Abstract
Introduction
When vestibular schwannoma (VS) collides with meningioma at the cerebellopontine angle (CPA), a particular threat occurs. Sudden acceleration of tumor growth and unpredictable involvement of cranial nerves results in a special environment that aggravates management. The goal of this study was to analyze the extent of resection, postoperative facial and cochlear function, surgical strategy, and survival rates in patients with neurofibromatosis type 2 (NF2) with meningioma–vestibular schwannoma (M-VS) collision tumors.
Methods
A total of 1284 VS, including 165 NF2 VS were operated at our department between January 2004 and May 2018. Out of these cases, a group of six NF2 patients with seven M-VS collision tumors was found following careful analysis of neuroradiological data and pathological and surgical reports. Patients were evaluated for extent of tumor resection and, furthermore, postoperative facial and hearing function.
Results
Six patients with NF2 with seven M-VS collision tumors were included in this study. Mean age was 32 ± 8.2 years. A gross total resection (GTR) of both colliding tumors was achieved in only one case, a GTR of the meningioma and a subtotal resection (STR) of the VS in four cases and in two cases only, the meningioma was removed. In five of the cases, facial function was intact or good (House and Brackmann grades I–II) at long-term follow-up (mean follow-up 22 months). No mortality occurred during follow-up.
Conclusions
Collision between M and VS at the CPA is a particular phenomenon in NF2 patients that may aggravate the situation with less favorable surgical outcome than NF-2 VS without meningioma.
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References
Bonneville F, Sarrazin JL, Marsot-Dupuch K, Iffenecker C, Cordoliani YS, Doyon D, Bonneville JF (2001) Unusual lesions of the cerebellopontine angle: a segmental approach. Radiographics 21:419–438
Chen AF, Samy RN, Gantz BJ (2001) Cerebellopontine angle tumor composed of Schwann and meningeal proliferations. Arch Otolaryngol Head Neck Surg 127:1385–1389
Evans DG, Huson SM, Donnai D, Neary W, Blair V, Teare D, Newton V, Strachan T, Ramsden R, Harris R (1992) A genetic study of type 2 neurofibromatosis in the United Kingdom. I. Prevalence, mutation rate, fitness, and confirmation of maternal transmission effect on severity. J Med Genet 29:841–846
Frassanito P, Montano N, Lauretti L, Pallini R, Fernandez E, Lauriola L, Novello M, Maira G (2011) Simultaneously occurring tumours within the same cerebello-pontine angle: refining literature definitions and proposal for classification. Acta Neurochir 153:1989–1993
Graffeo CS, Perry A, Copeland WR, Giannini C, Neff BA, Driscoll CL, Link MJ (2017) Synchronous tumors of the cerebellopontine angle. World Neurosurg 98:632–643
Grauvogel J, Grauvogel TD, Taschner C, Baumgartner S, Maier W, Kaminsky J (2010) A rare case of radiologically not distinguishable coexistent meningioma and vestibular schwannoma in the cerebellopontine angle—case report and literature review. Case Rep Neurol 2:111–117
Kim BS, Seol HJ, Lee JI, Shin HJ, Park K, Kong DS, Nam DH, Cho YS (2016) Clinical outcome of neurofibromatosis type 2-related vestibular schwannoma: treatment strategies and challenges. Neurosurg Rev 39:643–653
Kutz JW, Barnett SL, Hatanpaa KJ, Mendelsohn DB (2009) Concurrent vestibular schwannoma and meningioma mimicking a single cerebellopontine angle tumor. Skull Base 19:443–446
Pallini R, Tancredi A, Casalbore P, Mercanti D, Larococca LM, Conales A, Lauretti L, Fernandez E (1998) Neurofibromatosis type 2: growth stimulation of mixed acoustic schwannoma by concurrent adjacent meningioma: possible role of growth factors. Case report. J Neurosurg 89:149–154
Samii M, Gerganov V, Samii A (2008) Microsurgery management of vestibular schwannomas in neurofibromatosis type 2: indications and results. Prog in Neurol Surg 21:169–175
Samii M, Matthies C, Tatagiba M (1997) Management of vestibular schwannomas (acoustic neuromas): auditory and facial nerve function after resection of 120 vestibular schwannomas in patients with neurofibromatosis 2. Neurosurgery 40:696–705
Tatagiba M, Roser F, Schuhmann MU, Ebner FH (2014) Vestibular schwannoma surgery via the retrosigmoid transmeatal approach. Acta Neurochir 156:421–425
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This study was performed in accordance with the ethical standards of the institutional research committee (University of Tuebingen/Ethic Commission) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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This article is part of the Topical Collection on Tumor – Schwannoma
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Adib, S.D., Tatagiba, M. Surgical management of collision-tumors between vestibular schwannoma and meningioma in the cerebellopontine angle in patients with neurofibromatosis type 2. Acta Neurochir 161, 1157–1163 (2019). https://doi.org/10.1007/s00701-019-03933-1
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DOI: https://doi.org/10.1007/s00701-019-03933-1