Early Outcome of Cerebellopontine Angle Tumour Surgery at Bir Hospital, Nepal

Abstract

INTRODUCTION: Cerebellopontine angle tumours are the most common neoplasms in the posterior fossa, accounting for 10-15% of intracranial tumours. Most tumours are benign, with 75-86% being vestibular schwannomas, followed by meningiomas, epidermoids, lipomas, and vascular malformations. The objective of this study was to evaluate the preoperative clinical status, postoperative complications and to assess early postoperative facial nerve outcome by House Brackmann (HB) grading according to tumour size. Histopathological findings were recorded.

METHOD: A prospective study was carried in 29 patients with cerebellopontine angle tumours who underwent surgery at the National Academy of Medical Sciences (NAMS), Bir Hospital between September 2017 to March 2019. Retromastoidretrosigmoid (RMRS) approach surgery was done. Data were entered regarding preoperative clinical status, tumour size, postoperative complications and HB grading (I-VI) to characterize the degree of facial paralysis and histopathological findings.

RESULT: The study comprised of twenty-nine patients. Twenty-six (89.7%) were Vestibular Schwannoma, 2 (6.9%) Meningioma and 1 (3.4%) Epidermoid cyst. Thirteen (45%) patients had tumours sized between 26- 40mm, 11 (38%) were more than 40mm and 5 (17.2%) had tumours sized 11-25mm. Grade I facial nerve function was seen in 15 (52%) of patients. Meanwhile, 10 (34.5%) had grade II, 2 (6.9%) grade III and 1 (3.4%) patient each had grade IV and V facial dysfunction. Excellent (HB I-II) grading was seen in tumour size of 11-25mm whereas intermediate (HB III-IV) and poor (HB V-VI) grading was seen in the size of 26-40mm and >40mm respectively. Facial nerve dysfunction (28.6%) and tinnitus/vertigo and CSF leakage each (21.5%), Pseudomeningocele and hearing loss (14.2%) are major postoperative complications. One mortality case was reported due to respiratory failure.

CONCLUSION: The patients with cerebellopontine angle tumours have several clinical features; however hearing loss and raised intracranial pressure are more common. Facial nerve dysfunction and tinnitus/vertigo, CSF leakage, pseudomeningocele and hearing loss are found to be major postoperative complications. Size of tumours significantly associated postoperatively with the degree of the facial paralysis.