Vestibular schwannoma - intracanalicular

Case contributed by Adan Radiology Department
Diagnosis almost certain

Presentation

Hearing impairment, asymmetrical sensory neural hearing loss (SNHL) and dizziness.

Patient Data

Age: 55 years
Gender: Female

Avidly enhancing lesion is noted in the intracanalicular segment of the right internal auditory canal measuring about 12 x 4.6 mm causes minor expansion of the canal. No cerebellopontine angle component to the lesion. 
Normal appearance of the visualised parts of the posterior fossa, the brain stem.
The left internal auditory canal and their content (VII and VIII cranial nerves) are normal.
The cochlea, vestibule and semicircular canals are unremarkable.
Both cerebellopontine angle cisterns are free. 
No abnormal enhancing lesion visualised in both cerebellopontine angle cisterns, as well as in left internal auditory canals, following contrast administration
Evidence of bilateral white matter high signal intensity foci are noted on T2WI, FALIR sequences suggestive of chronic small vessel diseases.
No evidence of haemorrhage, infarction, mass, brain oedema or midline shift.
The visualised parts of the skull base and sinuses are unremarkable.

OPINION:
The findings mentioned above suggest vestibular schwannoma involves the intracanalicular segment of the right vestibulocochlear nerve (CN VIII).

Annotated images

mri

Axial and corona FIESTA images a predominantly right intracanalicular mass lesion( red arrows), mostly likely schwannoma.

Axial and coronal fat-suppressed gadolinium-enhanced T1W images demonstrating avid contrast enhancement in the lesion (green arrows).

Case Discussion

The vestibulocochlear nerve is the most common intracranial nerve for schwannoma involvement. Vestibular schwannomas that originate from the IAC comprise approximately 90% of cerebellopontine angle tumours. 

Contrast-enhanced MRI is the modality of choice for diagnosis of the suspected cases, and in those patients with initial changes in the hearing, to better clarify the diagnosis.

Our case according to the Koos grading scale is grade 1: intracanalicular tumour of vestibular schwannomas.

The case courtesy Dr Safwat Al Moghazi  MD

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