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CPA-IAC Metastases
Bronwyn E. Hamilton, MD; H. Ric Harnsberger, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Abbreviations

                • Cerebellopontine angle (CPA)-internal auditory canal (IAC) metastases
              • Synonyms

                • Leptomeningeal carcinomatosis, meningeal carcinomatosis, carcinomatous meningitis
                  • All of above terms are misnomers for following reasons
                    • Neoplasms are not always carcinomas
                    • Pachymeninges (dura) and leptomeninges (pia + arachnoid) are often both involved
                    • Usually does not contain inflammatory component
                      • "-itis" suffix makes no sense
              • Definitions

                • CPA-IAC metastases: Systemic or CNS neoplasia affecting area of CPA-IAC

              IMAGING

              • General Features

                • CT Findings

                  • MR Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Gross Pathologic & Surgical Features

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          Selected References

                                          1. Mitsuya K et al: FLAIR hyperintensity along the brainstem surface in leptomeningeal metastases: a case series and literature review. Cancer Imaging. 20(1):84, 2020
                                          2. Singh SK et al: Extraaxial cerebellopontine angle medulloblastoma with multiple intracranial metastases in adult: a rare case report with a review of literature. Asian J Neurosurg. 15(3):695-8, 2020
                                          3. Thakkar JP et al: Leptomeningeal metastasis from solid tumors. J Neurol Sci. 411:116706, 2020
                                          4. Eliezer M et al: Clinical and radiological characteristics of malignant tumors located to the cerebellopontine angle and/or internal acoustic meatus. Otol Neurotol. 40(9):1237-45, 2019
                                          5. Mata-Mbemba D et al: MRI characteristics of primary tumors and metastatic lesions in molecular subgroups of pediatric medulloblastoma: a single-center study. AJNR Am J Neuroradiol. 39(5):949-55, 2018
                                          6. Ko Y et al: Association of MRI findings with clinical characteristics and prognosis in patients with leptomeningeal carcinomatosis from non-small cell lung cancer. J Neurooncol. 143(3):553-62, 2019
                                          7. Le Rhun E et al: How we treat patients with leptomeningeal metastases. ESMO Open. 4(Suppl 2):e000507, 2019
                                          8. Maeda K et al: Symmetric ventral brainstem lesion in leptomeningeal carcinomatosis. Intern Med. 58(5):759-60, 2019
                                          9. Cheng H et al: Leptomeningeal metastases in non-small-cell lung cancer. Lancet Oncol. 19(1):e43-55, 2018
                                          10. Conte G et al: The 'full-blown' MRI of sudden hearing loss: 3D FLAIR in a patient with bilateral metastases in the internal auditory canals. Neuroradiol J. 31(1):39-41, 2018
                                          11. Oh J et al: Application of 3D fast spin-echo t1 black-blood imaging in the diagnosis and prognostic prediction of patients with leptomeningeal carcinomatosis. AJNR Am J Neuroradiol. 39(8):1453-9, 2018
                                          12. Cheng CY et al: Novel anterior brainstem magnetic resonance imaging findings in non-small cell lung cancer with leptomeningeal carcinomatosis. Front Neurol. 8:579, 2017
                                          13. Debnam JM et al: Most common sites on MRI of intracranial neoplastic leptomeningeal disease. J Clin Neurosci. 45:252-6, 2017
                                          14. Krupa M et al: Leptomeningeal carcinomatosis and bilateral internal auditory canal metastases from ovarian carcinoma. Radiol Case Rep. 12(2):386-90, 2017
                                          15. Ropero Carmona MF et al: Bilateral metastasis in the internal auditory canal of malignant melanoma. Acta Otorrinolaringol Esp. 68(3):181-2, 2017
                                          16. Zhang M et al: Metastases in cerebellopontine angle from the tumors of central nerve system. J Clin Neurosci. 42:84-90, 2017
                                          17. Lee EK et al: Intracranial metastases: spectrum of MR imaging findings. Acta Radiol. 53(10):1173-85, 2012
                                          18. Warren FM et al: Imaging characteristics of metastatic lesions to the cerebellopontine angle. Otol Neurotol. 29(6):835-8, 2008
                                          19. Siomin VE et al: Posterior fossa metastases: risk of leptomeningeal disease when treated with stereotactic radiosurgery compared to surgery. J Neurooncol. 67(1-2):115-21, 2004
                                          20. Soyuer S et al: Intracranial meningeal hemangiopericytoma: the role of radiotherapy: report of 29 cases and review of the literature. Cancer. 100(7):1491-7, 2004
                                          21. Kesari S et al: Leptomeningeal metastases. Neurol Clin. 21(1):25-66, 2003
                                          22. Krainik A et al: MRI of unusual lesions in the internal auditory canal. Neuroradiology. 43(1):52-7, 2001
                                          23. Schick B et al: Magnetic resonance imaging in patients with sudden hearing loss, tinnitus and vertigo. Otol Neurotol. 22(6):808-12, 2001
                                          24. Whinney D et al: Primary malignant melanoma of the cerebellopontine angle. Otol Neurotol. 22(2):218-22, 2001
                                          25. Cha ST et al: Cerebellopontine angle metastasis from papillary carcinoma of the thyroid: case report and literature review. Surg Neurol. 54(4):320-6, 2000
                                          26. Shen TY et al: Meningeal carcinomatosis manifested as bilateral progressive sensorineural hearing loss. Am J Otol. 21(4):510-2, 2000
                                          27. Zamani AA: Cerebellopontine angle tumors: role of magnetic resonance imaging. Top Magn Reson Imaging. 11(2):98-107, 2000
                                          28. Lewanski CR et al: Bilateral cerebellopontine metastases in a patient with an unknown primary. Clin Oncol (R Coll Radiol). 11(4):272-3, 1999
                                          29. Swartz JD: Meningeal metastases. Am J Otol. 20(5):683-5, 1999
                                          30. Arriaga MA et al: Metastatic melanoma to the cerebellopontine angle. Clinical and imaging characteristics. Arch Otolaryngol Head Neck Surg. 121(9):1052-6, 1995
                                          31. Kingdom TT et al: Isolated metastatic melanoma of the cerebellopontine angle: case report. Neurosurgery. 33(1):142-4, 1993
                                          32. Mark AS et al: Sensorineural hearing loss: more than meets the eye? AJNR Am J Neuroradiol. 14(1):37-45, 1993
                                          33. Yuh WT et al: Metastatic lesions involving the cerebellopontine angle. AJNR Am J Neuroradiol. 14(1):99-106, 1993
                                          34. Lee YY et al: Loculated intracranial leptomeningeal metastases: CT and MR characteristics. AJR Am J Roentgenol. 154(2):351-9, 1990
                                          35. Maiuri F et al: Cerebellar metastasis from prostatic carcinoma simulating, on CT-scan, a cerebellopontine angle tumor. Case report. Acta Neurol (Napoli). 11(1):21-4, 1989
                                          36. Gentry LR et al: Cerebellopontine angle-petromastoid mass lesions: comparative study of diagnosis with MR imaging and CT. Radiology. 162(2):513-20, 1987
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Pathology

