2025 Proffered Presentations
S248: LONG-TERM CRANIAL NERVE OUTCOMES FOLLOWING CEREBELLOPONTINE ANGLE MENINGIOMA RESECTION: A TWO-YEAR RETROSPECTIVE ANALYSIS
Ishav Shukla, BS; Nicholas Bever, BS; Ali Ebada, BS; Jeffrey Traylor, MD; Samuel Barnett, MD; Matthew Sun, MD; University of Texas Southwestern Medical Center
Introduction: Surgeries for tumors in the cerebellopontine angle (CPA) are challenging, causing deficits in hearing, balance, facial sensation, among others. While previous studies have focused on vestibular schwannomas, there is less data on long-term postoperative cranial nerve (CN) outcomes for meningiomas, making this one of the first retrospective studies to explore the effects of surgical and clinical characteristics on immediate and long-term CN outcomes in CPA meningioma patients.
Methods: Patients with CPA meningiomas treated with surgical resection at UT Southwestern Medical Center between 2011 and 2022 were included. Data including surgeon, tumor volume, surgical approach, resection extent, intraoperative monitoring, blood loss, WHO grade, and CN function was collected pre-operatively, immediately post-operatively, and at 6, 12, 18, and 24 months post-operatively. Statistical analyses, including paired t-tests, multivariate and Cox proportional hazards regressions, were performed.
Results: The analysis consisted of 48 patients with a mean age of 54.27 years (SD = 14.24), with a female predominance (79.2%). The mean tumor diameter was 28.60 mm (SD = 11.34). Pre-operatively, the most common CN deficits were observed in CN 3/4/6 in 22.9% (11 patients), CN 5 54.2% (26 patients), and CN 8 in 77.1% (37 patients). Immediate post-operative deficits were recorded for CN 3/4/6 in 34.1% (48.8% increase, p = 0.34), CN 5 in 43.2% (20.3% reduction, p = 0.40), and CN 8 in 43.2% (43.9% reduction, p = 0.002). At 6 months post-op, deficits for CN 3/4/6 were present in 27.8% (21.6% increase, p = 0.20), CN 5 in 27.8% (48.7% reduction, p = 0.10), and CN 8 in 50.0% (35.1% reduction, p = 0.05). At 12 months post-op, deficits for CN 3/4/6 were present in 16.7% (27.4% reduction, p = 0.15), CN 5 in 27.8% (48.7% reduction, p = 0.10), and CN 8 in 38.9% (49.5% reduction, p = 0.03). At the 24-month follow-up, deficits for CN 3/4/6 were present in 23.1% (0.7% increase, p = 1.00), CN 5 in 30.8% (43.2% reduction, p = 0.24), and CN 8 in 33.3% (56.8% reduction, p = 0.01).
The mean total number of deficits per patient decreased significantly from 1.50 pre-operatively to 0.85 at 6 months post-op (43.3% reduction, p = 0.030) and to 0.60 at 12 months post-op (60.0% reduction, p < 0.001). Multivariate logistic regression indicated that female sex was a predictor for the resolution of a CN deficit (OR = 26.057, p = 0.022). Multivariate Cox regression indicated that gross total resection (GTR) significantly increased the odds of resolution of a CN deficit (HR = 4.305, p = 0.030). Additionally, a longer time to initial improvement of any CN deficit was associated with a reduced likelihood of achieving complete resolution of all deficits (HR = 0.996, p = 0.021).
Conclusion: Our study demonstrates significant long-term improvements in CN deficits following CPA meningioma resection, highlighting the positive impact of GTR and female sex on CN recovery outcomes. CN 8 deficits showed the most significant reduction post-operatively. Early intervention and consistent follow-up may be crucial in improving long term CN function.