PRESENT STATE OF NEURORADIOLOGICAL DIAGNOSIS OF CEREBELLOPONTINE TUMORS

  • 1 January 1984
    • journal article
    • research article
    • Vol. 24  (11) , 493-501
Abstract
By means of 124 tumors of the cerebello-pontine angle (CPA) the diagnostic results of the neuroradiological investigative methods computed tomography (CT), CT-air-cisternography, magnetic resonance tomography (MRT) and selective angiography are critically analysed with regard to their differential diagnostic significance and from this their order of employment. The histologically proven CPA-tumors consisted of 68 neurinomas, 8 meningeomas, 2 epidermoids, 29 tumors of the glomus tympano-jugulare, 2 metastases, 2 hemangioblastomas, 1 ectopic neuroepithelial cyst, 4 arachnoidal cysts, 6 cases with adhesive arachnitis and 2 abscesses. CT-findings were present in all cases; additional MRT-findings existed in 8 patietns, and selective angiographies were done in 103 patients. The description of the normal CPA-anatomy and its pathological findings in CT-air-cisternography is based on 250 examinations, 35 of which were done on both sides and 38 simultaneously with an enhanced CT. For early diagnosis of CPA-tumors with less than 10 mm size and preponderantly otologic symptoms and signs CT-air-cisternography is recommended as examination method of choice; the same is true for native CT with subsequent enhancement in advanced stages with further neurologic signs. MRT-examinations should be done only in 2nd place. The advantage of non-invasive, qualitative tumor detection is reduced by the deficient specifity of MRT-findings. Because of distinct MRT-representations of intrameatal tumor-parts in acoustic neurinomas this method is already now likely to be qualified for early diagnosis, possibly replacing CT-air-cisternography. Selective angiographies are of significant importance for the preoperative vascular status and for the diagnosis of glomus-tumors; further differential diagnosis of CPA-tumors is also angiographically limited, because neurinomas and meningeomas, as well as in individual cases of hemangioblastomas and abscesses, may be comparably supplied by meningeal vessels. Except in neurinomas, this dural tumor-vascularization is yet a reliable angiographic sign for tumorous infiltration of the dura.