                                                  • Clinical Issues

                                                    • Diagnostic Checklist

                                                      TERMINOLOGY

                                                      • Abbreviations

                                                        • Cerebellopontine angle (CPA)-internal auditory canal (IAC) metastases
                                                      • Synonyms

                                                        • Leptomeningeal carcinomatosis, meningeal carcinomatosis, carcinomatous meningitis
                                                          • All of above terms are misnomers for following reasons
                                                            • Neoplasms are not always carcinomas
                                                            • Pachymeninges (dura) and leptomeninges (pia + arachnoid) are often both involved
                                                            • Usually does not contain inflammatory component
                                                              • "-itis" suffix makes no sense
                                                      • Definitions

                                                        • CPA-IAC metastases: Systemic or CNS neoplasia affecting area of CPA-IAC

                                                      IMAGING

                                                      • General Features

                                                        • CT Findings

                                                          • MR Findings

                                                            • Imaging Recommendations

                                                              DIFFERENTIAL DIAGNOSIS

                                                                PATHOLOGY

                                                                • General Features

                                                                  • Gross Pathologic & Surgical Features

                                                                    • Microscopic Features

                                                                      CLINICAL ISSUES

                                                                      • Presentation

                                                                        • Demographics

                                                                          • Natural History & Prognosis

                                                                            • Treatment

                                                                              DIAGNOSTIC CHECKLIST

                                                                              • Consider

                                                                                • Image Interpretation Pearls

                                                                                  Selected References

                                                                                  1. Mitsuya K et al: FLAIR hyperintensity along the brainstem surface in leptomeningeal metastases: a case series and literature review. Cancer Imaging. 20(1):84, 2020
                                                                                  2. Singh SK et al: Extraaxial cerebellopontine angle medulloblastoma with multiple intracranial metastases in adult: a rare case report with a review of literature. Asian J Neurosurg. 15(3):695-8, 2020
                                                                                  3. Thakkar JP et al: Leptomeningeal metastasis from solid tumors. J Neurol Sci. 411:116706, 2020
                                                                                  4. Eliezer M et al: Clinical and radiological characteristics of malignant tumors located to the cerebellopontine angle and/or internal acoustic meatus. Otol Neurotol. 40(9):1237-45, 2019
                                                                                  5. Mata-Mbemba D et al: MRI characteristics of primary tumors and metastatic lesions in molecular subgroups of pediatric medulloblastoma: a single-center study. AJNR Am J Neuroradiol. 39(5):949-55, 2018
                                                                                  6. Ko Y et al: Association of MRI findings with clinical characteristics and prognosis in patients with leptomeningeal carcinomatosis from non-small cell lung cancer. J Neurooncol. 143(3):553-62, 2019
                                                                                  7. Le Rhun E et al: How we treat patients with leptomeningeal metastases. ESMO Open. 4(Suppl 2):e000507, 2019
                                                                                  8. Maeda K et al: Symmetric ventral brainstem lesion in leptomeningeal carcinomatosis. Intern Med. 58(5):759-60, 2019
                                                                                  9. Cheng H et al: Leptomeningeal metastases in non-small-cell lung cancer. Lancet Oncol. 19(1):e43-55, 2018
                                                                                  10. Conte G et al: The 'full-blown' MRI of sudden hearing loss: 3D FLAIR in a patient with bilateral metastases in the internal auditory canals. Neuroradiol J. 31(1):39-41, 2018
