Schwannomas may occur on any of the lower cranial nerves. The facial and trigeminal nerves are more frequently affected than the bulbar nerves . These lesions may occur entirely within the CPA but, in the case of trigeminal schwannomas, dumbbell extension through Meckel's cave into the middle cranial fossa is usual.
Cerebellopontine angle arachnoid cysts are rare and often present with headache and ataxia, rather than cranial nerve compression syndromes. If symptoms are few, observation is advocated. However, symptomatic lesions require treatment. This is most safely met through a wide fenestration procedure rather than excision or shunting .
Basilar artery ectasia and posterior circulation aneurysms can present as a mass in the CPA. With modern imaging techniques and careful history taking these lesions should be recognised at a stage that enables appropriate neurovascular management to be directed at them.
The foramen of Luschka provides a communication between the fourth ventricle and the CPA. In view of this, lesions of the ventricular system, such as ependymomas, choroid plexus tumors and dermoid tumors, may protrude into the CPA. Presentation may be related to cranial nerve compression, mass effect or hydrocephalus. Other rare tumors of the CPA include chordomas, haemangioblastomas, metastases and lipomas. Whilst MRI findings may provide diagnostic information, an accurate pre-opera-tive diagnosis is often not possible.
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