cerebellopontine angle mass
Schwannom am
Kleinhirnbrückenwinkel rechts (links im Bild) in der MRT T1KM axial.
A rare cause
of infant facial paralysis: atypical teratoid rhabdoid tumour located in the cerebellopontine angle. a–d On the brain MRI, a dural-based, extra-axial mass lesion was observed on the left CPA, 4 × 3 cm in size, with heterogenous contrast after the application of IV contrast dye, which was heterogenous-hypointense on T1W and FLAIR sequences, heterogenous hyperintense on T2W, the mass appears to enter the cavernous sinus via Meckle’s cave. Time there is concomitant calcification, bleeding and oedema of the surrounding
Cerebellopontine angle (CPA) masses are relatively common. Although a diverse range of pathologies may be seen in this region, the most common by far is a vestibular schwannoma.
Pathology
Cerebellopontine angle masses can be divided into four groups, based on imaging characteristics:
- enhancing mass
- mass with high T1 signal on MRI
- mass with CSF intensity/density
- other masses
Alternatively, a quick mnemonic to remember the common entities affecting the cerebellopontine angle is AMEN or SAME.
Enhancing mass
- vestibular schwannoma: most common by far (~80%)
- meningioma: second mostcommon (~10%)
- trigeminal schwannoma
- facial nerve schwannoma
- ependymoma
- metastasis, e.g. breast, lung, malignant melanoma
High T1 signal mass
- hemorrhagic vestibular schwannoma
- neurenteric cyst: usually prepontine, but fluid may be proteinaceous and high on T1
- thrombosed berry aneurysm: often will have a calcified rim and hemosiderin staining
- white epidermoid: rare; restricts on DWI
- cerebellopontine angle lipoma: usually has the facial nerve and vestibulocochlear nerve coursing through it; saturates on fat suppressed sequences
- ruptured intracranial dermoid cyst: often multiple droplets with original midline lesion still often seen
CSF density mass
- epidermoid cyst: third most common (~5%)
- arachnoid cyst
Other masses
Many other masses can present at or around the cerebellopontine angle. They include:
- primary melanocytic neoplasm
- neurosarcoidosis
- cholesterol granuloma
- paraganglioma
- petrous apicitis
- chondrosarcoma
- chordoma
- endolymphatic sac tumor
- pituitary adenoma
- brainstem glioma
- choroid plexus papilloma
- lymphoma
- hemangioblastoma
- ependymoma
- medulloblastoma
- dysembryoplastic neuroepithelial tumor
- ganglioglioma (rare )
- mass mimics
- calcified choroid plexus from the fourth ventricle protruding through the lateral foramen of Luschke: Bochdalek's flower basket
Siehe auch:
- Arachnoidalzyste
- Cholesterolgranulom der Felsenbeinspitze
- Meningeom
- Chondrosarkom
- Aneurysma
- Ependymom
- Chordom
- Lymphom
- Neurosarkoidose
- Schwannom
- brainstem glioma
- Gangliogliom
- Nervus facialis
- Paragangliom
- Hämangioblastom
- Nervus vestibulocochlearis
- Medulloblastom
- Hypophysenadenom
- neuroenterische Zyste
- Metastase
- trigeminal schwannoma
- Plexuspapillom
- Dysembryoplastischer neuroepithelialer Tumor
- Epidermoid
- Vestibularisschwannom
- epidermale Inklusionszyste
- zerebellopontines Lipom (Lipom im Kleinhirnbrueckenwinkel)
- Tumor des Saccus endolymphaticus
- white epidermoid
- zystische Tumoren im Kleinhirnbrückenwinkel
- sakkuläre zerebrale Aneurysmata
- Kleinhirnbrücken-Symptomatik
- SAME
- AMEN
- Pyramidenspitzen-Osteomyelitis
- Schwannom des Nervus facialis
und weiter:
- neurinoma of the trigeminal nerve
- internal acoustic meatus
- cerebellopontine angle
- Epidermoidzyste im Kleinhirnbrückenwinkel
- Meningeom des Kleinhirnbrückenwinkels
- mass lesions
- MRI protocol posterior fossa / cerebellopontine angle
- intrakranielle Lipome der hinteren Schädelgrube
- Arachnoidalzyste im Kleinhirnbrückenwinkel
- zystisches Meningeom im Kleinhirnbrückenwinkel
- epidermoid tumor of the cerebellopontine angle
- bilaterales Vestibularisschwannom
Assoziationen und Differentialdiagnosen zu Tumor Kleinhirnbrückenwinkel:
Cholesterolgranulom
der Felsenbeinspitze
