A 15-year-old girl came to us with a large brain tumour. It was diagnosed at another hospital when she was investigated for hearing loss, headache, and giddiness. Magnetic resonance imaging (MRI) characteristics of the tumour indicated that this could most likely have arisen from the cranial nerve that subserves hearing and balance, or the vestibulocochlear nerve, on the right side. These tumours are called vestibular schwannomas (VS). The massive size of the tumour distorted her cerebellum and brain stem and had created an obstruction to the flow of CSF, causing hydrocephalus. We decided to proceed with surgical removal of the tumour.
Anatomically, tumours arising from the vestibulocochlear nerve are closely related to the cranial nerve that controls the muscles of the face (the facial nerve). With the slow growth of VS, the facial nerve gets stretched over them and can get displaced in any direction, draping the surface of the tumour. Thus, the facial nerve could be located either on the front, back, top or bottom of a VS. The diameter of the facial nerve is a few millimetres, and its colour simulates the colour of the tumour. Hence identifying the facial nerve on the surface of VS and preserving it anatomically and functionally is a major challenge while resecting VS. For this young girl, who has her entire life ahead of her, injury to the facial nerve during extirpation of the tumour was something our surgical team could never dream of.
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Esta historia es de la edición November 2021 de Future Medicine India.
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