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Differential Diagnosis of Cerebellopontine Angle lesions. By: Nour-Eldin A Mohammed Referrence:Stephan Chapman 2003. Cerebellopontine Angle. Extra-axial area lateral to the prepontine cistern containing CSF, arachnoid tissue, cranial nerves and their associated vessels. Borders

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Differential Diagnosis of Cerebellopontine Angle lesions

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Differential diagnosis of cerebellopontine angle lesions l.jpg

Differential Diagnosis of Cerebellopontine Angle lesions

By:

Nour-Eldin A Mohammed

Referrence:Stephan Chapman 2003


Cerebellopontine angle l.jpg

Cerebellopontine Angle

  • Extra-axial area lateral to the prepontine cistern containing CSF, arachnoid tissue, cranial nerves and their associated vessels.

    Borders

  • Medial: lateral surface of the brainstem

  • Lateral : petrous bone

  • Superior : middle cerebellar peduncle & cerebellum

  • Inferior : arachnoid tissue of lower cranial nerves

  • Posterior : cerbellar peduncle


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Differential Diagnosis:

  • Vestibular Schwannoma (acoustic neuroma). Most Common Cause

  • Meningioma

  • Epidermoid cyst

  • Trigeminal neuroma

  • Vertebrobasilar system aneurysm

  • Metastases

  • Skull base/temporal bone tumours:eg, glomus tumors,metastases,cholesterol granuloma

  • Skull base infection:osteomyelitis of the petrous apex (Gradengo’s syndrome) , Malignant otitis externa


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Acoustic Neuroma

  • Comprises 60-92% of CPA lesions

  • Involve the vestibular division of the 8th cranial nerve


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  • Features of Acoustic Neuroma:

  • Centered over the petrous bone

  • Acute angle with the petrous bone

  • Extension into the internal auditory canal

  • Homogenous enhacement

  • No dural tail

  • No calcifications


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Meningioma:

  • Second most common CPA lesion 3-7 %

  • Arise from cap cells near arachnoid villi which are more prominent near cranial nerve foramina and venous sinuses.

  • Usually arise from posterior surface of the petrous bone and usually do not extend into IAC


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  • Features of Meningioma:

  • Broad base over the petrous bone

  • Homogenous signal

  • A small toungue extension into the internal auditory canal without widening it

  • Homogenous enhacement

  • dural tail

  • Calcifications , psammoma bodies

  • Hyperostosis


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Epidermoid Cyst:

  • Accounts for 2-6 % of CPA masses

  • Congenital lesions that present in adulthood

  • Rests of ectodermal tissue containing stratified squamous lining and keratin

  • May arise within the temporal bone or in the CPA


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  • Features of Epidermoid:

  • Low density Cyst with lobulated margin

  • CSF like signal (with high signal in diffusion,flair and proton seq

  • May exert extensive mass effect

  • Also occur parasellar and rarely itradiploic

TI WI

T2 WI

Proton WI


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Arachnoid Cyst


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Trigeminal Neuroma

  • Similar to vestibular neuoma but arises from the trigeminal nerve


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Vascular Lesions:

1. Vertebrobasilardolichoectasia:

Enlongation and dilitation of the vertebrobasilar artery.

Symptomas : Facial spasm, trigeminal neuralgia

2. AICA loop

May loop over, under, or between CN VII & CN VIII.

Symptoms - vertigo

3. Giant Aneurysms

4. Hemangioma

5. Paragangliomas (may extend to CPA)

GlomusJugulare

GlomusTympanicum


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Basilar artery Dolicoectasia


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AICA LOOP


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Anterior inferior cerebellar artery Giant aneurysm


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GlomusJugulare


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Thank You


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