A cerebellopontine angle tumor is a tumor that is located at the angle between the cerebellum and the nearby bridge. The so-called petrous bone is also located nearby. In the majority of cases, an acoustic neuroma is present, but epidermoid tumors, meningiomas, cholesteatomas, glomus jugulare tumor, and brain metastasis are also possible.
What is a cerebellopontine angle tumor?
Various tumors form in the area between the brainstem and cerebellum, and they are usually benign. The most common of these are meningiomas and acoustic neuromas. Cerebellar bridge angle tumors may result in loss of certain cranial nerves. Later in the course of the disease, hydrocephalus and compression of the brainstem sometimes occur. Since magnetic resonance imaging has become available as an examination method, cerebellopontine angle tumors are usually diagnosed earlier than in earlier times. Consequently, the prospects of cure are also much more favorable. Nowadays, the goal of surgical interventions is to preserve the functions of the cranial nerves as much as possible. The cerebellopontine angle tumor is thereby partially or completely removed.
Causes
Currently, there is little certainty about the causes of cerebellopontine angle tumor development. However, medical researchers are making efforts to elucidate the reasons for the formation of cerebellopontine angle tumors.
Symptoms, complaints, and signs
Cerebellopontine angle tumors cause numerous different symptoms and are accompanied by typical signs. The symptoms vary according to the severity and location of the cerebellopontine angle tumor. In principle, the type of cerebellopontine angle tumor is decisive. Thus, acoustic neuromas usually cause functional failures of the so-called vestibulocochlear nerve. This results in hearing disorders that usually occur on one side and last for several months or even years. In addition, affected patients often suffer from dizziness and tinnitus. If the facial nerve is affected, complaints of the facial musculature become apparent. In connection with meningiomas, there are sometimes inconstant hearing disorders as well as impairments of the trigeminal and facial nerves. Cerebellar complaints such as muscle hypotonia, adiadochokinesis, and lateral gait deviation are also possible. In modern times, so-called decompensated cerebellopontine angle tumors have become rare. If nausea, headache, and disturbances of consciousness are manifested in the case, emergency medical treatment is mandatory.
Diagnosis and course of the disease
A variety of possible examination methods are available to diagnose cerebellopontine angle tumors. After thorough consideration of the individual case, the treating physician makes the decision on the use of diagnostic means. For example, it is possible to perform an MRI examination in which the cerebellopontine angle tumor is to be differentiated from surrounding areas. Epidermoid tumors, which are sometimes difficult to distinguish from other areas, are sometimes problematic. In addition, CT scans are used and are routinely performed prior to surgical procedures. There is also the possibility of electrophysiology. Here, for example, an audiometry as well as a check of the vestibularis are carried out. These examinations are particularly indicated prior to surgery. If glomus tumors or special acoustic neuromas are present, a laryngoscopy is sometimes necessary. The corresponding examinations are performed on an interdisciplinary basis in cooperation with various departments. In a computed tomography scan, the bony part of the skull base is examined. If the porus acusticus internus is dilated, this gives an indication of the disease. Special contrast media are used in magnetic resonance imaging. With their help, tumors can be visualized.
Complications
As a rule, cerebellopontine angle tumor has a very negative impact on the patient’s life and can significantly reduce the quality of life. In most cases, the patient experiences severe motor and psychological disturbances. Patients often suffer from tinnitus or other hearing complaints.Vision may also be impaired by the cerebellopontine angle tumor. Furthermore, dizzy spells can also occur, which in the further course can lead to complete unconsciousness. Likewise, severe headaches and nausea occur. Consciousness and concentration are also disturbed by the cerebellopontine tumor and ordinary thinking and acting is no longer possible for the affected person without further ado in most cases. It is not uncommon for certain regions of the body to also be paralyzed by this tumor. The diagnosis can be made relatively quickly, so that early treatment of the tumor can also be initiated. In most cases, the treatment does not lead to further complications. Surgery or radiation can be used to remove the tumor. If treatment is initiated early, there is also no reduction in life expectancy.
When should you see a doctor?
Neurologic deficits and dizzy spells indicate a serious condition that needs medical attention. A cerebellopontine angle tumor progresses slowly and can cause various symptoms of the auditory and neurologic systems as it progresses. Anyone who notices unusual symptoms that cannot be attributed to any specific cause should consult their primary care physician. Tinnitus indicates that the tumor is already advanced and should therefore be clarified immediately. The same applies to nausea, headaches and visual disturbances. Nonspecific symptoms also require a diagnosis in any case. In the event of circulatory problems or even a loss of consciousness, the emergency services should be alerted. The affected person must then be examined and treated in hospital. The right person to contact is the family doctor or a neurologist. With children, the first step should be to see the pediatrician. If symptoms recur during or after removal of the tumor, the physician must be informed. It is possible that a recurrence has formed, and another procedure is necessary.
