case_images: PMC9908090_01
case_images: Axial contrast-enhanced T1-weighted MRI showed a large left-sided VS (two crossed white lines), grade T4b (Hannover classification), with severe brainstem compression
case_images: cureus-0015-00000033552-i01.jpg
case_images: PMC9908090_01_cureus-0015-00000033552-i01.jpg
case_images: FIG1
case_images: T4b (Hannover classification), with severe compression of the brainstem (Figure 1). There was a long conversation and discussion about the possible treatments, and she opted for surgical treatment in hopes of improving symptoms.
case_images: Lateral decubitus position. The patient's head was positioned parallel to the floor, flexed, and slightly tilted to the contralateral side
case_images: cureus-0015-00000033552-i02.jpg
case_images: PMC9908090_01_cureus-0015-00000033552-i02.jpg
case_images: FIG2
case_images: The patient was placed in a lateral decubitus position (Figure 2).
case_images: Curvilinear skin incision
case_images: cureus-0015-00000033552-i03.jpg
case_images: PMC9908090_01_cureus-0015-00000033552-i03.jpg
case_images: FIG3
case_images: A curved skin incision was placed two fingers behind the ear (Figure 3).
case_images: Retrosigmoid craniotomy
case_images: cureus-0015-00000033552-i04.jpg
case_images: PMC9908090_01_cureus-0015-00000033552-i04.jpg
case_images: FIG4
case_images: A burr-hole was placed in the asterion, and a retrosigmoid craniotomy was carried out (Figure 4).
case_images: Postoperative coronal contrast-enhanced T1-weighted MRI showed subtotal resection (white arrows)
case_images: cureus-0015-00000033552-i05.jpg
case_images: PMC9908090_01_cureus-0015-00000033552-i05.jpg
case_images: FIG5
case_images: Postoperative MRI showed subtotal resection (Figure 5).
case_images: The facial nerve thinned and spread out over the capsule (white arrowheads)
case_images: cureus-0015-00000033552-i06.jpg
case_images: PMC9908090_01_cureus-0015-00000033552-i06.jpg
case_images: FIG6
case_images: The facial nerve was thinned and spread out over the capsule (Figures 6, 7).
case_images: The facial nerve (white arrow) and last piece of residual tumor (star)
case_images: cureus-0015-00000033552-i07.jpg
case_images: PMC9908090_01_cureus-0015-00000033552-i07.jpg
case_images: FIG7
case_images: The facial nerve was thinned and spread out over the capsule (Figures 6, 7).
case_images: Total resection with anatomically preserved facial nerve (white arrow)
case_images: cureus-0015-00000033552-i08.jpg
case_images: PMC9908090_01_cureus-0015-00000033552-i08.jpg
case_images: FIG8
case_images: A total resection was achieved (Figure 8).
case_images: Postoperative axial contrast-enhanced T1-weighted MRI showed total resection
case_images: cureus-0015-00000033552-i09.jpg
case_images: PMC9908090_01_cureus-0015-00000033552-i09.jpg
case_images: FIG9
case_images: Postoperative MRI showed total resection (Figure 9).
case_images: Good recovery of facial nerve function at follow-up
case_images: cureus-0015-00000033552-i10.jpg
case_images: PMC9908090_01_cureus-0015-00000033552-i10.jpg
case_images: FIG10
case_images: HB grade IV after the second surgery, which improved at the follow-up to HB grade II (Figure 10). Hearing status decreased after surgery.