Nationwide clinico-epidemiological treatment analysis of adult patients

The goal of this research is to present the epidemiologic features of cerebellopontine tumors angle (CPAT) and the internal Acoustic Meatus in the adult Polish populations throughout this second decade the XXI century, and to study the treatment options for them.

Materials and methods

A retrospective review of patients suffering from cerebellopontine angle (CPA) as well as internal acoustic meatus tumors that were diagnosed in Poland between 2011 and 2020 was conducted. The data that were recorded in the National Health Fund (NHF) database were analysed. International Classification of Diseases codes (ICD-9 and ICD-10) were used to determine study participants and treatment methods.

Results

Between 2011 and 2020, From 2011 to 2020, 6,173 Polish adults were found to have cerebellopontine angles and internal Acoustic meatus tumors. The incidence rate of cerebellopontine angle and internal acoustic meatus tumors in Poland was 1.99 per 100,000 inhabitants/year. The majority of patients are women The most frequent symptoms were dizziness and vertigo (43.48 percent) and loss of sensorineural hearing (39.58 percent). 4.65 percent of patients experienced sudden deafness. In this category of patients, the probability for CPAT diagnosis was most high (6.25 for every 1,000 patients).

Conclusions

The prevalence of CPAT and the demographics of patients were similar to studies conducted elsewhere. The study revealed that a greater amount of patients being treated using radiotherapy, but fewer who undergo microsurgery. Hearing loss that is sudden (SSNHL) is a rare manifestation of CPAT however, a thorough diagnosis should be made due to the possibility of diagnosing these tumors is higher in this group.

Introduction

Cerebellopontine angle (CPA) is an anatomical area of the posterior cranial fossa that is bordered by the pons superior to the tentorium, cerebellum posteriorly, and pons as well as the temporal bone anteriorly. Nerves for vestibulocochlear and facial run through the CPA between the brainstem and the inside the internal acoustic muscle (IAM). The anterior inferior cerebellar artery passes close to the cranial nerves and form an artery that could be able to enter IAM together with the vestibulocochlear nerves. Because of its position and the complex topography CPA masses can present with a variety of symptoms, including auditory loss, hearing impairment facial paresis, and dizziness/vertigo.

The most frequent tumor in CPA is called vestibular schwannoma (VS).

Numerous stage grading techniques have been proposed over the years, based on size of the tumor as well as its exact site. The most commonly used scales are Sterkers, House, Koos and Samii classifications [55. Today, the most frequently employed is the Koos system because it is a reliable method of CPA and IAM tumor classification [66. The most frequent location of origin topographically lies in the vestibular inferior section of the vestibulocochlear nerve in IAM the mass will develop into cerebellopontine angle cancer (CPAT) only when it is Koos grade II or greater [1 6].

The incidence reported for VS of the United States is approximately 1 per 100 000 people-years. However, it can vary across ethnic groups, ranging from 0.36 to 100 000 persons-years within African Americans through Asian Pacific Islanders (1.37 per 100,000 person-years) to the highest rate reported for Taiwan (2.66 for every 100,000 people-years) [7 8[7, 8].

Since VS is by far the most frequent CPAT one-sided sensorineural hearing loss as well as Tinnitus are the most common symptoms that are seen at 95% or over 60% of patients [99. Vestibular symptoms, along with progressive imbalances or dizziness could be also reported by the patient, as along with facial paresis particularly for non-acoustic CPATs [22.

Treatment options for CPATs consist of treatments, i.e. radiation therapy or microsurgical removal (mainly the stereotactic method of radiotherapy) as well as the “wait and scan” strategy [1010. In Poland there are only a few departments of neurosurgery and otorhinolaryngology manage CPATs using the retrosigmoid and middle fossa or translabyrinthine methods. In recent years, radiosurgery also been a choice in the treatment of Polish patients. The procedures are all performed as inpatient treatments. The increased accessibility to diagnostic imaging has made it possible to implement a secure “wait and scan” strategy. As of now, there have been no studies that have reported the exact number of tumors that have been diagnosed, controlled or treated Poland.

The purpose of this study is to present the epidemiological characteristics of cerebellopontine angles and internal acoustic tumors in the adult Polish populations throughout in the second decade the XXI century. We will also analyze the treatment options for these tumors based on the database provided by National Health Fund (NHF).

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