369 - ORIGINAL ARTICLE Auditory and Facial Nerve Function...

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Auditory and Facial Nerve Function Following Surgery for Cerebellopontine Angle Meningiomas Pete S. Batra, MD; Jose C. Dutra, MD; Richard J. Wiet, MD Objective: To investigate the postoperative auditory and facial nerve function results after cerebellopontine angle meningioma removal. Design: Retrospective chart review. Setting: Tertiary care referral center. Patients: Twenty-one patients undergoing surgical re- moval of cerebellopontine angle meningiomas by the se- nior author (R.J.W.). Interventions: Translabyrinthine or retrosigmoid ap- proach for tumor extirpation. Main Outcome Measures: Postoperative auditory (pure-tone average and speech discrimination score) and facial (House-Brackmann scale) function within 1 year of follow-up. Results: Twenty-three operations were performed on 21 patients. Hearing preservation through the retrosigmoid approach was attempted in 11 patients (48%). Normal hear- ing (class A) was preserved in 9 of 10 patients. Normal post- operative facial nerve function (House-Brackmann grade I) was conserved in 11 (65%) of 17 patients . Conclusions: Thisreviewdemonstratesthatsuccessfulhear- ingpreservationispossiblewithmeningiomas.Therefore, the retrosigmoid approach should be used whenever ser- viceablehearingispresentpreoperatively.Normalfacialnerve function can also be preserved in the majority of patients. Arch Otolaryngol Head Neck Surg. 2002;128:369-374 A PPROXIMATELY 10% of all in- tracranial tumors origi- nate in the cerebellopon- tine angle (CPA), with vestibular schwannomas comprising the majority of tumors in this location. 1 Meningiomas are the second most common neoplasm in the CPA, represent- ing 10% to 15% of tumors. 2 They are his- tologically considered to be benign tu- mors arising from the arachnoid villi of the venous sinuses. 3 The usual sites of attach- ment of the posterior fossa meningiomas are the posterior surface of the petrous bone, tentorium, clivus, cerebellar convexity, and foramen magnum, in decreasing order of fre- quency. 4 According to Nager and Masica, 4 meningiomas originate in 4 specific loca- tions in the posterior petrous pyramid: the internal auditory meatus, jugular fora- men, region of the geniculate ganglion, and sulcus of the greater and lesser superficial petrosal nerves. This may account for the variability of location of meningiomas and for their relationship to critical structures. Clinical manifestations of meningio- mas are usually otologic or neurologic, sec- ondary to involvement of contiguous struc- tures of the posterior fossa. Presenting symptoms commonly include hearing loss, imbalance, tinnitus, facial numbness, and headaches. Less frequently, patients may complain of trigeminal neuralgia, diplo- pia, nausea, facial paresis, otalgia, or loss of taste. 2 Indeed, the clinical symptoms of meningiomas can be very similar to those of vestibular schwannomas, thus making the preoperative differentiation between the 2 neoplasms difficult.
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This note was uploaded on 12/11/2009 for the course UNT 123456 taught by Professor 123456 during the Spring '09 term at University of North Texas Health Science Center.

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369 - ORIGINAL ARTICLE Auditory and Facial Nerve Function...

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