PMC9908090_01
Axial contrast-enhanced T1-weighted MRI showed a large left-sided VS (two crossed white lines), grade T4b (Hannover classification), with severe brainstem compression
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FIG1
T4b (Hannover classification), with severe compression of the brainstem (Figure 1). There was a long conversation and discussion about the possible treatments, and she opted for surgical treatment in hopes of improving symptoms.
Lateral decubitus position. The patient's head was positioned parallel to the floor, flexed, and slightly tilted to the contralateral side
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FIG2
The patient was placed in a lateral decubitus position (Figure 2).
Curvilinear skin incision
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FIG3
A curved skin incision was placed two fingers behind the ear (Figure 3).
Retrosigmoid craniotomy
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FIG4
A burr-hole was placed in the asterion, and a retrosigmoid craniotomy was carried out (Figure 4).
Postoperative coronal contrast-enhanced T1-weighted MRI showed subtotal resection (white arrows)
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FIG5
Postoperative MRI showed subtotal resection (Figure 5).
The facial nerve thinned and spread out over the capsule (white arrowheads)
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FIG6
The facial nerve was thinned and spread out over the capsule (Figures 6, 7).
The facial nerve (white arrow) and last piece of residual tumor (star)
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FIG7
The facial nerve was thinned and spread out over the capsule (Figures 6, 7).
Total resection with anatomically preserved facial nerve (white arrow)
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FIG8
A total resection was achieved (Figure 8).
Postoperative axial contrast-enhanced T1-weighted MRI showed total resection
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FIG9
Postoperative MRI showed total resection (Figure 9).
Good recovery of facial nerve function at follow-up
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FIG10
HB grade IV after the second surgery, which improved at the follow-up to HB grade II (Figure 10). Hearing status decreased after surgery.