case_images: PMC3263002_01
case_images: Axial and coronal contrast-enhancing T1WI showing a left CP angle enhancing mass with intrameatal extension and cystic changes measuring mass 23 x 25 x 18 mm on presentation in September 2007
case_images: SNI-2-187-g001.jpg
case_images: PMC3263002_01_SNI-2-187-g001.jpg
case_images: F1
case_images: He was evaluated for these symptoms and imaging revealed an enhancing mass [23 (AP) x 25 (T) x 18 (CC) mm] [Figure 1] with central areas of cystic change within the left CP angle extending into the left internal auditory canal.
case_images: Axial and coronal contrast-enhancing T1WI in May 2008 with tumor measuring 13 x 17.5 x 10.4 mm
case_images: SNI-2-187-g002.jpg
case_images: PMC3263002_01_SNI-2-187-g002.jpg
case_images: F2
case_images: Repeat imaging done 6 months later revealed a further reduction in size [13 (AP) x 17.5 (T) x 10.4 (CC) mm] [Figure 2] and conservative management was continued.
case_images: Axial and coronal contrast-enhancing T1WI in May 2009 with tumor measuring 15 x 18.7 x 11.5 mm
case_images: SNI-2-187-g003.jpg
case_images: PMC3263002_01_SNI-2-187-g003.jpg
case_images: F3
case_images: About a year later, he had magnetic resonance imaging (MRI) of the brain done, which revealed a marginal increase in size [15 (AP) x 18.7 (T) x 11.5 (CC) mm] [Figure 3].
case_images: Axial and coronal contrast-enhancing T1WI in September 2009 with tumor measuring 24.5 x 25 x 17.5 mm
case_images: SNI-2-187-g004.jpg
case_images: PMC3263002_01_SNI-2-187-g004.jpg
case_images: F4
case_images: About 4 months later, re-imaging showed that the schwannoma had substantially enlarged [24.5 (AP) x 25 (T) x 17.5 (CC) mm] [Figure 4].
case_images: Axial and coronal contrast-enhancing T1WI in February 2010 with tumor measuring 15 x 18 x 12 mm
case_images: SNI-2-187-g005.jpg
case_images: PMC3263002_01_SNI-2-187-g005.jpg
case_images: F5
case_images: The patient decided not to undergo any treatment and had a repeat scan 5 months later that again showed a decrease in the size of the left acoustic neuroma [15 (AP) x 18 (T) x 12 (CC) mm] [Figure 5] with internal acoustic canal (IAC) extension being stable at 5-6 mm.
case_images: Graphical representation of tumor volume over time
case_images: SNI-2-187-g006.jpg
case_images: PMC3263002_01_SNI-2-187-g006.jpg
case_images: F6
case_images: The volume of the tumor was calculated using the formula [Antero-posterior(AP) x transverse(T) x cranio-caudal(CC)/2] and the trend in volume changes over time is depicted in Figure 6.
case_images: GKS plan March 2010
case_images: SNI-2-187-g007.jpg
case_images: PMC3263002_01_SNI-2-187-g007.jpg
case_images: F7
case_images: The dimensions on the day of treatment including the intracanalicular component were [15 (AP) x 17 (T) x 13 (CC) mm] [Figure 7].
case_images: Axial and coronal contrast-enhancing T1WI in May 2011 with tumor measuring 15 x 11 x 9 mm
case_images: SNI-2-187-g008.jpg
case_images: PMC3263002_01_SNI-2-187-g008.jpg
case_images: F8
case_images: He is on regular follow-up with MR imaging, and at 1 year since Gamma knife radiosurgery(GKRS), his images show a solid tumor without any cystic component, measuring [15 (AP) x 11 (T) x 9 (CC) mm] [Figure 8] and he remains clinically stable.