Presentation
Progressive headache and right sided progressive sensorineural hearing loss.
Patient Data
An extra-axial expanding lesion occupies the right cerebellopontine angle, extends into and funnels the right internal auditory canal.
The lesion invaginates the right side of the pons, right middle cerebellar peduncle and anteromedial part of the right cerebellar hemisphere.
The fourth ventricle is displaced to the left side and compressed.
The lesion measures 4.7 x 4.0 x 4.0 cm (side to side, A.P and cephalo-caudal maximal diameters). It shows multiple different sized cystic changes.
Following injection of contrast, the lesion shows heterogeneous enhancement.
DWI revealed no diffusion restriction of the tumor and its contained cystic changes.
Incidentally noted small right paramedian posterior fossa arachnoid cyst.
Case Discussion
Vestibular schwannoma with cystic changes is not uncommon. It can appear as intratumoral multiple cysts or as a cyst outside the tumor tissue (arachnoid).
These cysts are usually following CSF signal in all sequences, including free diffusion. Hyperintense signal on T1 in some cases can be due to blood or high protein/colloid content or necrotic products. They usually show circumferential enhancement after contrast administration.
The diagnosis was achieved based on the classical imaging features.
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