Successful Minimally Invasive Removal of Acoustic Neuroma in a 42-Year-Old Patient

Patient Background

A 42-year-old female presented with progressive hearing loss in the right ear over 6 months, accompanied by tinnitus and occasional dizziness. MRI revealed a 2.5 cm vestibular schwannoma (acoustic neuroma) in the right cerebellopontine angle.

Diagnostic Workup

• Audiometry: Moderate sensorineural hearing loss (right ear)
• MRI with gadolinium: Well-defined enhancing lesion, 2.5 x 2.0 cm
• Electronystagmography: Reduced vestibular function on the right
• Facial nerve EMG: Normal function bilaterally

Surgical Approach

A retrosigmoid (suboccipital) approach was chosen to attempt hearing preservation. Key steps included:

1. Intraoperative facial nerve monitoring throughout
2. Careful tumor dissection from the facial nerve using microsurgical technique
3. Near-total tumor removal achieved
4. Brainstem auditory evoked responses maintained during surgery

Outcomes

• Facial nerve function: House-Brackmann Grade I (normal) at 6 months
• Hearing: Serviceable hearing preserved (Gardner-Robertson Class II)
• Tumor control: No recurrence at 2-year follow-up MRI
• Recovery: Discharged on postoperative day 4

Discussion

This case highlights the importance of early detection and the feasibility of hearing preservation surgery for small-to-medium acoustic neuromas. The retrosigmoid approach offers the best chance of hearing preservation when tumor size permits.