scholarly journals Cerebellopontine angle meningioma extending into internal auditory canal presenting with unilateral facial weakness and sensorineural hearing loss: Case presentation with review of literature

2017 ◽  
Vol 5 (1) ◽  
pp. 34-40
Author(s):  
Ravinder Kumar ◽  
Gagan Jaiswal ◽  
Abhishek Bhargava ◽  
Jyoti Kundu
Keyword(s):  
Hearing Loss ◽  
Cerebellopontine Angle ◽  
Management Strategies ◽  
Internal Auditory Canal ◽  
Petrous Bone ◽  
Tumour Resection ◽  
Facial Weakness ◽  
Medical College ◽  
Unilateral Headache ◽  
Dural Tail

Tumour types other than schwannomas are uncommonly encountered in the cerebellopontine angle, and unusual lesions extending into the internal auditory canal are even rarer. We herein present a case of a 50-year-old woman with a right cerebellopontine angle meningioma (measuring 34mm x 35mm x 36mm), arising from the posterior surface of the petrous bone or the petrotentorial junction, secondarily involving the internal auditory canal. Contrast enhanced MRI showed typical appearance of a meningioma, with calcifi ed fl at surface against the petrous bone, a hemispheric or ice-cream-cone shape sign, adjacent hyperostosis, and ‘dural tail’ extending from the tumour. Initial clinical evaluation revealed continued presence of a stable neurological defi cit such as unilateral headache, hearing loss, reduced taste sensation, positive corneal and conjunctival refl ex along with right facial weakness (House-Brackmann grade III) signalling towards the involvement of V, VII and VIII cranial nerve. The variation in the anatomy of the faciocochlear nerve bundle in relation to the tumour has to be kept in mind, and preservation of these vital neural structures should be the goal in every case. Tumour resection was performed through a suboccipital-retrosigmoidal approach with a good outcome. Ours is an unusual case report analysing the diagnostic and therapeutic issues, surgical management strategies and treatment outcomes related to this rare disease entity.Journal of Kathmandu Medical College Vol. 5, No. 1, Issue 15, Jan.-Mar., 2016, Page: 34-40

Meningiomas Of the Internal Auditory Canal

Neurosurgery ◽  
2004 ◽  
Vol 55 (1) ◽  
pp. 119-128 ◽  
Author(s):  
Makoto Nakamura ◽  
Florian Roser ◽  
Sharham Mirzai ◽  
Cordula Matthies ◽  
Peter Vorkapic ◽  
...  
Keyword(s):  
Cerebellopontine Angle ◽  
Clinical Symptoms ◽  
Management Strategies ◽  
Internal Auditory Canal ◽  
Signs And Symptoms ◽  
Vestibular Schwannomas ◽  
Additional Patient ◽  
Surgical Removal ◽  
Neurosurgical Department ◽  
Vestibulocochlear Nerve

Abstract OBJECTIVE: Meningiomas arising primarily within the internal auditory canal (IAC) are notably rare. By far the most common tumors that are encountered in this region are neuromas. We report a series of eight patients with meningiomas of the IAC, analyzing the clinical presentations, surgical management strategies, and clinical outcomes. METHODS: The charts of the patients, including histories and audiograms, imaging studies, surgical records, discharge letters, histological records, and follow-up records, were reviewed. RESULTS: One thousand eight hundred meningiomas were operated on between 1978 and 2002 at the Neurosurgical Department of Nordstadt Hospital. Among them, there were 421 cerebellopontine angle meningiomas; 7 of these (1.7% of cerebellopontine angle meningiomas) were limited to the IAC. One additional patient underwent surgery at the Neurosurgical Department of the International Neuroscience Institute, where a total of 21 cerebellopontine angle meningiomas were treated surgically from 2001 to 2003. As a comparison, the incidence of intrameatal vestibular schwannomas during the same period, 1978 to 2002, was 168 of 2400 (7%). There were five women and three men, and the mean age was 49.3 years (range, 27–59 yr). Most patients had signs and symptoms of vestibulocochlear nerve disturbance at presentation. One patient had sought treatment previously for total hearing loss before surgery. No patient had a facial paresis at presentation. The neuroradiological workup revealed a homogeneously contrast-enhancing tumor on magnetic resonance imaging in all patients with hypointense or isointense signal intensity on T1- and T2-weighted images. Some intrameatal meningiomas showed broad attachment, and some showed a dural tail at the porus. In all patients, the tumor was removed through the lateral suboccipital retrosigmoid approach with drilling of the posterior wall of the IAC. Total removal was achieved in all cases. Severe infiltration of the facial and vestibulocochlear nerve was encountered in two patients. There was no operative mortality. Hearing was preserved in five of seven patients; one patient was deaf before surgery. Postoperative facial weakness was encountered temporarily in one patient. CONCLUSION: Although intrameatal meningiomas are quite rare, they must be considered in the differential diagnosis of intrameatal mass lesions. The clinical symptoms are very similar to those of vestibular schwannomas. A radiological differentiation from vestibular schwannomas is not always possible. Surgical removal of intrameatal meningiomas should aim at wide excision, including involved dura and bone, to prevent recurrences. The variation in the anatomy of the faciocochlear nerve bundle in relation to the tumor has to be kept in mind, and preservation of these structures should be the goal in every case.

