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The “Deep Subarcuate Fossa” sign and three types of anomalous subarcuate loops encountered during vestibular schwannoma removal

  • Original Article - Tumor - Schwannoma
  • Published:
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Abstract

Background

An anomalous subarcuate loop (SL) of the anteroinferior cerebellar artery (AICA) is a rare anatomic variation, which increases the complexity and risk of vestibular schwannoma (VS) removal. However, preoperative diagnosis of this anomaly remains difficult. The aim of this study was to report three types of anomalous SLs encountered during VS removal and to describe the “Deep Subarcuate Fossa (SF)” sign and its significance in the diagnosis and treatment of an osseous-penetrating SL.

Methods

We prospectively observed 963 patients with newly/recently diagnosed VS who underwent surgical treatment performed by the senior author (P.Z.) from 2012 to 2021 and identified 16 patients with an anomalous SL. The SF was retrospectively measured on preoperative thin-slice temporal bone computed tomography in 963 patients.

Results

Three types of anomalous SLs were encountered during VS removal: the apex of the SL was embedded in the dorsal tumor capsule (type I, 1 case), the dura (type II, 8 cases), or the dura and bone (type III, 7 cases) surrounding the SF. The depth of the SF in 7 patients with a type III anomalous SL ranged from 2.3 to 7.0 mm (3.56 ± 1.56 mm), which was significantly larger than that in 845 patients without an osseous-penetrating SL (1.23 ± 0.43 mm) (p = 0.008). When the depth of the SF exceeded 2 mm, the sensitivity and precision of the diagnosis of a type III anomalous SL were 100% (7/7) and 31.8% (7/22), respectively.

Conclusion

Three types of anomalous SLs may be encountered during VS removal, and AICA displacement is recommended before tumor removal. The “Deep SF” sign may indicate the existence of a type III anomalous SL and it can predict the depth of the AICA in the bone and guide the drilling of the bone around the vessel loop.

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Abbreviations

3D:

Three-dimensional

AICA:

Anteroinferior cerebellar artery

CPA:

Cerebellopontine angle

CT:

Computed tomography

IAM:

Internal acoustic meatus

MRI:

Magnetic resonance imaging

SA:

Subarcuate artery

SC:

Subarcuate canaliculus

SF:

Subarcuate fossa

SL:

Subarcuate loop

SSC:

Superior semicircular canal

VS:

Vestibular schwannoma

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Acknowledgements

The authors thank Huijie Shen for providing the artwork and Jiawen Zhang and Dongdong Wang for help with measuring the width and depth of the SF. The authors also thank Angela Morben, DVM, ELS, from Liwen Bianji (Edanz) (www.liwenbianji.cn) for editing the English text of a draft of this manuscript.

Funding

This study was funded by the Chinese Academy of Medical Sciences (CAMS) Innovation Fund for Medical Sciences (CIFMS, 2019-I2M-5-008) and the Clinical Research Plan of Shanghai Hospital Development Center (No.SHDC2020CR1049B).

Author information

Author notes

  1. Ming Xu and Jian Xu contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China

    Ming Xu, Jian Xu, Mingyu Chen, Ying Wang & Ping Zhong

  2. National Center for Neurological Disorders, Shanghai, China

    Ming Xu, Jian Xu, Mingyu Chen, Ying Wang & Ping Zhong

  3. Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China

    Ming Xu, Jian Xu, Mingyu Chen, Ying Wang & Ping Zhong

  4. Neurosurgical Institute of Fudan University, Shanghai, China

    Ming Xu, Jian Xu, Mingyu Chen, Ying Wang & Ping Zhong

  5. Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China

    Ming Xu, Jian Xu, Mingyu Chen, Ying Wang & Ping Zhong

  6. Research Units of New Technologies of Micro-Endoscopy Combination in Skull Base Surgery, Chinese Academy of Medical Sciences, Shanghai, China

    Ming Xu, Jian Xu, Mingyu Chen, Ying Wang & Ping Zhong

Authors
  1. Ming Xu
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Corresponding author

Correspondence to Ping Zhong.

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Ethics approval

All procedures performed were in accordance with the ethical standards of the Huashan Hospital Institutional Review Board (HIRB: KY2020-065) and with the 1964 Helsinki declaration and its later amendments. Informed consent was obtained from all individual participants included in the study.

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The authors declare no competing interests.

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This article is part of the Topical Collection on Tumor - Schwannoma

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 198 KB)

Supplementary file2 Displacement of a type I anomalous SL encountered during removal of a left-sided vestibular schwannoma (Case 5) (MP4 60140 KB)

Supplementary file3 Displacement of a type III anomalous SL encountered during removal of a left-sided vestibular schwannoma (Case 9) (MP4 80842 KB)

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Xu, M., Xu, J., Chen, M. et al. The “Deep Subarcuate Fossa” sign and three types of anomalous subarcuate loops encountered during vestibular schwannoma removal. Acta Neurochir 164, 2483–2490 (2022). https://doi.org/10.1007/s00701-022-05288-6

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  • DOI: https://doi.org/10.1007/s00701-022-05288-6

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