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Ms. M.G. is a 46-year-old woman with a history of hypertension and prior bilateral laser eye surgery. In 2009, she presented with vertigo, tinnitus, and decreased hearing in the left ear. An MRI scan revealed an enhancing mass in the posterior fossa that was thought to be an acoustic neuroma. In May of 2009, she underwent gamma-knife radiotherapy for the 2.7 cm mass.

In September of 2012, M.G. noted progressive change in her voice quality as well as a swallowing disturbance and left facial spasms. A subsequent MRI showed significant enlargement of the tumor to a maximal size of 3.7 cm with brainstem compression and extension through the jugular foramen. In January of 2013, the patient presented for a neurosurgical consult to discuss treatment options. At this time, a review of systems was also positive for absent hearing in the left ear, vertigo, tinnitus, mild headache, and balance disturbance. On physical exam, the patient was awake, alert, and fully oriented. A cranial nerve exam revealed a hoarse voice, a deviating palate and uvula, absent hearing to finger rubs on the left, mildly decreased sensation of trigeminal nerve in the V3 distribution on the left side, and slight asymmetry in the left trapezius muscle. The remainder of the cranial nerve exam was normal. Motor strength and sensory function were intact in both upper and lower extremities, but she did have a positive Romberg’s sign. At this time, the diagnosis of a left posterior fossa jugular foramen schwannoma was made.

In February of 2013, the patient underwent left retrosigmoidal approach to resection of the posterior fossa jugular foramen schwannoma. Because dissection of the tumor from the facial nerve was unsuccessful, a small portion of the tumor was left adherent to the facial nerve superiorly. The patient had a mild left facial palsy postoperatively and was treated with a Decadron taper, but she was subsequently discharged home in a stable condition.

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