Vestibular schwannoma and tuberculoma occurring In collision in the posterior fossa: A case report

Abstract

Introduction: Though acoustic schwannoma is the most common primary tumour in the cerebello-pontine angle, its occurrence with tuberculoma has never been reported.

Presentation of case: A case of a vestibular schwannoma and tuberculoma occurring as collision tumors in the posterior fossa in a 46 years old female is reported. She presented with chronic raised intracranial pressure manifesting as headache, occasional diplopia, speech disturbance, and unsteady gait. Magnetic resonance imaging of the brain demonstrated a vestibular schwannoma and tuberculoma in the right cerebello-pontine angle. The lesions were resected through retro sigmoid route. The caudal mass was vestibular schwannoma while the rostral and medial portion was tuberculoma.

Discussion: The occurrence of a vestibular schwannoma and tuberculoma in collision has hitherto never been reported. The pathogenesis, surgical challenges and management of such a rare entity is discussed and the relevant literature is briefly reviewed.

Conclusion: The association of vestibular schwannoma and tuberculoma is rare. Surgical excision of lesions occurring in collision can be formidable. They require careful planning and strategy.

Keywords: Cerebello-pontine angle; Collision; Posterior fossa; Schwannoma; Tuberculoma.

Fig. 1

A and B are axial MR images with T1 post contrast and T2 weighted sequences respectively. They show T2 hyperintense and contrast enhancing acoustic schwannoma with T2 hypointense and ring enhancing tuberculoma in the adjacent right cerebellar hemisphere separated by a thin rim of gliotic tissue. Another small tuberculoma in right middle cerebellar peduncle is also seen. C and D are post-operative axial MR image showing reduction in size of tuberculoma.