Diagnosis
Acoustic neuroma, vestibular schwannoma.
Patient:
Young woman, 24 years old, Ukraine
Physician:
Prof. Dr. med. Martin Scholz, Head of Neurosurgery Department, Sana Hospital Duisburg
Expert Opinion by Prof. Martin Scholz:
The patient presents with a large right-sided vestibular schwannoma (acoustic neuroma) that is exerting significant mass effect and displacement on the pons region of the brainstem. In this clinical scenario, surgical resection of the acoustic neuroma is mandatory, performed via a suboccipital approach (lateral retrosigmoid craniotomy).
To preserve auditory function and facial nerve integrity, tumor resection will be conducted under continuous intraoperative monitoring of brainstem auditory evoked potentials (BAEP) and facial nerve monitoring.
Given the tumor's size and its direct compressive effect on adjacent brainstem tissue, alternative management options—such as radiation therapy or conservative observation—are not clinically appropriate.
During surgery, extreme caution is required along the anterior aspect of the tumor to safeguard the facial nerve. If necessary, a thin residual capsule of the tumor will be left in place to avoid damaging the nerve and compromising facial expression.
Patient’s Inquiry:
- How urgently does the surgery need to be performed?
Doctor's Answer:
The surgery should be scheduled in the near future because the lesion is space-occupying and active brainstem compression is present. It is impossible to predict how long clinical symptoms and complaints will remain minimal before sudden neurological decline occurs.