Presentation
The patient presented with severe headache and tinnitus 3 months ago.
Patient Data
A large well defined extra-axial SOL is seen implicating the left cerebellopontine angle with intra-canalicular extension, measures about 4.2x3.5x3.8cm in maximal AP, transverse, and CC dimensions respectively, the mass shows low attenuated central necrosis with an adjacent cystic component. Following contrast, the mass enhances avidly, it is seen filling the ipsilateral cerebellopontine cistern, compressing the brain stem more appreciated at the pontine region with compressed slit-like 4th ventricle.
Case Discussion
A 40-year-old male presented to the ENT department with tinnitus. For the past 2 weeks, he had a severe headache, no pertinent past medical, family, or surgical history. Computed tomography (CT) revealed a large left cerebellopontine angle mass lesion.
The differential diagnosis for CPA masses is Vestibular schwannoma, meningioma, and metastases.
The most likely diagnosis of our case is Vestibular schwannoma, There is typically expansion of the IAC and widening of the porus acoustics. The border of a schwannoma typically makes an acute angle with the petrous temporal bone. The cystic change is also seen, calcification is uncommon. Enhancement is heterogeneous but avid. on the other hand, meningioma often has a broad dural base along the petrous temporal bone and is avidly homogenous enhanced with a dural tail. On unenhanced computed tomography (CT), meningiomas are iso- to hyperdense compared to brain parenchyma with adjacent bony remodeling or hyperostosis, and calcification is common.