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The cerebello-pontine angle has always posed a challenge to the
neurosurgeon, the otoneurosurgeon, and the neuroradiologist. Angle
masses which are very small and difficult to detect frequently
produce symptoms, but may remain silent while growing to
exceptional size. The neuroradiologist must have firm knowl edge of
the clinical manifestations of the diverse angle lesions in order
to tailor his studies to the patients' needs. The majority of angle
lesions are benign; thus successful surgery has the potential for
complete cure. Angle lesions typically arise in conjunction with
vital neurovascular structures, and often displace these away from
their expected positions. Large lesions may attenuate the
vestibulocochlear and facial nerves and thin them over their dome.
Since the nerves often remain functional, the surgeon then faces
the need to separate the tumor from the contiguous nerve, with
preservation of neurological function. Depending on the exact
location and extension of the lesion, resection may best be
attempted via otologic or neurosurgical approaches. The
neuroradiologist must determine - precisely -the presence, site,
size, and extension( s) of the lesion and the displacement of vital
neurovascular structures as a guide to selecting the line of
surgical attack. Since the arteries, veins, and nerves that
traverse the angle are fine structures, the neuroradiologist must
perform studies of the highest quality to do his job effectively."
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