• 75-year-old right-handed gentleman with known diagnosis of acoustic neuroma (vestibular schwannoma) who had undergone stereotactic radiosurgery for this tumor two years ago and who presented with black out episodes, progressive loss of gait and balance, staggering gait, facial numbness on the right side, and difficulty with swallowing.
  
  
• On physical examination he had staggering gait, facial numbness and weakness on the right side.
  
  

Imaging

MRI scan shows increased dimensions of the vestibular schwannoma together with vasogenic edema of the brain stem as well as mild effacement of the fourth ventricle.

Surgical Procedure

• He underwent a right retrosigmoid craniectomy and surgical resection of this brain tumor using stereotaxy and brain mapping, intraoperative neurophysiological monitoring including facial nerve monitoring, SSEP, MEP, and brain stem auditory evoked response (BAER).

• The pathology of the tumor confirmed diagnosis of acoustic neuroma (vestibular schwannoma)
  
  

    
Before Operation                                                  After Operation

Post-op MRI confirms gross total resection of the tumor with no injury to surrounding neurovascular structures.

• Postoperatively, the patient’s facial weakness worsened, however, this gradually improved as the inflammation and edema at the surgical site resolved.