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Successful surgery of an exophytic brainstem glioma mimicking a cerebellar- pontine angle tumor

K Roessler, E Heynold, R Coras, L├╝cking, M Buchfelder
World Neurosurgery 2019 May 14
31100526

BACKGROUND: Non tectal plate exophytic brainstem gliomas with pilocytic histology are very rare and occur mainly in children. Because of their eloquent location, therapy consists in most cases of bioptic histological verification and radiotherapy in case of progression.

CASE DESCRIPTION: We report on a 43- year's old adult patient who presented with intermittent tinnitus and reduced hearing on his left ear as well as a slight left sided ataxia. MR imaging revealed a left sided solid cystic cerebellar- pontine angle (CPA) tumor completely obliterating the CPA. Radiologically, a solid cystic vestibular schwannoma was diagnosed. Intraoperatively, a glossy- greyish intensively bleeding tumor without any capsule or delineation to the brain stem or the cranial nerves was resected using electrophysiological monitoring. The postoperative histology revealed a pilocytic astrocytoma. Three months postoperatively, hearing was preserved (pure tone average -35dB) and ataxia was equal to preoperatively, gradually becoming better. The postoperative MR scans demonstrated a complete resection of the tumor with completely restored brain stem contours.

CONCLUSIONS: Exophytic brainstem gliomas may occur in the CPA and mimic vestibular schwannoma. Complete resection even with preserved hearing without neurological deterioration may be feasible.

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