Subscribe to RSS
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.1055/s-0041-1726601
A Retrospective Clinicoradiologic Study of 126 Cerebellopontine Angle Tumors to Predict the Outcome of House–Brackmann Status to Prognosticate Them: A Single-Center Tertiary Care Perspective
![](https://www.thieme-connect.de/media/10.1055-s-00028728/202203/lookinside/thumbnails/10.1055-s-0041-1726601-1.jpg)
Abstract
Introduction House–Brackmann (HB) grading had been described to quantify the facial nerve involvement in cerebellopontine angle (CPA) tumors, a very common tumor in neurosurgical practice. Very few studies have specifically looked into the factors predicting the facial nerve morbidity and its severity. Here, we try finding these while going through the clinicoradiologic factors and its natural course to help us prognosticate the patients.
Objective To analyze the size of tumor and duration of symptoms to predict the severity of HB status of facial nerve presentation and outcome, and to study the course of the disease to help prognosticate the patients with respect to facial nerve status.
Materials and Methods This was a retrospective analysis of 126 operated CPA tumors, where we studied the natural course of HB status with respect to size and duration of symptoms of patients at our institute between December 2016 to February 2020.
Results Average duration of symptoms were 33.8 days with increasing risk of HB outcome after 36 days of symptoms. All patients improved to their preoperative facial nerve status at 3 months and only 18 maintained the worsened HB status. Average size of tumor was 3.53 cm, and size higher than 3.8 cm was associated with poorer HB outcome.
Conclusion Although there can be a significant deterioration of HB status in immediate postoperative period, it improves to preoperative status in due time. Tumor larger than 3.8 cm and symptom duration more than 36 days are two important factors predicting poorer HB outcome.
Publication History
Article published online:
24 November 2021
© 2021. Neurological Surgeons’ Society of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
-
References
- 1 House WF, Hitselberger WE. Transtemporal bone microsurgical removal of acoustic neuromas. Morbidity and mortality of acoustic neuromas. Arch Otolaryngol 1964; 80: 752-754
- 2 Shelton C. Unilateral acoustic tumors: how often do they recur after translabyrinthine removal?. Laryngoscope 1995; 105 (9 Pt 1) 958-966
- 3 Tos M, Thomsen J, Harmsen A. Results of translabyrinthine removal of 300 acoustic neuromas related to tumour size. Acta Otolaryngol Suppl 1988; 452: 38-51
- 4 Rehman L, Bokhari I, Siddiqi SUH, Bagga V, Hussain MM. Intracranial epidermoid lesions: our experience of 38 cases. Turk Neurosurg 2017; 28 (05) 763-767
- 5 Atalay B, Altinörs N, Yilmaz C, Koçbiyik A. Extraaxial chloroma of the cerebellopontine angle: case report. Turk Neurosurg 2007; 17 (04) 286-288
- 6 Bhandari L, Alapatt J, Govindan A, Sreekumar T. Primary cerebellopontine angle melanoma: a case report and review. Turk Neurosurg 2012; 22 (04) 469-474
- 7 Zhou J, Chen L, Zhang C, Ouyang H, Silky C, Qi S. Primary cerebellopontine angle Rathke’s cleft cyst: case report. Turk Neurosurg 2014; 24 (03) 427-429
- 8 Briggs RJ, Luxford WM, Atkins Jr JS, Hitselberger WE. Translabyrinthine removal of large acoustic neuromas. Neurosurgery 1994; 34 (05) 785-790
- 9 Nayak P, Kumar R. Retromastoid-sub occipital: a novel approach to cerebello pontine angle in acoustic neuroma surgery-our experience in 21 cases. J Neurosci Rural Pract 2011; 2 (01) 23-26
- 10 Nair S, Baldawa SS, Gopalakrishnan CV, Menon G, Vikas V, Sudhir JB. Surgical outcome in cystic vestibular schwannomas. Asian J Neurosurg 2016; 11 (03) 219-225
- 11 Sterkers JM, Morrison GA, Sterkers O, El-Dine MM. Preservation of facial, cochlear, and other nerve functions in acoustic neuroma treatment. Otolaryngol Head Neck Surg 1994; 110 (02) 146-155
- 12 Hitselberger WE, House WF. Classification of acoustic neuromas. Arch Otolaryngol 1966; 84 (03) 245-246
- 13 Koos WT, Day JD, Matula C, Levy DI. Neurotopographic considerations in the microsurgical treatment of small acoustic neurinomas. J Neurosurg 1998; 88 (03) 506-512
- 14 Samii M, Matthies C. Management of 1000 vestibular schwannomas (acoustic neuromas): surgical management and results with an emphasis on complications and how to avoid them. Neurosurgery 1997; 40 (01) 11-21
- 15 Chen L, Chen LH, Ling F, Liu YS, Samii M, Samii A. Removal of vestibular schwannoma and facial nerve preservation using small suboccipital retrosigmoid craniotomy. Chin Med J (Engl) 2010; 123 (03) 274-280
- 16 Velho V, Naik H, Bhide A, Bhople L, Gade P. Lateral semi-sitting position: a novel method of patient’s head positioning in suboccipital retrosigmoid approaches. Asian J Neurosurg 2019; 14 (01) 82-86
- 17 Safdarian M, Safdarian M, Chou R, Hashemi SMR, Rahimi-Movaghar V. A systematic review about the position-related complications of acoustic neuroma surgery via suboccipital retrosigmoid approach: Sitting versus lateral. Asian J Neurosurg 2017; 12 (03) 365-373
- 18 Pirouzmand F, Tator CH, Rutka J. Management of hydrocephalus associated with vestibular schwannoma and other cerebellopontine angle tumors. Neurosurgery 2001; 48 (06) 1246-1253
- 19 Ojemann RG, Montgomery WW, Weiss AD. Evaluation and surgical treatment of acoustic neuroma. N Engl J Med 1972; 287 (18) 895-899
- 20 Wu H, Zhang L, Han D. et al. Summary and consensus in 7th International Conference on acoustic neuroma: An update for the management of sporadic acoustic neuromas. World J Otorhinolaryngol Head Neck Surg 2016; 2 (04) 234-239
- 21 Rinaldi V, Casale M, Bressi F. et al. Facial nerve outcome after vestibular schwannoma surgery: our experience. J Neurol Surg B Skull Base 2012; 73 (01) 21-27
- 22 Calzada AP, Go JL, Tschirhart DL, Brackmann DE, Schwartz MS. Cerebellopontine angle and intracanalicular masses mimicking vestibular schwannomas. Otol Neurotol 2015; 36 (03) 491-497
- 23 Sarrazin J, Hélie O, Cordoliani Y. [Cerebellopontine angle tumors in adults]. J Radiol 2000; 81 (06) , Suppl) 675-690
- 24 Patibandla MR, Panigrahi MK, Gurram PL, Thotakura AK, Kulkarni D. Morphometric analysis of posterior fossa in Indian CP angle acoustic schwannoma patients. Asian J Neurosurg 2016; 11 (03) 255-260
- 25 Iwai Y, Yamanaka K, Ishiguro T. Surgery combined with radiosurgery of large acoustic neuromas. Surg Neurol 2003; 59 (04) 283-289
- 26 Celikkanat SM, Saleh E, Khashaba A. et al. Cerebrospinal fluid leak after translabyrinthine acoustic neuroma surgery. Otolaryngol Head Neck Surg 1995; 112 (06) 654-658