Presentation
Headache, Hearing loss, Tinnitus
Patient Data
Extraaxial lesion (52 x 47 x 50mm) is seen in the right cerebellopontine angle. The lesion is extending into the right internal auditory canal and jugular foramen. Lesion appears hypointense on T1 and heterogeneously hyperintense on T2 & FLAIR sequence and shows intense heterogeneous enhancement on post contrast study.
Lesion causes significant compression over right lateral aspect of brainstem and 4th ventricle with its distortions and resultant upstream obstructive hydrocephalus. Lesion also causes mass effect in the form of cerebellar tonsillar herniation into the foramen magna.
Case Discussion
Vestibular schwannomas are benign tumors (WHO grade 1), which usually arise from the intracanalicular segment of the vestibular portion of the vestibulocochlear nerve (CN VIII). Extra-canalicular extension is showing ice-cream cone appearance representing tumor growth inwards along a path of least resistance.In this case, Internal auditory canal involvement is seen which is associated with decreased rates of hearing preservation. As per Koos grading scale, this is Grade 4 lesion which is large tumor with brainstem and cranial nerve displacement.
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