Retrosigmoid approach to cerebellopontine angle tumor resection: Surgical modifications

Heman‐Ackah, Selena E.; Cosetti, Maura K.; Gupta, Sachin; Golfinos, John G.; Roland, J. Thomas

doi:10.1002/lary.23524

Cited by 12 publications

(3 citation statements)

References 23 publications

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“…The retrosigmoid approach to dissecting CPA tumors has been modified to limit the need to retract the cerebellum for CPA access as well as improve reconstruction of the defect using only autologous bone. 12 Takami, et al reported a glioblastoma of the internal auditory canal, a rare tumor with only three case reports present in the literature, in which the surgical team initially suspected an early stage vestibular schwannoma. The patient presented with characteristic CPA tumor features, such as hearing loss and imbalance, but the symptoms rapidly progressed to facial weakness within four months.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…11 The retrosigmoid transmeatal approach is utilized with favorable outcomes with experienced surgeons. 11,12 The retrosigmoid approach was classically associated with a postoperative cerebrospinal fluid (CSF) leak rate of 2 to 10% potentially due to the pneumatization of the petrous apex air cells; however, reconstructive techniques such as fat obliteration, cranioplasty, and eustachian tube packing have reduced the incidence of such CSF leakage complications. 13 PitNETs that have no direct connection to the normal pituitary gland and reside outside the sella turcica are called ectopic PitNETs.…”

Section: Introductionmentioning

confidence: 99%

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High-Grade Ectopic Pituitary Adenoma within the Cerebellopontine Angle: A Case Report

et al. 2023

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Ectopic pituitary tumors are neoplasms with no connection to the pituitary gland and are commonly deposited in other areas of the anterior skull base. A 32-year-old female presented with a three-month history of right sided facial weakness, sensorineural hearing loss, diplopia, and severe headaches. Physical examination revealed a mid-dilated sluggishly reactive right pupil with slight limitation in all gazes, as well as right-sided orbicularis weakness, lagophthalmos, and decreased facial sensation. An MRI of the head without contrast revealed a 3.7 x 1.8 x 2.6 cm mildly enhancing mass in the right internal acoustic meatus and along the petrous ridge. The case was brought before the institution’s tumor board, where concern for higher grade pathology, such as hemangiopericytoma, was discussed. Per patient preference, surgical biopsy of the tumor was performed. Immunohistochemical staining revealed a WHO grade II neuroendocrine tumor, with cells staining positive for synaptophysin, chromogranin, and CD56, with a Ki-67 index of 8%. In addition to the ectopic location, this pituitary tumor was noted to be aggressive in nature based on its high Ki-67 index. Surgical excision or radiologic therapy of tumors involving the CPA are appropriate treatments in most cases.

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Section: Accepted Manuscriptmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

High-Grade Ectopic Pituitary Adenoma within the Cerebellopontine Angle: A Case Report

et al. 2023

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“…Various vascular and neoplastic lesions that are approached in this manner include vestibular schwannomas, meningiomas, and aneurysms of nearby arteries. [5,9] Histopathology ree major histopathologic sub-types of neurenteric cysts have been noted in literature: Types A, B, and C. [2,6,8,12] Type A most closely resembles respiratory or gastrointestinal epithelium and contains a pseudostratified layer of ciliated columnar or cuboidal epithelium situated on a basement membrane and connective tissue. Type B cysts contain simple, non-ciliated mucinproducing epithelium superior to/underlaid by more connective tissue and can contain smooth muscle, glandular, and lymphoid tissue, as well as nerve ganglia.…”

Section: Imagingmentioning

confidence: 99%

Fenestration of intracranial neurenteric cyst: A case report

Ogulnick

Kazim

Carlson

et al. 2021

Surgical Neurology International

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Background: Neurenteric cysts are rare congenital lesions of endodermal origin which result from the failure of the neurenteric canal to close during embryogenesis. The majority of neurenteric cysts occur in the spinal cord, though in rare instances can occur intracranially, typically in the posterior fossa anterior to the pontomedullary junction (80%) or in the supratentorial region adjacent to the frontal lobes (20%). Case Description: We present the case of a 75-year-old woman with an extra-axial cystic lesion centered in the premedullary cistern causing brainstem compression. The lesion was later histopathologically confirmed to be a neurenteric cyst. She presented initially with a 4-month history of worsening headache, dizziness, and unsteady gait. We performed a left retrosigmoid craniotomy for cyst fenestration/biopsy with the aid of operating microscope and stealth neuronavigation. Following the procedure, the patient recovered without complications or residual deficits. Conclusion: This case illustrates the successful fenestration of an intracranial neurenteric cyst with good clinical outcome. We present the pre- and post-operative imaging findings, a technical video of the procedure, histopathological confirmation, and a brief review of the relevant clinical literature on the topic.

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