Skull Base 2001; 11(3): 199-206
DOI: 10.1055/s-2001-16608
CASE REPORTS

Copyright © 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Staged Resection of Large Hypervascular Vestibular Schwannomas in Young Adults

Takumi Abe1 , Hitoshi Izumiyama1 , Youichi Imaizumi1 , Shinsuke Kobayashi1 , Motohiko Shimazu1 , Ken Sasaki1 , Kiyoshi Matsumoto1 , Miki Kushima2
  • 1Department of Neurosurgery, Showa University School of Medicine, Tokyo, Japan
  • 2Department of Hospital Pathology, Showa University School of Medicine, Tokyo, Japan
Further Information

Publication History

Publication Date:
24 August 2001 (online)

ABSTRACT

Two young adults underwent resection of large hypervascular vestibular schwannomas (acoustic neuromas) via two-stage surgery. The first patient, a 27-year-old woman with hydrocephalus, had a large hypervascular vestibular tumor in the left cerebellopontine angle (CPA) supplied by the left anterior inferior cerebellar artery (AICA) and posterior inferior cerebellar artery (PICA). The second patient, a 34-year-old woman, had a large AICA-supplied hypervascular vestibular tumor in the left CPA that displaced the brain stem significantly. At the initial stage, only the lateral aspect of the tumor was debulked due to excessive bleeding from the tumor bed. Angiography 1 or 2 months after the initial operation showed that the tumor was hypovascular. At the second stage, the remnant medial aspect of the tumor was relatively avascular and nonadherent to the brain stem. Without blood transfusion during the second stage, the tumor was removed totally in the first patient and subtotally in the second patient. Pathological examination revealed that dilatated blood vessels were prominently increased at the first surgery; however, at the second surgery, the number of blood vessels had decreased, showing necrosis and degeneration. Although there are no absolute indications for the staged resection of vestibular schwannomas, this procedure may represent one of the safest options for these difficult lesions in young adults.

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