Acoustic Schwannoma Presenting as a Tumor of the External Auditory Canal

1987 ◽  
Vol 96 (4) ◽  
pp. 415-418 ◽  
Author(s):  
Patrice Tran Ba Huy ◽  
Jean Michel Hassan ◽  
Michel Wassef ◽  
Jacqueline Mikol ◽  
Claude Thurel
Keyword(s):  
Hearing Loss ◽  
External Auditory Canal ◽  
Cerebellopontine Angle ◽  
Internal Auditory Canal ◽  
Unilateral Hearing Loss ◽  
Acoustic Neurinoma ◽  
History Of ◽  
Acoustic Schwannoma ◽  
Initial Episode ◽  
Central Compensation

An acoustic neurinoma involving the internal auditory canal, the vestibule, the cochlea, the middle ear, and extending into the cerebellopontine angle and the external auditory canal, is described in a 56-year-old woman. An initial episode of vertigo was followed by a 27-year history of progressive unilateral hearing loss leading to complete deafness and areflexia with central compensation. The tumor was removed by a two-step surgical procedure, and the histologic features were those of a schwannoma.

Syphilis causing hearing loss

2008 ◽  
Vol 19 (10) ◽  
pp. 721-722 ◽  
Author(s):  
S Y Chan ◽  
M Medhi ◽  
A Ekbote ◽  
S Moses ◽  
N Sibtain ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Highly Active Antiretroviral Therapy ◽  
Internal Auditory Canal ◽  
Secondary Syphilis ◽  
Hiv Positive ◽  
Magnetic Resonance Imaging Scan ◽  
Facial Weakness ◽  
Highly Active ◽  
Syphilis Serology ◽  
Hiv 1

An HIV-positive man with hepatitis B co-infection, naïve to highly active antiretroviral therapy, with a CD4 of 594 copies/mL and HIV-1 viral load of 140,070 copies, presented with right-sided facial weakness and hearing loss. He had been treated for secondary syphilis three months earlier when his rapid plasma reagin (RPR) result was 1:16, this had fallen to neat. At presentation, his RPR had risen to 1:16 again. A magnetic resonance imaging scan showed enhancement of the internal auditory canal and right cochlea. His cerebrospinal fluid examination was normal. He was treated with acyclovir and prednisolone before the syphilis serology was known. He was then treated for syphilis with doxycycline. He made an excellent recovery.

High Jugular Bulb: Implications for Posterior Fossa Neurotologic and Cranial Base Surgery

1993 ◽  
Vol 102 (2) ◽  
pp. 100-107 ◽  
Author(s):  
Steven D. Rauch ◽  
Wen-Zhuang Xv ◽  
Joseph B. Nadol
Keyword(s):  
Temporal Bone ◽  
Posterior Fossa ◽  
Cerebellopontine Angle ◽  
Internal Auditory Canal ◽  
Petrous Bone ◽  
Jugular Bulb ◽  
Variable Position ◽  
High Jugular Bulb ◽  
Cranial Base Surgery ◽  
Bone Exposure

The suboccipital-retrosigmoid approach to the internal auditory canal and cerebellopontine angle is being used with increasing frequency for neurotologic surgery, including vestibular nerve section and resection of acoustic neuroma. It offers wide exposure of the cerebellopontine angle and the cranial nerve VII—VIII complex as it courses from the brain stem to the temporal bone. Exposure of the internal auditory canal can be achieved by removing its posterior bony wall. Safe utilization of this approach requires familiarity with the variable position of structures within the petrous bone, including the lateral venous sinus and jugular bulb. We report here a case in which bleeding resulted from injury to a high jugular bulb during surgical exposure of the internal auditory canal via the suboccipital route and discuss the regional anatomy of the jugular bulb based on study of 378 consecutive temporal bone specimens from the collection of the Massachusetts Eye and Ear Infirmary. High jugular bulb was defined as encroachment of the dome of the bulb within 2 mm of the floor of the internal auditory canal. Forty-six percent of scoreable specimens met this criterion. However, when donors less than 6 years of age were excluded, a high jugular bulb was identified in 63% of specimens. Relevance to neurotologic surgery of the posterior fossa is presented.

