PMC3263002_01
Axial and coronal contrast-enhancing T1WI showing a left CP angle enhancing mass with intrameatal extension and cystic changes measuring mass 23 x 25 x 18 mm on presentation in September 2007
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F1
He was evaluated for these symptoms and imaging revealed an enhancing mass [23 (AP) x 25 (T) x 18 (CC) mm] [Figure 1] with central areas of cystic change within the left CP angle extending into the left internal auditory canal.
Axial and coronal contrast-enhancing T1WI in May 2008 with tumor measuring 13 x 17.5 x 10.4 mm
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F2
Repeat imaging done 6 months later revealed a further reduction in size [13 (AP) x 17.5 (T) x 10.4 (CC) mm] [Figure 2] and conservative management was continued.
Axial and coronal contrast-enhancing T1WI in May 2009 with tumor measuring 15 x 18.7 x 11.5 mm
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F3
About a year later, he had magnetic resonance imaging (MRI) of the brain done, which revealed a marginal increase in size [15 (AP) x 18.7 (T) x 11.5 (CC) mm] [Figure 3].
Axial and coronal contrast-enhancing T1WI in September 2009 with tumor measuring 24.5 x 25 x 17.5 mm
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F4
About 4 months later, re-imaging showed that the schwannoma had substantially enlarged [24.5 (AP) x 25 (T) x 17.5 (CC) mm] [Figure 4].
Axial and coronal contrast-enhancing T1WI in February 2010 with tumor measuring 15 x 18 x 12 mm
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F5
The patient decided not to undergo any treatment and had a repeat scan 5 months later that again showed a decrease in the size of the left acoustic neuroma [15 (AP) x 18 (T) x 12 (CC) mm] [Figure 5] with internal acoustic canal (IAC) extension being stable at 5-6 mm.
Graphical representation of tumor volume over time
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F6
The volume of the tumor was calculated using the formula [Antero-posterior(AP) x transverse(T) x cranio-caudal(CC)/2] and the trend in volume changes over time is depicted in Figure 6.
GKS plan March 2010
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F7
The dimensions on the day of treatment including the intracanalicular component were [15 (AP) x 17 (T) x 13 (CC) mm] [Figure 7].
Axial and coronal contrast-enhancing T1WI in May 2011 with tumor measuring 15 x 11 x 9 mm
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F8
He is on regular follow-up with MR imaging, and at 1 year since Gamma knife radiosurgery(GKRS), his images show a solid tumor without any cystic component, measuring [15 (AP) x 11 (T) x 9 (CC) mm] [Figure 8] and he remains clinically stable.