Concurrent Cochlear Implantation with Resection of Skull Base Hemangiopericytoma following Sudden Deafness in an Only Hearing Ear

ABSTRACT

A 72-year-old man with a known left acoustic neuroma, left-sided deafness, and a recently diagnosed right infratemporal fossa (ITF) hemangiopericytoma, presented with sudden deafness in his right ear. Imaging revealed right-sided skull base extension and a large intracranial tumor component. The patient underwent a frontotemporal crainiotomy with concomitant ITF approach. Complete tumor resection was possible, though invasion of the otic capsule was present. Immediately postresection, a cochlear implant (CI) was performed via a transmastoid approach. Full electrode insertion was achieved and confirmed by visualization through the dehiscent middle fossa floor. Mastoid obliteration was then performed with a free fat graft. Postoperative imaging confirmed complete tumor resection (Simpson grade I) and adequate CI placement. Follow-up magnetic resonance imaging was performed at 6 and 12 months, and no tumor recurrence was seen. Prior to CI activation, the patient was completely deaf bilaterally. At 18-month follow-up, however, excellent hearing was achieved with the right CI (16 of 22 electrodes active), and the patient is now conversational with no obvious deficit. His cognitive function is excellent, corresponding to preoperative status, and he is independent in his activities of daily living. Following adjuvant radiation, our patient remains disease free at 18 months.

Hemangiopericytoma - cochlear implant - infratemporal fossa - skull base tumor - sudden hearing loss

