Cerebellopontine Angle (CPA) Tumour

What is a Cerebellopontine Angle (CPA) tumour?

Cerebellopontine angle (CPA) tumours are abnormal tissue masses found on the posterior fossa (a small space in the skull near the brainstem and cerebellum). CPA tumours are not a specific type of tumour; rather, they are classified based on the area of the brain where it is found: triangular space in the posterior cranial fossa.

Brain anatomy
Cerebellopontine angle (CPA) tumours are found in the posterior fossa of the brain

It has been indicated that CPA tumours are one of the more common tumours and are mostly benign. While there are chances for these tumours to be malignant (cancerous), the likelihood is fairly low. There are different types of CPA tumours: 

  • Vestibular schwannoma: also known as acoustic tumour because it affects the acoustic nerve. These tumours are benign and slow-growing tumours that develop from Schwann cells' overproduction.
  • Lipomas: also known as intracranial lipomas, are fatty lumps found in the brain and made up of adipose tissues
  • Vascular malformations: believed to be congenital conditions in which enlarged vessels, tangled vessels or pockets of vessels form in the brain.
  • Haemangiomas: also known as cavernous haemangioma, is a cluster of capillaries found in the brain.
  • Meningiomas: tumours formed from meninges, a type of membrane in the brain.
  • Epidermoids: masses formed from the ectodermal tissues and hypothesised to be congenital. 
  • Facial schwannomas: tumour growing on the facial nerve, originating from Schwann cells.

What causes Cerebellopontine Angle (CPA) tumours?

The exact cause of CPA tumours remains unknown. In most cases, CPA tends to be a congenital error, and if not identified upon birth, becomes symptomatic in later stages.

What are the symptoms of Cerebellopontine Angle (CPA) tumours?

Symptoms may vary depending on the type of tumour and the exact location where it is found. The symptoms presented, too, are usually a result of the tumour compressing nearby nerves in the brain. Some of the symptoms of CPA tumours may include:

  • Hearing loss
  • Tinnitus 
  • Vertigo or imbalance 
  • Persistent headache 
  • Facial spasm 
  • Loss of sensation in the face 
  • Double vision (diplopia)

Are Cerebellopontine Angle (CPA) tumours painful?

The presence of pain in cases of CPA is not consistent. Where pain is present, it may manifest as sudden and intense pain on one side of the face. These are also known as trigeminal neuralgia.

Who is at risk of Cerebellopontine Angle (CPA) tumours in Singapore?

Depending on the type of CPA tumour found, the risk factors vary. Generally, however, CPA tumours are quite sporadic, with no statistical significance to any particular risk factors. Regardless, some potential risks may include: 

  • Environmental factors: prior exposure to ionising radiation may increase one’s risk of CTA, particularly meningiomas. 
  • Hormone therapy: meningioma-type tumour, particularly among women who undergo postmenopausal hormonal therapy. 
  • Congenital factors: certain genetic dispositions or errors in the embryonic developmental stage may account for the incidence of CPA. Sometimes, it is also affiliated with genetic conditions such as Neurofibromatosis type 2 (in cases where the tumour is a vestibular schwannoma).
Cerebellopontine angle (CPA) tumours can cause persistent ear-ringing symptoms, known as tinnitus.

How are Cerebellopontine Angle (CPA) tumours diagnosed in Singapore? 

CPA tumours are easily identifiable with imaging tests such as magnetic resonance imaging (MRI). However, symptoms are often dismissed as hearing conditions, subsequently delaying treatment. It is pertinent that CPA tumours are detected at early stages to reduce adverse outcomes such as damage to cranial nerves and brainstem compression. Though the mortality rate is generally low for CPA tumours, when left untreated, it could lead to brain haemorrhage and stroke.

Radiotherapy is one of the treatment options available for cerebellopontine angle (CPA) tumours.

What are the treatment options for Cerebellopontine Angle (CPA) tumours in Singapore? 

Depending on the type and size of the tumour, the treatment approach may vary. Some of the treatment options currently available are: 

  • Total resection: microsurgery that completely removes CPA tumours in an operating theatre. 
  • Radiosurgery: utilising a focused beam of radiation known as gamma rays to “arrest” (stunt) the growth of the tumour and to increase chances of preserving the cranial nerves. This is, however, primarily possible when the size of the tumour is relatively small.
  • Radiotherapy: radiation (also known as gamma rays) therapy is administered in multiple sessions to gradually treat the tumour, mainly where tumours are more significant. 
  • Combination of surgery and radiation: a combination of two treatment methods may be utilised first to remove large tumours and then treat any excess tumours with radiation.
brain MRI
An MRI of the brain will be taken in the diagnosis of CPA tumours.

Frequently asked questions  

Are cerebellopontine angle (CPA) tumours dangerous?

There was a time when cerebellopontine angle (CPA) tumours were considered deadly and dangerous, with a mortality rate of over 50%. However, modern medical development has enabled prompt and safe treatment, with CPA cases rarely affiliated with mortality. The key to reducing risk is early detection

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Copyright © 2023 Chou Neuroscience Clinic. All Rights Reserved