximity to the brainstem, multiple pairs of (V–XI) cranial nerves ( 2 ). At present, surgical treatment is the first choice for large cerebellopontine angle meningiomas, while small cerebellopontine angle meningiomas are always treated by stereotactic radiotherapy, pharmacotherapy and experimental therapy ( 3 ). In recent years, many studies have found that stereotactic radiotherapy had the limitations of low tumor control rate, post-treatment brain edema, and tissue adhesion, which hindered the further treatments ( 4 ).…”

Total Resection of Cerebellopontine Angle Meningioma via Presigmoid Transmastoid Approach: An Otologist’s Perspective

“…[4][5][6] However, it still has always proven arduous for neurosurgeons to optimally accomplish, 7 because of their complex anatomical regions, the deep and narrow surgical channels related, and lots of critical neurovascular structures in the surgical field. 8 Cerebellar retraction is an inevitable and frequent step when performing microsurgery of CPAMs via the retrosigmoid approach. Many complications have been reported due to this retraction, including postoperative posterior fossa edema, cerebellar contusions, injury of the stretched cranial nerves, and ischemic injuries of the cerebellum and perhaps even the brain stem.…”

“…The conventional surgical approaches of CPAMs in neurosurgery include suboccipital retrosigmoid approach, enlarged retrosigmoid approach, presigmoid approach, combined supratentorial approach, and so on 4–6. However, it still has always proven arduous for neurosurgeons to optimally accomplish,7 because of their complex anatomical regions, the deep and narrow surgical channels related, and lots of critical neurovascular structures in the surgical field 8. Cerebellar retraction is an inevitable and frequent step when performing microsurgery of CPAMs via the retrosigmoid approach.…”

“…[1][2][3][4][5][6][7] However, many transgender people do not openly share their personal desires or learn more about sex affirming surgery because of the discrimination and social stigma. 8,9 The Internet is the main resource to answer health-related questions for ∼48.6% of Internet users. 10 For patients interested in sex transitioning, online material provides numerous resources about the transitioning process, including surgical procedures, risks, and recovery.…”

Deadly complication of sacrificing superior petrosal vein during cerebellopontine angle tumor resection: A case report and literature review

“…CPA has always proven difficult for neurosurgeons to optimally manage,[ 1 ] also challenging to resect because of their complex regional anatomy, the deep and narrow surgical corridors involved, and the abundance of vital neurovascular structures in the surgical field. [ 25 ] The posterior fossa venous anatomy is often not well visualized during surgery. This is particularly true regarding the SPVC.…”