Objectives to define selection criteria and describe technique nuances for the use of endoscopy in surgery for cerebellopontine angle cpa lesions. The cerebellopontine angle cpa is a triangular space located posterior to the pyramid, inferior to the tentorium, lateral to the pons, and ventral to the cerebellum. Cerebellopontine angle and fourth ventricle part 1 of 2. It has the brain stem as its medial boundary, the cerebellum as its roof and posterior boundary, and the posterior surface of the.
Indications include unilateral hearing loss 85%, speech impediments, disequilibrium, tremors or other loss of motor control. The angle is bordered laterally and anteriorly by the posterior face of the petrous temporal bone. Intracranial epidermoid cysts, also known as primary cholesteatomas, are uncommon brain tumors that account for 0. The cp angle is located between the superior and inferior limbs of the cerebellopontine fissure, a vshaped angular cleft, formed by the cerebellum folding around the pons and middle cerebellar peduncle. Absence of beamhardening artifacts, multiplanar imaging capability, and greater intrinsic. The cerebellopontine angle cistern is a cerebrospinal fluidfilled space bound by the pons, cerebellum, and petrous temporal bone. Jun 12, 2010 mass lesions in the cerebellopontine angle cpa can be difficult to differentiate based solely on clinical symptoms and physical examination. Endoscopy is likely to complement contemporary microsurgical procedures. This study describes the endoscopic anatomy of the cerebellopontine angle cpa.
The cerebellopontine angle is a space filled with spinal fluid. Cerebellopontine angle cistern radiology reference article. The cerebellopontine angle cpa was examined using 2. This allows the project to stand out from its competitors and broadens its appeal. Although a diverse range of pathologies may be seen in this region, the most common by far is a vestibular schwannoma. Both benign and malignant entities, if encroaching on the same cranial nerve, can present in an identical manner. Synchronous tumors of the cerebellopontine angle mayo clinic. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis. Presents a triangular morphology, so that the roof is limited by the tentorium. Carefully crafted over many years by internationally renowned surgeon and educator dr.
The hemispheres of the brain contain highly specialized neural structures that direct the bodys physical and mental activities, such as those of the cerebellum, the medulla, and the pons. Written and edited by expert surgeons in collaboration with a worldrenowned anatomist, this exquisitely illustrated reference consolidates surgical, anatomical and technical knowledge for the entire human body in a single volume. In this article we describe the anatomy of the cpa. The inclusion of an interactive atlas adds to the importance of the text and complements it, and also obviates the need to. The cerebellopontine angle cpa is an anatomically complex region of the brain. Mccall, in aminoffs neurology and general medicine fifth edition, 2014. The cp angle is a triangular space located posterior to the pyramid, inferior to the tentorium, lateral to the pons, and ventral to the cerebellum. Cerebellopontine angle tumor neoplasm of cerebellopontine. Mass lesions in the cerebellopontine angle cpa can be difficult to differentiate based solely on clinical symptoms and physical examination. Superior anatomical view of the left cerebellopontine angle cpa. The cerebellopontine angle is also the site of a set of neurological disorders known as the cerebellopontine angle syndrome. Microanatomy of the cerebellopontine angle neupsy key. The cerebellopontine angle and posterior fossa cranial nerves by. Cn vii vestibulocochlear cn viii flocculus of the cerebellum.
Symptomatic lesion require marsupilization of cyst rather than excision or shunting. Cerebellopontine angle masses can be divided into four groups, based on imaging characteristics. The conjunction of these structures at the base of the skull, or petrous bone, forms a pyramid shaped space called the cerebellopontine angle. In this chapter, the microsurgical anatomy of the cerebellopontine angle by the retrosigmoid approach is presented. Acoustic neuromas vestibular schwannomas, arising from the neurilemmal junction of the vestibular nerve, account for between 80%90% of these tumours. Masses in this region are readily identified on crosssectional images. The symptoms and signs of cpa disease are nonspecific, relating either to compression of the neural structures found within it or from compression. It has the brain stem as its medial boundary, the cerebellum as its roof and posterior boundary, and. The cerebellopontine angle is a structure at the margin of the cerebellum and pons. The cerebellopontine angle is a space filled with csf, located in the lateral margin of the posterior fossa in situation prior to the lateral cerebellar hemispheres and pons. The cpa is defined as the angle formed in the horizontal section by the pons and the cerebellum in which the trigeminal v and acousticofacial nerve bundle viii are located.
