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Cerebellopontine-angle lesion
156
Surg Neurol 1996;46:154-6
Ausman
formed via a petrosal partial labyrinthectomypetrous apicectomy approach, with the goal of resecting as much of the tumor as is safely possible. If there is a good arachnoid plane between the tumor and the brain stem, there is a good chance that the tumor could be resected completely. If there is a poor arachnoid plane, tumor remnants may have to be left behind on the brain stem. Tumor remnants may also remain inside the cavernous sinus. In such a case, radiosurgery or simple follow-up would be the treatment options for the residual tumor. Laligam
N. !3ekhar, M.D., FACS
Department of Neurological Surgery The George Washington University Washington, DC
q1
T,-weighted MRI with gadolinium.
expectancy. I am making the assumption that her life expectancy is not going to be longer than 15 years and is more likely to be 5 years. She has already lived well past the average life expectancy of women in the United States. If the patient were 65 years old, then the decision making becomes somewhat more difficult. Once again, the considerations are very similar; however, I would want to see the patient a few times to see if her symptoms are truly progressive and if the tumor is in fact growing. If the patient became symptomatic with ataxia or hemiparesis, then microsurgery would be recommended. If the patient were 45 years old, I would have no hesitation in recommending surgical treatment of the lesion. In such a patient, surgery would be per-
This 85-year-old woman has a tumor at the petrous apex, which is most likely a meningioma. The patient’s symptoms may be related to the mass effect, but they are not disabling. Often elderly patients with skull base meningiomas will have imaging studies that appear more alarming than their clinical condition. The degree of brain stem compression evident on the magnetic resonance imaging (MRI) scan indicates that the meningioma is slowly growing. Considering the patient’s age, surgery may present a greater risk for morbidity than no treatment. We would favor careful observation. If hydrocephalus develops, shunting could be considered. Craniotomy could be an option if there was convincing evidence of progressive neurologic deterioration. In such a scenario, subtotal resection via a posterior fossa approach would seem appropriate in a patient of her age. Troy D. Payner, Julius M. Goodman,
M.D. M.D.
Practicing Neurosurgeons Indianapolis, Indiana
Surg Neurol 1996;46:154-6
Ausman
formed via a petrosal partial labyrinthectomypetrous apicectomy approach, with the goal of resecting as much of the tumor as is safely possible. If there is a good arachnoid plane between the tumor and the brain stem, there is a good chance that the tumor could be resected completely. If there is a poor arachnoid plane, tumor remnants may have to be left behind on the brain stem. Tumor remnants may also remain inside the cavernous sinus. In such a case, radiosurgery or simple follow-up would be the treatment options for the residual tumor. Laligam
N. !3ekhar, M.D., FACS
Department of Neurological Surgery The George Washington University Washington, DC
q1
T,-weighted MRI with gadolinium.
expectancy. I am making the assumption that her life expectancy is not going to be longer than 15 years and is more likely to be 5 years. She has already lived well past the average life expectancy of women in the United States. If the patient were 65 years old, then the decision making becomes somewhat more difficult. Once again, the considerations are very similar; however, I would want to see the patient a few times to see if her symptoms are truly progressive and if the tumor is in fact growing. If the patient became symptomatic with ataxia or hemiparesis, then microsurgery would be recommended. If the patient were 45 years old, I would have no hesitation in recommending surgical treatment of the lesion. In such a patient, surgery would be per-
This 85-year-old woman has a tumor at the petrous apex, which is most likely a meningioma. The patient’s symptoms may be related to the mass effect, but they are not disabling. Often elderly patients with skull base meningiomas will have imaging studies that appear more alarming than their clinical condition. The degree of brain stem compression evident on the magnetic resonance imaging (MRI) scan indicates that the meningioma is slowly growing. Considering the patient’s age, surgery may present a greater risk for morbidity than no treatment. We would favor careful observation. If hydrocephalus develops, shunting could be considered. Craniotomy could be an option if there was convincing evidence of progressive neurologic deterioration. In such a scenario, subtotal resection via a posterior fossa approach would seem appropriate in a patient of her age. Troy D. Payner, Julius M. Goodman,
M.D. M.D.
Practicing Neurosurgeons Indianapolis, Indiana