                                                                                  11. Oh J et al: Application of 3D fast spin-echo t1 black-blood imaging in the diagnosis and prognostic prediction of patients with leptomeningeal carcinomatosis. AJNR Am J Neuroradiol. 39(8):1453-9, 2018
                                                                                  12. Cheng CY et al: Novel anterior brainstem magnetic resonance imaging findings in non-small cell lung cancer with leptomeningeal carcinomatosis. Front Neurol. 8:579, 2017
                                                                                  13. Debnam JM et al: Most common sites on MRI of intracranial neoplastic leptomeningeal disease. J Clin Neurosci. 45:252-6, 2017
                                                                                  14. Krupa M et al: Leptomeningeal carcinomatosis and bilateral internal auditory canal metastases from ovarian carcinoma. Radiol Case Rep. 12(2):386-90, 2017
                                                                                  15. Ropero Carmona MF et al: Bilateral metastasis in the internal auditory canal of malignant melanoma. Acta Otorrinolaringol Esp. 68(3):181-2, 2017
                                                                                  16. Zhang M et al: Metastases in cerebellopontine angle from the tumors of central nerve system. J Clin Neurosci. 42:84-90, 2017
                                                                                  17. Lee EK et al: Intracranial metastases: spectrum of MR imaging findings. Acta Radiol. 53(10):1173-85, 2012
                                                                                  18. Warren FM et al: Imaging characteristics of metastatic lesions to the cerebellopontine angle. Otol Neurotol. 29(6):835-8, 2008
                                                                                  19. Siomin VE et al: Posterior fossa metastases: risk of leptomeningeal disease when treated with stereotactic radiosurgery compared to surgery. J Neurooncol. 67(1-2):115-21, 2004
                                                                                  20. Soyuer S et al: Intracranial meningeal hemangiopericytoma: the role of radiotherapy: report of 29 cases and review of the literature. Cancer. 100(7):1491-7, 2004
                                                                                  21. Kesari S et al: Leptomeningeal metastases. Neurol Clin. 21(1):25-66, 2003
                                                                                  22. Krainik A et al: MRI of unusual lesions in the internal auditory canal. Neuroradiology. 43(1):52-7, 2001
                                                                                  23. Schick B et al: Magnetic resonance imaging in patients with sudden hearing loss, tinnitus and vertigo. Otol Neurotol. 22(6):808-12, 2001
                                                                                  24. Whinney D et al: Primary malignant melanoma of the cerebellopontine angle. Otol Neurotol. 22(2):218-22, 2001
                                                                                  25. Cha ST et al: Cerebellopontine angle metastasis from papillary carcinoma of the thyroid: case report and literature review. Surg Neurol. 54(4):320-6, 2000
                                                                                  26. Shen TY et al: Meningeal carcinomatosis manifested as bilateral progressive sensorineural hearing loss. Am J Otol. 21(4):510-2, 2000
                                                                                  27. Zamani AA: Cerebellopontine angle tumors: role of magnetic resonance imaging. Top Magn Reson Imaging. 11(2):98-107, 2000
                                                                                  28. Lewanski CR et al: Bilateral cerebellopontine metastases in a patient with an unknown primary. Clin Oncol (R Coll Radiol). 11(4):272-3, 1999
                                                                                  29. Swartz JD: Meningeal metastases. Am J Otol. 20(5):683-5, 1999
                                                                                  30. Arriaga MA et al: Metastatic melanoma to the cerebellopontine angle. Clinical and imaging characteristics. Arch Otolaryngol Head Neck Surg. 121(9):1052-6, 1995
                                                                                  31. Kingdom TT et al: Isolated metastatic melanoma of the cerebellopontine angle: case report. Neurosurgery. 33(1):142-4, 1993
                                                                                  32. Mark AS et al: Sensorineural hearing loss: more than meets the eye? AJNR Am J Neuroradiol. 14(1):37-45, 1993
                                                                                  33. Yuh WT et al: Metastatic lesions involving the cerebellopontine angle. AJNR Am J Neuroradiol. 14(1):99-106, 1993
                                                                                  34. Lee YY et al: Loculated intracranial leptomeningeal metastases: CT and MR characteristics. AJR Am J Roentgenol. 154(2):351-9, 1990
                                                                                  35. Maiuri F et al: Cerebellar metastasis from prostatic carcinoma simulating, on CT-scan, a cerebellopontine angle tumor. Case report. Acta Neurol (Napoli). 11(1):21-4, 1989
                                                                                  36. Gentry LR et al: Cerebellopontine angle-petromastoid mass lesions: comparative study of diagnosis with MR imaging and CT. Radiology. 162(2):513-20, 1987