A view of the posterior fossa dura through the combined retrolabyrinthine subtemporal transapical approach. The anatomy of the region offers the opportunity for three basic approaches to the tumor in the meatus and cerebellopontine angle. Cerebellopontine angle cpa masses are relatively common. What is the anatomy of the cerebellopontine angle relevant to. Introduction cerebellopontine angle cpa is an extraaxial space situated in between the superior and inferior limbs of the. Written informed consent was obtained from all participants. One is directed through the middle cranial fossa and the roof of. Cerebellopontine angle cpa tumors are masses located in the region between the cerebellum and pons. Absence of beamhardening artifacts, multiplanar imaging capability, and. Recent reports of mr imaging of the normal anatomy and of lesions of the cerebellopontine angle cpa and internal auditory canal lac at low 1 5 and moderate 3,68 magnetic field strengths have been most encouraging. Surgery of the cerebellopontine angle 1st edition pdf download now surgery of the cerebellopontine angle is a single volume text which meshes the information available in surgical atlases with clinical disease entities. Disease involving the cerebellopontine angle cpa may arise from structures located within the cistern or from extension of lesions located primarily outside the cisternfrom the brainstem, fourth ventricle, choroid plexus and bony skull base. Pathology cerebellopontine angle masses can be divided into four g.
Cerebellopontine angle tumor is listed as a rare disease by the office of rare diseases ord of the national institutes of health nih. The cp a is bounded by the pons, the anterior aspect of the cerebellum and the petrous. Cerebellopontine angle mass radiology reference article. The cerebellopontine angle cpa is a triangular space located posterior to the. Posterior fossa dura pfd structures exposed through the standard retrolabyrinthine approach. N2 background synchronous tumors of the cerebellopontine angle cpa are very rare and inconsistently described.
Neuroendoscopic anatomy and surgery of the cerebellopontine. Introduction cerebellopontine angle cpa is an extraaxial space situated in. By far the most common pathology in this area is the acoustic neuroma or, more correctly, schwannoma which. Aug 30, 2016 2 microanatomy of the cerebellopontine angle introduction general anatomy special clinical anatomy and topography of the facial and vestibulocochlear nerves in large acoustic neurinomas introduction the feasibility and safety of any microsurgical intervention depend on the surgeons familiarity with the neuroanatomy. They constitute the most frequently diagnosed tumors of the posterior fossa and account for up to 10% of all intracranial neoplasms. This is a prospective study of 30 patients at the neurosurgical department medical city, with mean age of 36 years with cpa tumors predominantly acoustic neuroma that underwent surgical removal using a suboccipital retrosigmoid approach over a 1year. Grays surgical anatomy 1st edition pdf free pdf epub. This definition incorporates text from the wikipedia website wikipedia. Most cpa tumors are benign, with over 85% being vestibular schwannomas acoustic neuromas, lipomas, vascular malformations, and hemangiomas. Surgery of the cerebellopontine angle is a single volume text which meshes the information available in surgical atlases with clinical disease entities.
Imaging of the cerebellopontine angle practical neurology. Apr 26, 2020 the hemispheres of the brain contain highly specialized neural structures that direct the bodys physical and mental activities, such as those of the cerebellum, the medulla, and the pons. Acoustic neuromas, which are also called vestibular schwannomas, 3, and meningiomas are the two most frequent lesions and account for approximately 85%90% of all cpa tumors, 1. The cerebellopontine angle cistern, also known as the pontocerebellar cistern, is a triangular csffilled subarachnoid cistern that lies between the anterior surface of the cerebellum and the lateral surface of the pons. Microsurgical anatomy of the cerebellopontine angle by the. The microsurgical anatomy of acoustic neuromas, vascular compression syndromes, and other disor ders involving the nerves in the cerebellopontine angle are. The cerebellopontine angle is the space bound by the cerebellum, pons and temporal bone and contains the short intracranial courses of the fifth, seventh and eighth cranial nerves. The inclusion of an interactive atlas adds to the importance of the text and complements it, and also obviates the need to reference multiple sources. The cerebellopontine angle is located between the cerebellum and the pons. Neuroendoscopic anatomy and surgery of the cerebellopontine angle article in journal of clinical neuroscience 123. Cerebellopontine definition of cerebellopontine by medical. Subjects patients undergoing cpa lesion resection were selected for endoscopeassisted andor endoscopeguided lesion resection.
