Skull Base Surgery of the Posterior Fossa

107

Postoperative imaging showed residual enhance-
ment of the IAC; however, at 118 months postop-
erative, there was no recurrence (Fig. 8.3d).
Symptoms resolved and hearing improved so that
she could again use her phone on the right side.

Case 3: PPFM: Small-Sized Tumor

A 35-year-old woman presented with a 3-year
history of episodic dizziness and two episodes of
true vertigo 2 years apart. There was no tinnitus
and no change in hearing. MR imaging showed a
meningioma attached to the dura near the vestib-
ular aperture (Fig. 8.5). A left retrosigmoid crani-

otomy was performed and achieved a Simpson

Grade 1 resection. The patient had marked

improvement in audiovestibular symptoms.

Case 4: PPFM: Large-Sized Tumor

A 52-year-old woman presented with 6 months

of right-sided suboccipital headache, worse with

coughing, sneezing, and straining. She com-

plained of dizziness and “walking like a drunk.”

She was seen by a neurologist who ordered a MR

brain scan which revealed a 4.5 cm right PPFM

with mass effect (Fig. 8.6). Surgery was recom-

mended and a right-sided modified far lateral

Fig. 8.2 Case example 1, APFM. Axial (a) preoperative and (b) postoperative T1 post-contrast MRI of APFM

8 Meningiomas of the Cerebellopontine Angle