Meningiomas of the cerebellopontine angle

BACKGROUND Meningiomas of the cerebellopontine angle (CPA), although unifor m in location, are diverse with regard to the sire of dural origin and disp lacement of neurovascular structures. A study of patients with CPA meningio mas was undertaken to gain more information regarding the relationship betw een site of dural attachment, clinical presentation, operative approach, an d outcome. METHODS In this report, we retrospectively review 40 patients with CPA meni ngiomas managed surgically. RESULTS Common clinical presentations were hearing loss, unsteadiness, and dysequilibrium. Findings upon physical examination included hearing loss (7 3%), cerebellar signs (32%), trigeminal neuropathy (16%), and facial nerve dysfunction (16%). The most common site of dural origin was the petrous rid ge (anterior to the IAC [26%], posterior [21%], superior [18%], and inferio r [16%]). Less common sites of dural origin included the tentorium (31%), t he clivus (15%), the IAC (10%), and the jugular foramen (8%). Site of dural origin determined the direction of displacement of the facial/vestibulococ hlear nerve bundle. The most common microsurgical complication was facial n erve dysfunction (30%). Gross total resection was achieved in 82% of cases, whereas 18% underwent subtotal resection. Two patients died. Follow-up ran ged from three months to 13 years with three recurrences. CONCLUSIONS CPA meningiomas displace the seventh and eighth cranial nerves in various directions depending on the site of dural origin. Total surgical excision can be accomplished in the majority of cases with acceptable morb idity. (C) 2000 by Elsevier Science Inc.