Presentation
Dysphonia, rapidly progressive hearing loss was added to the anacusis, difficulty mobilizing the tongue in its left portion and the articulation of words with limitation of the mobilization of the right lower extremity.
Patient Data
Axial, coronal and sagittal slices, showing the integrity of the cranial vault, with partially visible convexity grooves and fissures, decreased corticosubcortical interface, a symmetrical ventricular system with rounded frontal horns, rounding of the third ventricle, dilation of temporal horns, absence of transependymal edema, bilateral femoral cistern, central midline.
An extra-axial lesion is observed that extends from the left cerebellopontine angle to the ipsilateral jugular foramen of 4.46 x 4.61 x 3.77 cm in a ventrodorsal, laterolateral and rostrocaudal direction, respectively, which has a heterogeneous texture, with irregular borders and morphology, predominantly isodense, which displaces the brain stem in a vector from left to right and collapses the fourth ventricle.
A craniectomy plus subtotal resection of the lesion was performed, where the edematous cerebellum dural opening was observed, which protrudes approximately 1.5 cm from the ridge, the cistern magna was drained allowing its resection, and arachnoid dissection was performed, a rounded lesion was observed, of firm consistency of yellowish coloration and dimensions of 4 x 4 x 5 cm which contacts and displaces the brain stem, with important involvement of lower cranial nerves X, XI, which apparently comes from cranial nerve IX, a dissection of defined edges with adequate cleavage plane is observed that displaces VII and VIII nerve structures and left posterior inferior cerebellar artery that is partially resected, subtotal dissection is performed.
Post-surgical changes of craniectomy at the left occipital level, with the absence of flow void signal in all sequences in the sigmoid sinus and distal portion of the transverse.
Encephalomalacic changes at the left middle cerebellar peduncle and lateral part of left cerebellar hemisphere as postsurgical sequels.
Preserved left VII and VII cranial nerves at the left internal auditory canal.
The left jugular fossa is still widened with internal soft tissue with cystic changes.
In subsequent notes, it is mentioned that histopathological result reports schwannoma without specifying cranial nerve, for which reason it is sent to radio neurosurgery for evaluation and to be a candidate for treatment.
However, in the radio neurosurgery consultation, it is mentioned that it does not have an accelerator to perform the procedure, for which reason it is sent to another unit in another city to assess treatment.
Case Discussion
In the last follow-up visit, he reported hypoesthesia of the right thoracic and pelvic limbs, with epiphora and left sialorrhea, frequently biting his tongue on the left side, with decreased muscle strength in the right hand that causes frequent falling of objects. with facial asymmetry due to easy left paralysis, left anacusia, without hearing alterations on the right side, the vestibular system without alteration, absent left gag reflex, present right, decreased taste in the posterior third of the tongue, present cough reflex, uvula lateralized to the left, symmetrical elevation of the soft palate.
The involvement of jugular foramen and the surgical note of the possible mass origin from the glossopharyngeal nerve (IX), makes the diagnosis of Jugular foramen schwannoma is more likely than vestibular schwannoma.
Despite the surgical event, the patient maintains significant sequelae that affect his quality of life.
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