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Meningioma of the cerebellopontine angle

CLINICAL HISTORY:
A 32-year old man complains of 4 months of hearing loss and tinnitus on the left side. He intermittently suffers attacks of vertigo with gait instability. He mentions numbness of the left outer ear, problems with concentration and headaches.

NEUROLOGICAL EXAMINATION shows hearing loss on the left, tendency to fall to the left at Romberg test and diplopia at left lateral gaze.

MRI:

a) TRANSAXIAL T2-WEIGHTED SPIN-ECHO (2800/95/1) SEQUENCE (IMAGE 1) shows a hyperintense tumor (arrowheads) in the left cerebellopontine angle with brainstem compression.

b) TRANSAXIAL 3D-CISS SEQUENCE (40/8/1) (IMAGE 2) shows that the tumor does not extend within the internal auditory canal (arrow).

b) TRANSAXIAL T1 WEIGHTED SPIN-ECHO (512/14/1) SEQUENCE (IMAGE 3): The tumor (arrowheads) is homogeneously hypointense.

c) TRANSAXIAL (IMAGES 4 - 5 AND 6) GADOLINIUM-ENHANCED T1-WEIGHTED SPIN-ECHO SEQUENCE shows homogeneous moderate enhancement of the lesion. The tumor extends up to the hiatus tentorii (arrow) and does extend into the internal auditory canal.

RADIOLOGICAL DIAGNOSIS is meningioma of the cerebellopontine angle, probably arising from the tentorium. Differential diagnosis with acoustic neuroma is based on the lack of expansion of the internal auditory canal.

SURGICAL INTERVENTION was performed via left suboccipital osteoclastic craniotomy. The tumor was situated ventral to the cranial nerves and compressed the brainstem to the right. The tumor tightly adhered to the brainstem. Implantation of the tumor was situated at the tentorium. Total resection was performed.

ANATOMOPATHOLOGICAL EXAMINATION (IMAGE 7) shows meningioma.

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Fig. 1

Meningioma of the cerebellopontine angle, Fig. 1
Meningioma of the cerebellopontine angle, Fig. 2
Meningioma of the cerebellopontine angle, Fig. 3
Meningioma of the cerebellopontine angle, Fig. 4
Meningioma of the cerebellopontine angle, Fig. 5
Meningioma of the cerebellopontine angle, Fig. 6
Meningioma of the cerebellopontine angle, Fig. 7