Microsurgical Outcomes in 1000 Patients With Cerebellopontine Angle Tumors: A Comprehensive Cohort Analysis

Abstract

Objective: To summarize the outcomes of 1000 consecutive microsurgical resection of cerebellopontine angle tumors. Study Design: Retrospective cohort study. Setting: Single tertiary care institution. Methods: We analyzed 1000 patients who underwent microsurgical resection of cerebellopontine angle tumors between November 2017 and August 2024. Patient and tumor-related characteristics are summarized, and the extent of resection, facial nerve function, hearing preservation, and postoperative complications are described. Volumetric analysis was used to assess resection completeness. Results: The median patient age was 49 years (interquartile range [IQR] 40-58), with 62% female and 74% Caucasian. Surgical approaches included 46.5% translabyrinthine (TL), 24.6% retrosigmoid (RS), 24.1% middle cranial fossa (MCF), and 4.8% other. The median tumor size was 19 mm (IQR 12-27), and 52% were left-sided. Overall, volumetric analysis for vestibular schwannoma tumors revealed that 88% of patients had ≤2% tumor volume remaining, 4% had >2% and ≤5%, 4% had >5% and ≤10%, and 4% had >10%. Additionally, the average extent of resection was 98% volume reduction. The most common postoperative complication was cerebrospinal fluid leak (10%), with 77% of cases treated by lumbar drain. Postoperative House-Brackmann (HB) scores of I or II were achieved in 88% of patients, which had improved to 90% at the time of last follow-up. Hearing preservation was 62% for MCF and 33% for RS cases. Conclusion: Microsurgical resection of cerebellopontine angle tumors yields favorable outcomes, particularly in preserving facial nerve function and hearing. Tumor size and surgical approach impacted hearing preservation, with the middle fossa approach being most effective for smaller tumors.