2025 Poster Presentations
P452: MASSIVE VESTIBULAR SCHWANNOMA REQUIRING SERIAL DEBULKINGS AND RADIOSURGERY
Douglas J Totten, MD, MBA; Hunter L Elms, MD; Evan C Cumpston; Charles W Yates, MD; Indiana University
Introduction: Vestibular schwannomas (VS) are diagnosed in a wide range of sizes with varying patient presentations. This report discusses a young male with a massive cystic VS in the absence of a genetic mutation who presented due to speech and balance concerns.
Methods: Case report of a patient with a massive vestibular schwannoma.
Results: A 32-year-old male presented with longstanding right unilateral sensorineural hearing loss (SNHL) and recently manifested slurred speech, balance problems, and reduced facial sensation above his right eye. An MRI identified a large, 5.0 x 5.4 x 5.1 cm cystic vestibular schwannoma with resultant brainstem compression and hydrocephalus (Figure 1). A translabyrinthine approach was performed with significant debulking of the tumor. Medially, however, a significant amount of tumor was unable to be resected (Figure 2). A retrosigmoid approach was subsequently performed to further debulk the tumor. His postoperative course was complicated by an infected pseudomeningocele requiring surgical washout and bone cement removal and eventual placement of a ventriculoperitoneal shunt. Residual tumor growth on interval MRI 5 months after the second operation prompted Gamma Knife radiosurgery which the patient tolerated well (Figure 3). Subsequent MRI 4 months after radiosurgery demonstrated stable residual tumor without interval growth (Figure 4). The patient experienced significant improvement in ambulation after tumor removal. He also developed significant facial weakness (House-Brackman V) postoperatively which progressed to full paralysis. Facial reanimation surgery is planned along with continued tumor surveillance.
Conclusion: Although the goal of VS surgery is maximal safe resection, in cases of massive VS, serial debulking may be required utilizing a combination of approaches for maximal tumor removal. Postoperative adjuvant radiation may be considered in tumors with progressive residual disease. This case report provides an example of a particularly large tumor requiring a complex approach to management. Further research into the tumor characteristics predictive of aggressive growth is needed.