Treatment and therapy
With regard to the treatment of cerebellopontine angle tumors, various approaches exist. These are used depending on the type, location, and stage of the tumor. In the majority of cases, surgical removal of the cerebellopontine angle tumor is attempted. In addition, the performance of radiosurgery is possible. However, possible complications, such as cerebrospinal fluid fistulas or hydrocephalus, must be considered. Radiosurgery is primarily used in older individuals, especially when patients suffer from meningiomas or acoustic neuromas of lesser extent. In this way, the majority of tumors smaller than three centimeters can be stabilized. For glomus tumors, on the other hand, radiosurgery is not the method of first choice. In addition, radiosurgical methods are also used when the risk of complete removal of the cerebellopontine angle tumor is too high. During surgery, the posterior fossa is opened. Electrophysiology and neuronavigation are used to check and maintain the functions of the cranial nerves. In the case of acoustic neuromas, a so-called translabyrinthine approach through the auditory canal is also possible. A few months after surgery, a baseline MRI is required. In principle, regular follow-up is necessary. In the case of completely removed tumors, annual follow-up examinations are to be performed, up to five years after surgical removal. Later follow-up appointments are scheduled on an individual basis. The same is true for patients treated with radiosurgery.
Outlook and prognosis
Even though cerebellopontine angle tumor is readily treatable and often even completely asymptomatic for many years, the affected person can take action on his or her own. Adherence to the prescribed medication as well as any dietary changes that may be necessary has top priority. In addition, the patient must take it easy and, depending on his or her occupation, obtain a sick note if necessary. Occurring pain can often be sufficiently treated with cool compresses or pain-relieving teas. In order to avoid injury to oneself or others, it is essential to refrain from driving or operating machinery if balance disorders and dizziness occur.If there is only a disturbance of the hearing ability, the temporary wearing of a hearing aid is helpful. In order to relieve the visual senses and prevent a worsening of symptoms in poor lighting, care should be taken to use sufficiently bright light sources. If the tumor is already far advanced at the time of diagnosis, this may lead to impairment of the facial muscles in the form of partial facial paralysis or the slipping of individual parts to form a grimace. The psychological suffering should not be underestimated in this phase and can be worked through by a psychotherapist. Provided that the tumor has been surgically removed, external stimuli in the form of direct sunlight, great heat or even drafts should be avoided at all costs.
Prevention
Regarding potential methods and measures for the prevention of cerebellopontine angle tumors, no profound knowledge exists to date. This is because the causes for the development of cerebellopontine angle tumors are still largely unclear. Consequently, effective measures to prevent the disease are not yet possible at the present time. For this reason, it is of great importance to regularly take advantage of the possibility of preventive examinations. Also, any complaints and typical symptoms of cerebellopontine angle tumors should be presented to a physician. A prompt diagnosis will improve the chances of recovery.
Follow-up
Follow-up care is part of any cancer treatment. This is to detect new disease as early as possible and initiate therapy. Doctors hope for the greatest success in treatment. It is no different with a cerebellopontine angle tumor. Follow-up care usually takes place in the clinic of the initial intervention. Immediately after a cure, there is the greatest risk of tumor recurrence. Therefore, the first follow-up takes place within three months. After that, the rhythm is prolonged. From the fifth year of freedom from symptoms, annual follow-up is sufficient. The statistical risk of a new disease is greatly reduced. The treating physician takes a detailed medical history. Magnetic resonance imaging allows clear statements about a recurrence of the cerebellopontine angle tumor. In addition, follow-up care is concerned with everyday support and, depending on the extent of the symptoms, with accompanying long-term treatment. This is because therapy can cause complications. For example, vision may be impaired or paralysis may occur. Neurological and psychological disorders can also occur. The difficulties can best be countered in a rehabilitation program. The patient also receives proper medication. The cerebellopontine angle tumor can also lead to inquiries about one’s own life, which are then discussed in psychotherapy.
This is what you can do yourself
A cerebellopontine angle tumor often runs for many years without symptoms and is easily treatable. The most important action is to follow the doctor’s instructions regarding medication and diet. If symptoms limit performance, a sick note from the primary care physician may be indicated. In general, sufferers should take it easy and focus on relieving symptoms. If there are hearing problems, a hearing test must be performed at an early stage. The sufferer may need a hearing aid temporarily. Those affected often suffer from symptoms such as dizziness and balance problems. To avoid accidents, activities such as driving or demanding work should be avoided. Since the symptoms occur mainly in poor lighting, a sufficiently bright light source should always be available. Larger tumors can affect the facial muscles and cause grimacing. This can be a psychological burden that should be worked through therapeutically. In the case of pain, natural remedies and conservative remedies, for example soothing teas or cool compresses, are available in addition to the prescribed drugs. After removal of the tumor, the affected ear should not be exposed to stimuli such as drafts or great heat, so as not to jeopardize wound healing. The doctor in charge can often advise the affected person on further self-help measures.