Methods cpa interventions without mass lesions were excluded. Outlines anatomy of cpa possible lesions of cpa clinical features differential diagnosis radiology diagnostic elements 3. Although a diverse range of pathologies may be seen in this region, the most common by far is a vestibular schwannoma pathology. Cerebellopontine angle tumors otolaryngologists perspective. Mr imaging of cerebellopontine angle and internal auditory. What is the anatomy of the cerebellopontine angle relevant.
Cerebellopontine angle masses may cause hearing loss, tinnitus, and vertigo. Cerebellopontine angle and posterior fossa cranial nerves by. In this chapter, we will describe the microsurgical anatomy of the cpa, along. Clinical features and outcomes in patients with nonacoustic. The cerebellopontine angle is the site of the cerebellopontine angle cistern one of the subarachnoid cisterns that contains cerebrospinal fluid, arachnoid tissue, cranial nerves, and associated vessels. The cerebellopontine angle syndrome is a distinct neurological syndrome of deficits that can arise due to the closeness of the cerebellopontine angle to specific cranial nerves. May 30, 2017 outlines anatomy of cpa possible lesions of cpa clinical features differential diagnosis radiology diagnostic elements 3. Neuroendoscopic anatomy and surgery of the cerebellopontine angle. Oct 26, 2011 carefully crafted over many years by internationally renowned surgeon and educator dr. Dif fusion imaging introduction the cerebellopontine angle cp a cistern is a subarachnoid space containing cranial nerves and vessels bathed in cerebrospinal fluid csf.
Cerebellopontine angle arachnoid cysts arachnoid cysts are intraarachnoid masses of uncertain origin filled with csf often present with headache and ataxia. Cerebellopontine angle tumor definition of cerebellopontine. One is directed through the middle cranial fossa and the roof of the meatus. Lesions of the cerebellopontine angle cpa are frequent and represent 6%10% of all intracranial tumors, 1, 2. These usually present with a viith cranial nerve palsy either late in their course as the facial nerve is displaced and compressed by an expanding cerebellopontine tumor or as a postoperative complication after neurosurgical resection. Cerebellopontine angle tumor neoplasm of cerebellopontine angle. Moss, in liu, volpe, and galettas neuroophthalmology third edition, 2019. Cerebellopontine angle cpa tumors are the most common neoplasms in the posterior fossa, accounting for 510% of intracranial tumors. Cerebellopontine angle, endoscopic, sinodural angle, skull base. Acoustic schwannoma most common mass in the cpa, up to 75% of cases usually arises from the superior vestibular nerve usually a solid spaceoccupying mass with a tail in the internal acoustic meatus canal that uniformally enhances with contrast. Cerebellopontine angle anatomy the cp angle is a triangular space located posterior to the pyramid, inferior to the tentorium, lateral to the pons, and ventral to the cerebellum. Cerebellopontine angle meningioma presenting with hearing loss. This means that cerebellopontine angle tumor, or a subtype of cerebellopontine angle tumor, affects less than 200,000 people in the us population.
Tumours of the cerebellopontine angle account for 8%10% of all intracranial tumours. Five years later he began to popularize the middle cranial fossa approach. A view of the cerebellopontine angle through the retrolabyrinthine approach note the narrow field and limited control. With the use of microdrills and microscope he was able to identify and preserve the facial nerve. Surgery of the cerebellopontine angle 1st edition pdf. Endoscopes were introduced into the basal cisterns and it was found that the neurovascular structures of this angle could be seen in detail. Inpatient rehabilitation of cerebellopontine angle epidermoid. Cerebellopontine angle an overview sciencedirect topics.