Headaches, acoustic neuroma, preoperative planning. Examination is obtained for operative planning and intraoperative navigation. Fiducial markers are in place. Again seen is an enhancing mass at the right cerebellopontine angle cistern measuring approximately 3.0 x 2.9 x 2.7 cm in the AP, transverse, and craniocaudal dimensions similar to prior. There is mass effect on the right lateral aspect of the pons as well as on the right middle cerebellar peduncle and right cerebellar hemispheres. There is also mass effect on the cisternal segment of the right trigeminal nerve which is anteromedially displaced. Enhancing mass extends through the porus acusticus into the right internal auditory canal. No extension into the cochlea seen, but can be correlated with prior dedicated IAC MRI.Unchanged diffuse prominence of the ventricular system without evidence of obstruction relating to the cerebellopontine angle neoplasm. Again noted is aneurysm involving the right MCA bifurcation as well as the left M1 segment as seen on recent CTA.
1. Heterogeneously enhancing right cerebellopontine angle mass measuring 3.0 x 2.9 x 2.7 cm extending into the right internal auditory canal consistent with known vestibular schwannoma.2. Mass-effect on the right pons, middle cerebellar peduncle, cerebellum, as well as the cisternal segment of the right trigeminal nerve.3. Communicating hydrocephalus, possibly related to the schwannoma (associated with elevated CSF protein concentration). No direct mass effect on the ventricular system. 4. Middle cerebral artery aneurysms better demonstrated on recent CT angiogram.