case_images: PMC11802263_01
case_images: Preoperative audiometric testing showing significantly reduced pure tone thresholds and 4% word recognition in the affected ear, consistent with AAO-HNS class D hearing. AAO-HNS, American Academy of Otolaryngology:Head and Neck Surgery.
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case_images: PMC11802263_01_10-1055-a-2516-7311-i24oct0071-1.jpg
case_images: FI24oct0071-1
case_images: Audiometry showed significantly reduced pure tone thresholds and 4% word recognition in the affected ear, consistent with American Academy of Otolaryngology:Head and Neck Surgery (AAO-HNS) class D hearing ( Fig. 1 ).
case_images: (
  A, B
  )
  .
  Preoperative MRI with JF tumor (*) and separate JF (*) and IAC tumors (arrow). (
  C, D
  )
  .
  Postoperative MRI with residual JF tumor (*) and residual JF tumor (*) with nonmanipulated IAC tumors (arrow). IAC, internal auditory canal; JF, jugular foramen; MRI, magnetic resonance imaging.
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case_images: FI24oct0071-2
case_images: Magnetic Resonance Imaging (MRI) demonstrated a large left 3.3-cm JFS and separate left 1-cm intracanalicular VS extending to the internal auditory canal (IAC) fundus, without an appreciable fundal cap ( Fig. 2A,B ). The small intracanalicular VS was not manipulated and the IAC dura was left intact ( Fig. 2C,D ).
case_images: Preoperative caloric testing demonstrating completely absent response in the left ear, as no nystagmus was elicited with the application of either hot or cold water.
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case_images: FI24oct0071-3
case_images: Preoperative vestibular testing showed absent caloric response on the left ( Fig. 3 ) as well as numerous central ocular motor deficits including spontaneous left-beat and downbeat nystagmus, gaze-evoked nystagmus, impaired smooth pursuit, optokinetic nystagmus, and a central positional nystagmus. 
case_images: Postoperative audiometric testing showing normal audiometric thresholds with 100% discrimination, consistent with AAO-HNS class A hearing. AAO-HNS, American Academy of Otolaryngology:Head and Neck Surgery.
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case_images: FI24oct0071-4
case_images: Postoperative audiometry at 6 weeks showed normal audiometric thresholds with 100% discrimination (AAO-HNS class A hearing) ( Fig. 4 ).
case_images: Postoperative caloric testing and video Head Impulse Test (vHIT) demonstrating a subtle response in the left ear, as a very weak nystagmus was elicited with both hot and cold water. The above vHIT demonstrates significant corrective saccades with loss of gain in the superior vestibular nerve > inferior vestibular nerve, demonstrating ongoing unilateral vestibulopathy.
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case_images: FI24oct0071-5
case_images: Peripheral vestibulopathy was relatively unchanged on postoperative vestibular testing but central findings resolved ( Fig. 5 ).