Cerebellopontine angle (CPA) tumors are extremely common in neurosurgical practices, yet they can be deceptive in their simplicity. When a patient is diagnosed with CPA, they often complain about imbalance, hearing loss, and headache. Most radiologists often believe that these common symptoms are a result of either vestibular schwannoma or meningioma.
The brain however, has its own rules. Occasionally such symptoms can point to a much deeper problem. This particular case is about how a lesion that looked extra-axial, behaved like it, turned out to be a medulloblastoma – one of the rarest CPA tumors in adults.
Understanding The Case Better
35- year-old Roma (name changed for privacy), arrived at Dr. Raghvendra Ramdasi’s clinic with the following complains:
- Giddiness and imbalance for 3 months
- Reduced hearing in the right ear for 2 months
- Headache and vomiting for 15 days
Known as one of the best skull base neurosurgeons in Mumbai, Dr. Ramdasi’s 20+ years of experience had taught him that no simple symptom is always simple in nature. He felt that a deeper problem is hidden beneath the symptoms, requiring more evaluation.
MRI findings of her brain revealed a right CPA mass appearing extra-axial with tentorial attachment. The lesion was isointense on T1, heterogeneously hyperintense on T2, and showed strong, patchy post-contrast enhancement. Diffusion-weighted imaging (DWI) demonstrated marked restriction, indicating high cellularity. Also, moderate cerebellar edema, mild hydrocephalus and importantly- no T2 hyperintense CSF cleft were detected between tumor and cerebellum. Audiometry revealed mild sensorineural hearing loss.
Using The Right Treatment Method For This Case
Under Dr. Raghvendra Ramdasi treatment plan, Roma had to undergo a retrosigmoid craniotomy under intra-operative neuromonitoring. Within in, the mass was found to be intra-axial with exophytic extension into the CPA, rather than a purely extra-axial tumor.
This case required precision expertise to remove the tumor without affecting other brain functions. Hence, Dr. Ramdasi turned to minimally evasive surgical procedures to treat the problem. This surgical method uses endoscopic tube which is inserted through the nasal passage all the way to the brain, ensuring next to no scarring or big cuts that could affect the brain.
With the help of minimally invasive methods, near-total excision was achieved with preservation of cranial-nerve function. Roma recovered completely within the span of a few weeks – regaining balance, resolution of headache and significant improvement in hearing.
Microscopy confirmed medulloblastoma (classic type). The diagnosis transformed a presumed benign CPA tumor into an oncologically significant entity requiring neuro-oncology follow-up.
Key Take Aways
Medulloblastomas generally arise from the vermis or roof of the fourth ventricle and are most common in children. However, Ectopic or lateral medulloblastomas extending into the CPA are extremely rare in adults.
Balasubramanian et al. (2024) found that CPA medulloblastomas accounted for less than 0.1% of adult posterior fossa tumors. Their symptoms are often misdiagnosed as schwannoma or meningioma until surgery confirms otherwise.
Dr. Ramdasi is no stranger to such cases. He believes that neurosurgeons have a responsibility to analyse and get to the root of the problem, especially if symptoms seem too simple. Our brain is a very volatile organ, it does not follow the conventional rules set by the discipline of neurology and neurosurgery. Hence, deep analysis and contemplating all factors while diagnosis can go a long way to save a person’s life.
Get Treatments Only From Reliable Skull Base Neurosurgeon In Mumbai
With decades of experience solving some of the rarest brain tumor cases, Dr. Raghvendra Ramdasi has extensive knowledge on the best treatment options. Known as one of the best neurosurgeons in Mumbai, his expertise with minimally invasive techniques has saved thousands of lives.
If you or your loved ones need an expert evaluation of brain related symptoms, then please don’t hesitate to reach out to Dr. Ramdasi and his team. The earlier the diagnosis, the better are chances of recovery.