By Anton Valavanis, Othmar Schubiger, Thomas P. Naidich
The cerebello-pontine attitude has continually posed a problem to the neurosurgeon, the otoneurosurgeon, and the neuroradiologist. perspective lots that are very small and tough to notice usually produce indicators, yet may well stay silent whereas turning out to be to remarkable dimension. The neuroradiologist should have enterprise knowl fringe of the scientific manifestations of the varied perspective lesions as a way to tailor his stories to the sufferers' wishes. the vast majority of perspective lesions are benign; therefore profitable surgical procedure has the possibility of entire healing. perspective lesions generally come up at the side of important neurovascular constructions, and sometimes displace those clear of their anticipated positions. huge lesions might attenuate the vestibulocochlear and facial nerves and skinny them over their dome. because the nerves frequently stay sensible, the general practitioner then faces the necessity to separate the tumor from the contiguous nerve, with upkeep of neurological functionality. looking on the precise position and extension of the lesion, resection may well top be tried through otologic or neurosurgical methods. The neuroradiologist needs to make sure - accurately -the presence, web site, measurement, and extension( s) of the lesion and the displacement of important neurovascular constructions as a consultant to picking the road of surgical assault. because the arteries, veins, and nerves that traverse the perspective are tremendous constructions, the neuroradiologist needs to practice reports of the best quality to do his task effectively.
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Additional resources for Clinical Imaging of the Cerebello-Pontine Angle
44 Acoustic Neurinoma a b Fig. 29a, b. Right-sided large acoustic neurinoma. a Non contrast axial CT. The right cerebellopontine angle is filled and dilated by an almost homogeneous hypodense mass (arrows) . b Post contrast CT. The hypodense tumor shows intense, but irregular enhancement The vast majority of acoustic neurinomas show substantial contrast enhancement. Enhancement is reported to occur in 90 to 100% of medium-sized and large neurinomas (159, 182, 259, 387, 427, 539, 574, 596). The enhancement is homogeneous in 74% (Fig.
28a, b. Bilateral acoustic neurinoma (Recklinghausen disease). a Non contrast CT. The pontocerebellar cistern is obliterated bilaterally. A slightly hyperdense mass can be delineated on the right side (arrows), whereas on the left side, the tumor is isodense and cannot be seen on the non contrast scan. b Post contrast CT. Despite their slightly different appearance on the non contrast scan, both acoustic neurinomas show intense enhancement are isodense with the surrounding cerebellum and are therefore not directly visible on a non contrast scan (Fig.
All other primary tumors such as epidermoids, neurinomas of other cranial nerves, arachnoid cysts, primary melanomas etc. are very rare. The relative frequencies of pontocerebellar tumors are given in Table 2. Table 2. Classification and frequency of cerebello-pontine angle lesions Revilla (1947) Zillch (1956) Ya~argil (1978) Authors' material No. % % No. % No. 4 Pathology of the Cerebello-Pontine Angle 31 Intraaxial and extraaxial tumors that originate outside the pontocerebellar cistern may invade the cerebello-pontine angle secondarily.