Mehta Neel H, Patel Ruchit V, Gupta Saksham, Arora Harshit, Nawabi Noah L, Karanth Rayha, Sadler Samantha, Medeiros Lila, Jha Rohan, Chavarro Velina S, Bernstock Joshua D, Smith Timothy R, Arnaout Omar
Harvard Medical School, Boston , Massachusetts , USA.
Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston , Massachusetts , USA.
Neurosurgery. 2024 Nov 1;97(1):105-111. doi: 10.1227/neu.0000000000003258.
Cerebellopontine angle (CPA) meningiomas present challenges given their proximity to neurovascular structures. Postoperative complications and persistent symptoms can debilitate patients, and our ability to predict recovery course remains variable. Here, we examine the presentation, management, and outcomes of patients with CPA meningiomas.
We retrospectively reviewed CPA meningiomas resected at Mass General Brigham, using descriptive statistics and logistic regression to identify predictors of progression or recurrence.
In total, 95 patients were identified (median age 59.1 years, 82.1% female) who presented most commonly with hearing loss (49.5%), ataxia (42.1%), and headaches (29.5%). The retrosigmoid (78.9%) or transmastoid retrosigmoid (17.9%) approaches were most frequently used for resection, with gross total resection (GTR) achieved in 62.1% of patients: Simpson grade 1 (32.6%), grade 2 (17.9%), and grade 3 (11.6%). Smaller tumor size (t = 3.17, P = .002) is associated with GTR. For tumors with intracanalicular invasion, drilling the internal auditory canal (IAC) was also associated with GTR (χ 2 = 21.8, P < .001). Among cases with invasion, GTR was achieved in 88.5% of cases when the IAC was drilled vs 11.8% of cases when the IAC was not drilled. The cranial nerve VII/VIII complex was frequently inferior (45.6%) or superior (19.1%) to the meningioma. Postoperative hearing loss was stable (38.7%) or improved (54.8%) in most of patients at the final clinical follow-up (median: 39.4 months). 25.3% of patients had progression/recurrence, with some difference between World Health Organization grade 1 (median: 3.0 years, IQR: 2.9 years) and World Health Organization grade 2 (median: 1.6 years, IQR: 2.8 years) tumors. After multivariate adjustment, Simpson grade I ( P = .02), Simpson grade II ( P = .01), or being of older age ( P = .003) were associated with lower odds of progression/recurrence.
GTR remains critical to achieve optimal symptom control and reduce progression/recurrence rates for CPA meningiomas. Drilling the IAC is an important predictor of GTR in tumors with intracanalicular invasion.
桥小脑角（CPA）脑膜瘤因其靠近神经血管结构而带来挑战。术后并发症和持续症状会使患者衰弱，而我们预测恢复过程的能力仍存在差异。在此，我们研究CPA脑膜瘤患者的临床表现、治疗及预后。
我们回顾性分析了在麻省总医院布莱根分院切除的CPA脑膜瘤，使用描述性统计和逻辑回归来确定进展或复发的预测因素。
共纳入95例患者（中位年龄59.1岁，82.1%为女性），最常见的表现为听力损失（49.5%）、共济失调（42.1%）和头痛（29.5%）。乙状窦后入路（78.9%）或经乳突乙状窦后入路（17.9%）是最常用的切除方法，62.1%的患者实现了全切除：辛普森一级（32.6%）、二级（17.9%）和三级（11.6%）。较小的肿瘤大小（t = 3.17，P = .002）与全切除相关。对于有内听道侵犯的肿瘤，磨除内听道（IAC）也与全切除相关（χ2 = 21.8，P < .001）。在有侵犯的病例中，磨除IAC时88.5%的病例实现了全切除，未磨除IAC时为11.8%。面神经VII/ VIII复合体常位于脑膜瘤下方（45.6%）或上方（19.1%）。在最后的临床随访（中位时间：39.4个月）时，大多数患者的术后听力损失稳定（38.7%）或改善（54.8%）。25.3%的患者出现进展/复发，世界卫生组织一级肿瘤（中位时间：3.0年，四分位间距：2.9年）和世界卫生组织二级肿瘤（中位时间：1.6年，四分位间距：2.8年）之间存在一些差异。多因素调整后，辛普森一级（P = .02）、辛普森二级（P = .01）或年龄较大（P = .003）与进展/复发几率较低相关。
全切除对于实现CPA脑膜瘤的最佳症状控制和降低进展/复发率仍然至关重要。磨除IAC是有内听道侵犯肿瘤全切除的重要预测因素。
