PMC4722513_01
Contrast axial (a) and coronal T2 (b) magnetic resonance images at initial presentation showing solid enhancing cerebellopontine angle mass with adjacent nonenhancing cerebellar cyst
SNI-7-1-g001.jpg
PMC4722513_01_SNI-7-1-g001.jpg
F1
A 45-year-old female with profound left-sided sensorineural hearing loss, left facial palsy (House-Brackmann Grade 3), and left cerebellar signs of 3 months duration with magnetic resonance imaging (MRI) showing well enhancing mass in the left CPA with adjacent nonenhancing cerebellar cyst [Figure 1], underwent left retromastoid suboccipital craniectomy and gross total removal of tumor at local district hospital.
T1-weighted (a) and T2-weighted (b) axial magnetic resonance images at recent presentation. Contrast axial (c) and coronal (d) magnetic resonance imaging showing solid densely enhancing tumor in left cerebellopontine angle
SNI-7-1-g002.jpg
PMC4722513_01_SNI-7-1-g002.jpg
F2
MRI showed recurrent solid densely enhancing tumor in left CPA [Figure 2].
Preoperative digital subtraction angiography showing feeders from left posterior inferior cerebellar artery (a), and feeders from ascending pharyngeal branch of external carotid artery (b)
SNI-7-1-g003.jpg
PMC4722513_01_SNI-7-1-g003.jpg
F3
Posterior 1/3 was supplied by left posterior inferior cerebellar artery (PICA) and few small dural branches from left vertebral artery [Figure 3].
Postembolization digital subtraction angiography through left vertebral artery (a) and left external carotid artery (b) showing significant reduction in tumor vascularity
SNI-7-1-g004.jpg
PMC4722513_01_SNI-7-1-g004.jpg
F4
Check angiogram showed very little blush in the tumor region [Figure 4].
"En-bloc" excision of the tumor
SNI-7-1-g005.jpg
PMC4722513_01_SNI-7-1-g005.jpg
F5
Embolization was followed on the next day by "en-bloc" excision of the tumor [Figure 5].
(a) Photomicrograph showing tumor with blood vessels containing glue material (blue arrow) and fibrin thrombi (white arrow) (H and E, x20). (b) Tumor showing stromal edema, hyalinization, and micro cystic changes (H and E, x100)
SNI-7-1-g006.jpg
PMC4722513_01_SNI-7-1-g006.jpg
F6
These changes were more prominent adjacent to the vessels [Figure 6].
Postoperative axial (a) and coronal (b) contrast magnetic resonance imaging showing complete tumor excision
SNI-7-1-g007.jpg
PMC4722513_01_SNI-7-1-g007.jpg
F7
Postoperative contrast MRI confirmed total excision of the tumor [Figure 7].