scholarly journals Unilateral internal auditory canal stenosis with progressive facial weakness

2012 ◽  
Vol 18 (2) ◽  
pp. 179-182
Author(s):  
Sathiya Murali ◽  
Arpana Shekhar ◽  
S Shyam Sudhakar ◽  
Kiran Natarajan ◽  
Mohan Kameswaran
Keyword(s):  
Hearing Loss ◽  
High Resolution ◽  
Facial Nerve ◽  
Temporal Bone ◽  
Internal Auditory Canal ◽  
Facial Weakness ◽  
Profound Hearing Loss ◽  
Canal Stenosis ◽  
Temporal Bone Ct ◽  
Magnetic Resonance Imaging Mri

Internal auditory canal (IAC) stenosis is a rare cause of sensorineural hearing loss. Patient may present with symptoms of progressive facial nerve palsy, hearing loss, tinnitus and giddiness. High resolution temporal bone CT-scan and magnetic resonance imaging (MRI) are the important tools for diagnosis. No specific management has been devised. Here is presentation of a case of unilateral (left) IAC stenosis with profound hearing loss and progressive House Brackmann Grade III-IV facial weakness. The diameter of the IAC was less than 2 mm on high resolution temporal bone computed tomography (HRCT) scan. It was managed by facial nerve decompression by translabyrinthine approach in an attempt to prevent further deterioration of facial palsy. DOI: http://dx.doi.org/10.3329/bjo.v18i2.12014 Bangladesh J Otorhinolaryngol 2012; 18(2): 179-182

Endoscopic fenestration of a cerebellopontine angle arachnoid cyst resulting in complete recovery from sensorineural hearing loss and facial nerve palsy

2011 ◽  
Vol 7 (2) ◽  
pp. 157-160 ◽  
Author(s):  
Joffre E. Olaya ◽  
Michelle Ghostine ◽  
Mark Rowe ◽  
Alexander Zouros
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Arachnoid Cyst ◽  
Cerebellopontine Angle ◽  
Complete Recovery ◽  
Sensorineural Hearing ◽  
Arachnoid Cysts ◽  
Facial Weakness ◽  
Cranial Nerve Palsies ◽  
Endoscopic Fenestration

Cerebellopontine angle arachnoid cysts are usually asymptomatic, but are frequently found incidentally because of increased use of neuroimaging. Nevertheless, as these cysts enlarge, they may compress surrounding structures and cause neurological symptoms. Patients may present with vague, nonspecific symptoms such as headache, nausea, vomiting, and vertigo. Cranial nerve palsies, including sensorineural hearing loss and facial weakness, although rare, have also been reported in association with posterior fossa arachnoid cysts. Although surgery for these entities is controversial, arachnoid cysts can be treated surgically with open craniotomy for cyst removal, fenestration into adjacent arachnoid spaces, shunting of cyst contents, or endoscopic fenestration. Reversal of sensorineural hearing loss following open craniotomy treatment has been described in the literature in only 1 adult and 1 pediatric case. Improvement in facial weakness has also been reported after open craniotomy and arachnoid cyst fenestration. The authors report the first case of complete recovery from sensorineural hearing loss and facial weakness following endoscopic fenestration in a patient with a cerebellopontine angle arachnoid cyst.

scholarly journals Chances of Improvement in Cases of Vestibular Schwannoma Presenting with Facial Nerve Weakness: Presentation of Two Cases and Literature Review

2018 ◽  
Vol 80 (01) ◽  
pp. 040-045
Author(s):  
Ahmed Rizk ◽  
Marcus Mehlitz ◽  
Martin Bettag
Keyword(s):  
Hearing Loss ◽  
Facial Nerve ◽  
Male Patient ◽  
Vestibular Schwannoma ◽  
Internal Auditory Canal ◽  
Retrosigmoid Approach ◽  
Neurophysiological Monitoring ◽  
Facial Weakness ◽  
First Case ◽  
The Brain

Background and Study Aim Facial nerve (FN) weakness as a presenting feature in vestibular schwannoma (VS) is extremely rare. We are presenting two different cases of VS with significant facial weakness and reviewed the literature for similar cases. Methods and Results We are presenting two cases of VS with significant facial weakness. The first case was a 63-year-old male patient presented with 3 weeks' history of severe left-sided facial weakness (House–Brackmann [HB] grade V) and hearing loss. Magnetic resonance imaging (MRI) of the brain showed a tumor in the left internal auditory canal. Gross total removal with anatomical and physiological FN preservation was performed through a retrosigmoid approach under neurophysiological monitoring. FN function improved postoperatively to HB grade II after 16 months. The other case was 83-year-old male patient presented with sudden left-sided hearing loss and severe facial weakness (HB grade V). MRI of the brain 2.5 years before showed a left-sided (Class-T3A) cystic VS. The tumor was asymptomatic; wait-and-scan strategy was advised by the treating neurologist. Recent MRI of the brain showed approximately three times enlargement of the tumor with brain stem compression, extensive cystic changes, and suspected intratumoral hemorrhage. Surgery was performed; the tumor was subtotally removed through a retrosigmoid approach with intraoperative FN monitoring. The FN was anatomically preserved; however, physiological preservation was not possible. Severe facial weakness with incomplete lid closure persisted postoperatively. Conclusion Surgical treatment could be offered to cases of suspected VS presenting with facial weakness, as these cases may still have a chance for improvement especially in laterally located tumors.

