MALIGNANT TRANSFORMATION OF PREVIOULSY RADIATED VESTIBULAR SCHWANNOMA: 2D operative video.
Publication/Presentation Date
9-23-2024
Abstract
Malignant transformation of vestibular schwannomas, though rare, demands a comprehensive, multidisciplinary treatment approach to optimize patient outcomes. In this publication, we discuss the rare case of malignant transformation in a vestibular schwannoma post-radiation treatment, exemplified by a 58-year-old female patient. Initially diagnosed with a right cerebellopontine angle vestibular schwannoma, the patient underwent CyberKnife treatment 16 years ago, receiving 18 Gy across three fractions. Despite initial stability, the patient experienced progressive hearing loss, ultimately requiring a BAHA implant. Years later, she presented with rapid-onset facial weakness, dizziness, nausea, and vomiting, leading to a wheelchair-bound state and nutritional support upon admission. Advanced imaging revealed a significantly enlarged tumor, characterized by brain edema and suspicious hemorrhage, prompting urgent surgical intervention. Our multidisciplinary approach, including ENT collaboration, led to the decision for a right retrosigmoid craniotomy and meatotomy. This strategy aimed at maximal tumor resection while preparing for potential facial nerve sacrifice due to the suspected malignancy. Intraoperative findings confirmed the tumor's malignant nature, necessitating facial nerve resection. Postoperatively, the patient demonstrated clinical improvement and was discharged with plans for physical therapy and adjuvant radiation therapy, considering the tumor's malignant peripheral nerve sheath transformation. This case underscores the importance of vigilant monitoring for vestibular schwannoma patients, particularly those with rapid symptom progression and tumor growth, highlighting the crucial role of adjuvant radiotherapy in treatment regimens. This study received Institutional Review Board (IRB) approval. The patient featured in the video presentation provided informed consent for the use of their image and information.
ISSN
1878-8769
Published In/Presented At
Saez Alegre, M., Morshed, R., Babajanian, E., Dornhoffer, J., Kollia, S., Athanasoulis, F., Torregrossa, F., Neff, B., & Van Gompel, J. J. (2024). MALIGNANT TRANSFORMATION OF PREVIOULSY RADIATED VESTIBULAR SCHWANNOMA: 2D operative video. World neurosurgery, S1878-8750(24)01631-0. Advance online publication. https://doi.org/10.1016/j.wneu.2024.09.082
Disciplines
Medicine and Health Sciences
PubMedID
39321915
Department(s)
Fellows and Residents
Document Type
Article