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Imaging of cerebellopontine angle lesions: an update. Part 2: intra-axial lesions, skull base lesions that may invade the CPA region, and non-enhancing extra-axial lesions

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Abstract

Computed tomography (CT) and magnetic resonance (MR) imaging reliably demonstrate typical features of vestibular schwannomas or meningiomas in the vast majority of mass lesions responsible for cerebellopontine angle (CPA) syndrome. However, a large variety of unusual lesions can also be encountered in the CPA. Covering the entire spectrum of lesions potentially found in the CPA, these articles explain the pertinent neuroimaging features that radiologists need to know to make clinically relevant diagnoses in these cases, including data from diffusion- and perfusion-weighted imaging or MR spectroscopy, when available. A diagnostic algorithm based on the lesion’s site of origin, shape and margins, density, signal intensity and contrast material uptake is also proposed. Non-enhancing extra-axial CPA masses are cystic (epidermoid cyst, arachnoid cyst, neurenteric cyst) or contain fat (dermoid cyst, lipoma). Tumours can also extend into the CPA by extension from the skull base (paraganglioma, chondromatous tumours, chordoma, cholesterol granuloma, endolymphatic sac tumour). Finally, brain stem or ventricular tumours can present with a significant exophytic component in the CPA that may be difficult to differentiate from an extra-axial lesion (lymphoma, hemangioblastoma, choroid plexus papilloma, ependymoma, glioma, medulloblastoma, dysembryoplastic neuroepithelial tumour).

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Acknowledgements

We are grateful to David Seidenwurm, MD, for his meticulous and exhaustive review of this manuscript.

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Authors and Affiliations

  1. Department of Neuroradiology, Pitié-Salpêtrière Hospital, 47, Boulevard de l’Hôpital, 75013, Paris, France

    Fabrice Bonneville & Jacques Chiras

  2. Department of Radiology, Adolphe de Rothschild Foundation, Paris, France

    Julien Savatovsky

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  1. Fabrice Bonneville
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Correspondence to Fabrice Bonneville.

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Bonneville, F., Savatovsky, J. & Chiras, J. Imaging of cerebellopontine angle lesions: an update. Part 2: intra-axial lesions, skull base lesions that may invade the CPA region, and non-enhancing extra-axial lesions. Eur Radiol 17, 2908–2920 (2007). https://doi.org/10.1007/s00330-007-0680-4

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