Preoperative Differentiation between Meningioma of the Cerebellopontine Angle and Acoustic Neuroma Using MRI

1993 ◽  
Vol 109 (1) ◽  
pp. 88-95 ◽  
Author(s):  
Anil K. Lalwani ◽  
Robert K. Jackler
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
San Francisco ◽  
Acoustic Neuroma ◽  
Cerebellopontine Angle ◽  
Internal Auditory Canal ◽  
Resonance Imaging ◽  
Mri Findings ◽  
Dural Tail ◽  
Magnetic Resonance Imaging Mri

Preoperative differentiation between acoustic neuroma (AN) and meningioma of the cerebellopontine angle (CPA) is important in selection of the surgical approach, successful tumor removal, and preservation of hearing and facial nerve. We retrospectively reviewed the magnetic resonance imaging (MRI) findings associated with 30 meningiomas involving the CPA (MCPA) encountered between 1987 to 1991 at the University of California, San Francisco. Magnetic resonance imaging was critical in differentiating meningioma from AN in the CPA. Typical findings on MRI associated with MCPA, differentiating them from ANs, Include: Meningiomas are sessile, possessing a broad base against the petrous face, whereas ANs are globular; they are often extrinsic and eccentric to the internal auditory canal (IAC); when involving the IAC, they usually do not erode the IAC; MCPAs demonstrate hyperostosis of the subjacent bone and possess intratumoral calcification; they involve adjacent intracranial spaces and structures; and meningiomas are characterized by a distinctive dural “tail” extending away from the tumor surface. While any one finding may not be diagnostic by itself, taken together the constellation of these findings is strongly Indicative of meningioma. In our experience, MRI with gadolinium enhancement was able to distinguish MCPA from AN in nearly every case.

scholarly journals A Study of Aetiological Profile of Unilateral Sensorineural Hearing Loss

2019 ◽  
Vol 27 (1) ◽  
pp. 19-28
Author(s):  
Prasenjit Gangopadhyay ◽  
Bipin Kishore Prasad
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Cerebellopontine Angle ◽  
Bone Fractures ◽  
Chronic Otitis Media ◽  
Pure Tone Audiometry ◽  
Petrous Bone ◽  
Connective Tissue Disorder ◽  
Sudden Sensorineural Hearing Loss ◽  
Sensorineural Hearing

Introduction: It is necessary to identify the aetiology of sudden sensorineural hearing loss for proper management. Despite advancement in the field of diagnostic radiology, immunochemistry and genetic studies, there are still many cases of USNHL where a definite cause cannot be identified. In this study, an attempt has been made to identify the aetiological factors responsible for unilateral sensorineural hearing loss (USNHL)..                                Materials and Methods: Seventyfive patients with acquired unilateral sensorineural hearing loss without chronic otitis media were included in the study. Hearing was assessed by tuning fork test and pure tone audiometry. Special tests were done to differentiate between cochlear and retrocochlear pathology, to objectively assess hearing loss and to diagnose nonorganic hearing loss. Radio-imaging was done to diagnose skull bone fractures, space occupying lesions in internal auditory meatus and cerebellopontine angle or intracranial pathologies. Biochemical analysis of blood, immunoglobulin and serological assay were done to rule out specific causes. Results: Majority of patients were within 21-30 years of age. 37 patients presented with sudden and remaining with progressive hearing loss. Majority (57.3%) were found to have idiopathic cochlear pathology. Amongst the remaining, there were 8 cases of acoustic trauma, 4 each of Meniere’s disease and cerebellopontine angle tumour and 3 each of Noise-induced hearing loss, labyrinthitis and Non-organic hearing loss. There were 2 cases of meningitis and 1 each of barotrauma, connective tissue disorder, iatrogenic trauma, fracture of petrous bone and cerebrovascular accident.  Conclusion: Most of the studies have been done on sudden sensorineural hearing loss. Current study, including sudden and progressive cases, is hence an attempt to ascertain aetiological profile of unilateral SNHL.

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