Tumor position relative to the porus acusticus may be of value in the determination of surgical approach for hearing preservations.
Hearing was preserved at pre-operative level or improved in 20/23 patients. Mean follow up was 36 months (range 1-110). Complications included facial palsy (n=1) (in patient undergoing facial nerve transposition), SNHL (n=3), CSF leak (n=1), Trigeminal neuralgia (n=1), dysphagia (n=1), ICH (n=1), brachial plexopathy (n=1), sialadenitis (n=1), VPS (n=1), vocal cord paresis (n=1). (C) Toward the lateral aspect of the auditory canal, the four nerves are almost delineated as individual nerves. Extent of resection was gross total (n=20), near total (n=6), and subtotal (n=5). (B) At the porus acusticus, the vestibulocochlear nerve is a single, crescent-shaped unit located posterior and inferior to the facial nerve. Patients reported vestibular complaints (n=20) and tinnitus (n=5). In those without hearing: transcochlear (n= 2), combined petrosal (n=2), and transotic (n=1) approaches were employed. Twenty-four patients with salvageable hearing underwent hearing preservation approaches including: retrosigmoid (n=10), extended middle fossa (n=3), combined petrosal (n=6), modified trans-jugular (n=2), retrolabyrinthine (n=1), or far lateral (n=2). Mean volume of the tumors was 13.0 +14.0cm 3. Tumors were classified as: inframeatal (n=5), premeatal (n=9), retromeatal (n=13), and suprameatal (n=4). Thirty-one patients (6M:25F, mean age 61, range (20-90yrs) were identified. Tumor position was classified relative to the meatus of the porus acousticus, and pre-operative hearing was dichotomized to “salvageable hearing” (Gardner-Robertson Grade 1-3) vs “non-salvageable hearing” (GR 4-5). Charts were analyzed with regards to: demographics, presentation, tumor volume, pre and post-operative audiometry, extent of resection, facial nerve function, and complications. Exclusion criteria included patients with multiple tumors (e.g. The charts of all patients undergoing surgery for CPA meningiomas were retrospectively reviewed between 2010 to 2018.
We describe our experience with CPA meningiomas in regard to pre-operative hearing status and location of the tumor relative to the porus acusticus. The ideal surgical approach to cerebellopontine angle (CPA) meningiomas is not established in the literature.