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 discover usually produce signs, yet may perhaps stay silent whereas turning out to be to extraordinary measurement. The neuroradiologist should have enterprise knowl fringe of the medical manifestations of the varied perspective lesions in an effort to tailor his reports to the sufferers' wishes. the vast majority of perspective lesions are benign; hence winning surgical procedure has the possibility of whole medication. attitude lesions generally come up along side important neurovascular buildings, and infrequently displace those clear of their anticipated positions. huge lesions may well attenuate the vestibulocochlear and facial nerves and skinny them over their dome. because the nerves usually stay practical, the physician then faces the necessity to separate the tumor from the contiguous nerve, with maintenance of neurological functionality. looking on the precise situation and extension of the lesion, resection might top be tried through otologic or neurosurgical methods. The neuroradiologist needs to be sure - accurately -the presence, web site, measurement, and extension( s) of the lesion and the displacement of important neurovascular buildings as a advisor to choosing the road of surgical assault. because the arteries, veins, and nerves that traverse the attitude are superb buildings, the neuroradiologist needs to practice experiences of the very best quality to do his task effectively.
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Extra info for Clinical Imaging of the Cerebello-Pontine Angle
In such cases, direct coronal CT may help to differentiate the hyperdense artifact from true tumor. The beam hardening artifact varies with precise beam path and is unlikely to be present at exactly the same site on the 2 right angle scans. The most valuable method for evaluating possible small neurinomas is gas CT cisternography (7, 26, 65, 242, 253,302,336,414,430,443,444,471,536,559,577, 590,612). This method combines high diagnostic accuracy with very low morbidity and is easy to perform rapidly in a busy CT suite (281, 559).
Acoustic Neurinoma 1 General Considerations A. Nomenclature, Statistics, and Pathology The acoustic neurinoma is a benign, slowly growing and encapsulated tumor that originates from the Schwann cell (74, 184, 327, 376, 441, 447, 492). The correct designation therefore is "Schwannoma". However, the term "acoustic neurinoma" is so widely accepted, it will also be used in this book. Acoustic neurinomas constitute 5 to 10% of all intracranial tumors and 70 to 90% of cere bello-pontine angle tumors (230, 417, 473, 586, 629, 641).
Slow growth rate of the tumor and central compensatory mechanisms (202) appear to account for 1) the frequent, long delay between the onset of sensorineural hearing loss and the correct diagnosis of an acoustic neurinoma and 2) the late onset of vestibular symptoms. With increasing tumor size and tumor extension into the cerebello-pontine angle, additional symptoms arise from compression of neighbouring structures (25, 143, 344, 530), including the adjacent cranial nerves, cerebellar hemispheres and ventricular system.
Clinical Imaging of the Cerebello-Pontine Angle by Anton Valavanis, Othmar Schubiger, Thomas P. Naidich