Laviv Yosef, Thomas Ajith, Kasper Ekkehard M
Division of Neurosurgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Division of Neurosurgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
World Neurosurg. 2017 Apr;100:100-117. doi: 10.1016/j.wneu.2016.12.091. Epub 2016 Dec 31.
The cerebellopontine angle (CPA) is a narrowed skull base area containing important cranial nerves and vessels and bordering with eloquent areas of the posterior fossa. Tumors of the CPA are a heterogeneous group and can have extradural, intradural/extra-axial, or intra-axial origins. Their vascular supply changes depending on their anatomic origin. Symptomatic, large CPA tumors require surgical resection in order to prevent irreversible, severe neurological damages. However, its tight and strategical location make surgery in the CPA very challenging and require appropriate pre-surgical planning. Pre-surgical diagnosis is of great importance as it allows us to choose the optimal management for the particular patient. This is of further significance when encountering high-risk lesions such as hypervascular tumors. Neurosurgeons should utilize every available pre-surgical diagnostic modalities as well as neo-adjuvant treatments in order to reduce such risks.
We review all reported cases of hypervascular lesions of the CPA and discuss the roles of angiography and stereotactic radiosurgery in their management.
Three lesions of the CPA can be considered as truly hypervascular: hemangioblastomas, hemangiopericytomas and paragangliomas. All lesions share many radiological features. However, each lesion has a different anatomical origin and hence, has a characteristic vascular supply. Pre-surgical angiography can be utilized as a diagnostic tool to narrow down the differential diagnosis of a vascular CPA lesion, based on the predominant supplying vessel. In addition, pre-surgical embolization at time of angiography will narrow the associated surgical risks.
Angiography is a crucial diagnostic and therapeutic tool, helping both in narrowing the presurgical differential diagnosis and in controlling intraoperative bleeding. Because of the high surgical risks associated with resection of vascular tumors in the CPA, noninvasive treatments, such as stereotactic radiosurgery, also may have a crucial role.
桥小脑角（CPA）是颅底一个狭窄区域，包含重要的颅神经和血管，与后颅窝的功能区相邻。CPA肿瘤是一组异质性肿瘤，可起源于硬膜外、硬膜内/轴外或轴内。其血供因解剖起源而异。有症状的大型CPA肿瘤需要手术切除，以防止不可逆转的严重神经损伤。然而，其位置紧密且关键，使得CPA手术极具挑战性，需要进行适当的术前规划。术前诊断至关重要，因为它能让我们为特定患者选择最佳治疗方案。在遇到高风险病变（如富血管肿瘤）时，这一点尤为重要。神经外科医生应利用所有可用的术前诊断方法以及新辅助治疗来降低此类风险。
我们回顾了所有报道的CPA富血管病变病例，并讨论了血管造影和立体定向放射外科在其治疗中的作用。
CPA的三种病变可被视为真正的富血管病变：血管母细胞瘤、血管外皮细胞瘤和副神经节瘤。所有病变都有许多放射学特征。然而，每种病变的解剖起源不同，因此具有独特的血供。术前血管造影可作为一种诊断工具，根据主要供血血管缩小血管性CPA病变的鉴别诊断范围。此外，血管造影时的术前栓塞将降低相关手术风险。
血管造影是一种关键的诊断和治疗工具，有助于缩小术前鉴别诊断范围并控制术中出血。由于CPA血管肿瘤切除相关的手术风险较高，立体定向放射外科等非侵入性治疗也可能发挥关键作用。
