Neurosurgery 97:105–111, 2025
This multi-institutional study of 95 cerebellopontine angle meningioma cases found that gross total resection, especially with internal auditory canal drilling for intracanalicular invasion, improves symptom control and reduces recurrence. Most patients experienced stable or improved hearing, with postoperative complications and recurrence rates detailed.
• Cerebellopontine angle (CPA) meningiomas are challenging due to their proximity to neurovascular structures and present commonly with hearing loss, ataxia, and headaches.
• Gross total resection (GTR) was achieved in 62.1% of 95 patients; smaller tumor size and drilling the internal auditory canal (IAC) for tumors with intracanalicular invasion were associated with higher GTR rates.
• Most patients had stable or improved hearing postoperatively; only a minority experienced worsening.
• Postoperative complications included cranial nerve dysfunction, CSF leak, and hydrocephalus, but there were no perioperative deaths.
• Tumor progression or recurrence occurred in 25.3% of patients, with higher rates in WHO grade 2 tumors; Simpson grade I/II resection and older age reduced recurrence risk.
• Extent of resection (EOR) is not reliably predicted by tumor size alone; other anatomical factors are important.
• Adjuvant radiation was mainly used for higher-grade tumors with subtotal resection, but most progression cases were managed with observation or salvage therapy.
• Surgical resection is effective for symptom control and reducing recurrence, especially with GTR and appropriate IAC management.
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