REFERENCES

• 1 Stout A P, Murray M R. Hemangiopericytoma: A vascular tumor featuring Zimmermann's pericytes.  Ann Surg. 1942;  116 26-33
• 2 Stout A P. Hemangiopericytoma; a study of 25 cases.  Cancer. 1949;  2 1027-1054 , illust
• 3 Dehner L P, Askin F B. Tumors of fibrous tissue origin in childhood. A clinicopathologic study of cutaneous and soft tissue neoplasms in 66 children.  Cancer. 1976;  38 888-900
• 4 Russell W O, Cohen J, Enzinger F et al.. A clinical and pathological staging system for soft tissue sarcomas.  Cancer. 1977;  40 1562-1570
• 5 Batsakis J G, Rice D H. The pathology of head and neck tumors: vasoformative tumors, part 9B.  Head Neck Surg. 1981;  3 326-339
• 6 de Campora E, Calabrese V, Bianchi P M, Camaioni A, Corradini C. Malignant hemangiopericytoma of the nasal cavity. Report of a case and review of the literature.  J Laryngol Otol. 1983;  97 963-968
• 7 Enzinger F M, Smith B H. Hemangiopericytoma. An analysis of 106 cases.  Hum Pathol. 1976;  7 61-82
• 8 Güdrün R. Haemangiopericytoma in otolaryngology.  J Laryngol Otol. 1979;  93 477-494
• 9 McMaster M J, Soule E H, Ivins J C. Hemangiopericytoma. A clinicopathologic study and long-term followup of 60 patients.  Cancer. 1975;  36 2232-2244
• 10 Sabini P, Josephson G D, Yung R T, Dolitsky J N. Hemangiopericytoma presenting as a congenital midline nasal mass.  Arch Otolaryngol Head Neck Surg. 1998;  124 202-204
• 11 Abdel-Fattah H M, Adams G L, Wick M R. Hemangiopericytoma of the maxillary sinus and skull base.  Head Neck. 1990;  12 77-83
• 12 Carew J F, Singh B, Kraus D H. Hemangiopericytoma of the head and neck.  Laryngoscope. 1999;  109 1409-1411
• 13 Diensthuber M, Götz F, Länger F, Lenarz T, Lenarz M. Extra- and intracranial dumbbell-shaped hemangiopericytoma.  Eur Arch Otorhinolaryngol. 2008;  265 481-484
• 14 Kanazawa T, Nishino H, Miyata M, Kuriki K, Abe K, Ichimura K. Haemangiopericytoma of infratemporal fossa.  J Laryngol Otol. 2001;  115 77-79
• 15 Karasen R M, Sutbeyaz Y, Gundogdu C, Eren S, Sirin S. Haemangiopericytoma of the middle ear with benign histological features.  J Laryngol Otol. 1999;  113 911-913
• 16 Sutbeyaz Y, Selimoglu E, Karasen M, Ciftcioglu A, Ozturk A. Haemangiopericytoma of the middle ear: case report and literature review.  J Laryngol Otol. 1995;  109 977-979
• 17 Ahsan S, Telischi F, Hodges A, Balkany T. Cochlear implantation concurrent with translabyrinthine acoustic neuroma resection.  Laryngoscope. 2003;  113 472-474
• 18 Arístegui M, Denia A. Simultaneous cochlear implantation and translabyrinthine removal of vestibular schwannoma in an only hearing ear: report of two cases (neurofibromatosis type 2 and unilateral vestibular schwannoma).  Otol Neurotol. 2005;  26 205-210
• 19 Arriaga M A, Marks S. Simultaneous cochlear implantation and acoustic neuroma resection: imaging considerations, technique, and functional outcome.  Otolaryngol Head Neck Surg. 1995;  112 325-328
• 20 Zanetti D, Campovecchi C B, Pasini S, Nassif N. Simultaneous translabyrinthine removal of acoustic neuroma and cochlear implantation.  Auris Nasus Larynx. 2008;  35 562-568
• 21 Fisch U. Infratemporal fossa approach for glomus tumors of the temporal bone.  Ann Otol Rhinol Laryngol. 1982;  91(5 Pt 1) 474-479
• 22 Koch M, Nielsen G P, Yoon S S. Malignant tumors of blood vessels: angiosarcomas, hemangioendotheliomas, and hemangiopericytomas.  J Surg Oncol. 2008;  97 321-329
• 23 Atkinson J B, Mahour G H, Isaacs Jr H, Ortega J A. Hemangiopericytoma in infants and children. A report of six patients.  Am J Surg. 1984;  148 372-374
• 24 Carvalho J R, Haddad L, Leonhardt F D et al.. Head and neck hemangiopericytoma in a child: case report.  Sao Paulo Med J. 2004;  122 223-226
• 25 Weiss S WGJ. Enzinger and Weiss's Soft Tissue Tumours. 4th ed. St. Louis, MO; C.V. Mosby 2001
• 26 Chnaris A, Barbetakis N, Efstathiou A, Fessatidis I. Primary mediastinal hemangiopericytoma.  World J Surg Oncol. 2006;  4 23
• 27 Espat N J, Bilsky M, Lewis J J, Leung D, Brennan M F. Soft tissue sarcoma brain metastases. Prevalence in a cohort of 3829 patients.  Cancer. 2002;  94 2706-2711
• 28 Espat N J, Lewis J J, Leung D et al.. Conventional hemangiopericytoma: modern analysis of outcome.  Cancer. 2002;  95 1746-1751
• 29 Heiser M A, Waldron J S, Tihan T, Parsa A T, Cheung S W. Temporal fossa hemangiopericytoma: a case series.  Otol Neurotol. 2009;  , (Epub ahead of print)
• 30 Tashjian V S, Khanlou N, Vinters H V, Canalis R F, Becker D P. Hemangiopericytoma of the cerebellopontine angle: a case report and review of the literature.  Surg Neurol. 2009;  72 290-295
• 31 Musacchio M, Mont'Alverne F, Belzile F, Lenz V, Riquelme C, Tournade A. Posterior cervical haemangiopericytoma with intracranial and skull base extension. Diagnostic and therapeutic challenge of a rare hypervascular neoplasm.  J Neuroradiol. 2003;  30 180-187
• 32 Chamberlain M C, Glantz M J. Sequential salvage chemotherapy for recurrent intracranial hemangiopericytoma.  Neurosurgery. 2008;  63 720-726 author reply 726-727
• 33 Galanis E, Buckner J C, Scheithauer B W, Kimmel D W, Schomberg P J, Piepgras D G. Management of recurrent meningeal hemangiopericytoma.  Cancer. 1998;  82 1915-1920
• 34 Staples J J, Robinson R A, Wen B C, Hussey D H. Hemangiopericytoma—the role of radiotherapy.  Int J Radiat Oncol Biol Phys. 1990;  19 445-451
• 35 Kirn D H, Kramer A. Long-term freedom from disease progression with interferon alfa therapy in two patients with malignant hemangiopericytoma.  J Natl Cancer Inst. 1996;  88 764-765
• 36 Ortega J A, Finklestein J Z, Isaacs Jr H, Hittle R, Hastings N. Chemotherapy of malignant hemangiopericytoma of childhood. Report of a case and review of the literature.  Cancer. 1971;  27 730-735
• 37 Walike J W, Bailey B J. Head and neck hemangiopericytoma.  Arch Otolaryngol. 1971;  93 345-353
• 38 Fletcher C D, McKee P H. Sarcomas—a clinicopathological guide with particular reference to cutaneous manifestation. III. Angiosarcoma, malignant haemangiopericytoma, fibrosarcoma and synovial sarcoma.  Clin Exp Dermatol. 1985;  10 332-349
• 39 Kraus D H, Dubner S, Harrison L B et al.. Prognostic factors for recurrence and survival in head and neck soft tissue sarcomas.  Cancer. 1994;  74 697-702
• 40 Ralston A, Stevens G, Mahomudally E, Ibrahim I, Leckie E. Cochlear implants: response to therapeutic irradiation.  Int J Radiat Oncol Biol Phys. 1999;  44 227-231