CPA病变.ppt

CPA病变 ＺＨＯＵＹＩＣＨＥＮＧ ２００７--０６－０５ Tumors of the cerebellopontine angle (CPA) are frequent; acoustic neuromas and meningiomas represent the great majority of such tumors. However, a large variety of unusual lesions can also be encountered in the CPA. The site of origin is the main factor in making a preoperative diagnosis for an unusual lesion of the CPA. CPA masses can primarily arise from the cerebellopontine cistern and other CPA structures (arachnoid cyst, nonacoustic schwannoma, aneurysm, melanoma, miscellaneous meningeal lesions) or from embryologic remnants (epidermoid cyst, dermoid cyst, lipoma). Tumors can also invade the CPA by extension from the petrous bone or skull base (cholesterol granuloma, paraganglioma, chondromatous tumors, chordoma, endolymphatic sac tumor, pituitary adenoma, apex petrositis). Finally, CPA lesions can be secondary to an exophytic brainstem or ventricular tumor (glioma, choroid plexus papilloma, lymphoma, hemangioblastoma, ependymoma, medulloblastoma, dysembryoplastic neuroepithelial tumor). Lesions of the cerebellopontine angle (CPA) are frequent and represent 6%–10% of all intracranial tumors (1),(2). Acoustic neuromas, which are also called vestibular schwannomas (3), and meningiomas are the two most frequent lesions and account for approximately 85%–90% of all CPA tumors (1). The other 10%–15% encompass a large variety of lesions that radiologists will encounter more and more frequently because of the remarkable sensitivity and accuracy of magnetic resonance (MR) imaging in evaluation of a CPA syndrome. In most cases, MR imaging and computed tomography (CT) show typical features of acoustic neuromas or meningiomas and are sufficient to establish the diagnosis. Acoustic neuromas are usually round or oval masses in the cerebellopontine cistern that emerge from the internal auditory canal, widen the porus, and grow posteriorly because of the anterior limit represented by the cisternal segment of the facial nerve (4). They can be he