Calcifying pseudoneoplasm of the neuraxis (CAPNON) of the jugular foramen: a case report and review of literature of skull base CAPNON
EANS Academy. Reddy K. 09/25/19; 275807; EP04091
Dr. Kesava (Kesh) Reddy
Dr. Kesava (Kesh) Reddy

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Abstract
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Background: Calcifying pseudoneoplas of the neuraxis (CAPNON) is a rare disease entity. Skull base CAPNONs are rare and the management of these lesions remains controversial.
Case description: Here we report a case of foramen magnum CAPNON in a 59-year-old man. He presented with right sided IX, X, XI, XII nerve palsies, as well as ataxia. Imaging revealed a heavily calcified lesion involving right jugular foramen, right cerebellopontine angle with medulla compression. He underwent a right sided far lateral approach for subtotal resection of this lesion and decompression of medulla. Postoperatively he had significant improvement of his ataxia but stable cranial neuropathies. He had radiographic evidence of disease progression at 15 months follow up without clinical progression of symptoms.
Literature review: Our literature search yield 17 other CAPNON cases at the skull base. All patients were symptomatic. All but one underwent surgical intervention. Gross total resection was documented in nine patients, while subtotal resection was documented in three cases. Only two patients had complete resolution of symptoms postoperatively, while other patients remained stable with persistence of cranial neuropathies. One patient who had presented with hearing loss had complete hearing loss after surgical intervention. Another patient had sacrifice of V3 division during surgical intervention. Similar to our patient, another patient had disease recurrence at three years.
Conclusions: Given CAPNON is a benign lesion, we recommend consideration of biopsy for lesions located at the skull base. Surgical intervention could be considered in cases of cranial neuropathies. However, patient should be counselled about persistent cranial neuropathies and disease progression in cases where gross total resection is not technically feasible.
Background: Calcifying pseudoneoplas of the neuraxis (CAPNON) is a rare disease entity. Skull base CAPNONs are rare and the management of these lesions remains controversial.
Case description: Here we report a case of foramen magnum CAPNON in a 59-year-old man. He presented with right sided IX, X, XI, XII nerve palsies, as well as ataxia. Imaging revealed a heavily calcified lesion involving right jugular foramen, right cerebellopontine angle with medulla compression. He underwent a right sided far lateral approach for subtotal resection of this lesion and decompression of medulla. Postoperatively he had significant improvement of his ataxia but stable cranial neuropathies. He had radiographic evidence of disease progression at 15 months follow up without clinical progression of symptoms.
Literature review: Our literature search yield 17 other CAPNON cases at the skull base. All patients were symptomatic. All but one underwent surgical intervention. Gross total resection was documented in nine patients, while subtotal resection was documented in three cases. Only two patients had complete resolution of symptoms postoperatively, while other patients remained stable with persistence of cranial neuropathies. One patient who had presented with hearing loss had complete hearing loss after surgical intervention. Another patient had sacrifice of V3 division during surgical intervention. Similar to our patient, another patient had disease recurrence at three years.
Conclusions: Given CAPNON is a benign lesion, we recommend consideration of biopsy for lesions located at the skull base. Surgical intervention could be considered in cases of cranial neuropathies. However, patient should be counselled about persistent cranial neuropathies and disease progression in cases where gross total resection is not technically feasible.
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