Poster 298: Tetraplegia Status Post Right Cerebellar Pontine Angle Tumor Removal Via Translabyrinthine Craniotomy and Excision: A Case Report

Abstract

Setting: Inpatient spinal cord injury (SCI) unit. Patient: A 28-year old woman. Case Description: The patient awoke, 2 years ago, with bilateral arm and hand numbness. Subsequently, she underwent magnetic resonance imaging (MRI) and computed tomography (CT) scan of her head. The CT scan was negative, and MRI revealed a right vestibular schwannoma. She underwent a cyberknife treatment and a 6-month follow-up MRI revealed no reduction in the tumor. Over the next 2 years, the patient developed abnormal gait. She experienced a decrease in hearing and a new MRI revealed an increased mass of a cerebellar pontine angle tumor budding the brainstem and internal auditory canal. A discussion was held about the potential complications concerning the surgery. Assessment/Results: The patient decided to undergo a translabyrinthine right-sided craniotomy and excision of vestibular schwannoma. Postoperatively, the patient was in respiratory distress and had no voluntary movements in her extremities. She had numerous attempts at extubation and reintubation due to respiratory distress. She underwent tracheostomy. The patient’s neurologic exam revealed a C4 American Spinal Injury Association (ASIA) grade C tetraplegia. Discussion: The patient underwent a right-sided craniotomy with subsequent excision of a right vestibular schwannoma and postoperatively became a C4 ASIA grade C tetraplegic. Conclusions: There is a possibility of the tumor causing compression and subsequent injury; I feel most likely the injury was due to a lack of perfusion to the spinal cord, either intra- or postoperatively. The procedure of a craniotomy and subsequent tumor removal of any kind carries the risk of infection, hemorrhage, stroke, and hemodynamic instabilities, as well as SCI. Unfortunately in this case, one of the potential complications described to the patient occurred. Although a postoperative course of this nature is rare, it is important to illustrate the extreme risks of this kind of procedure, as they do occur.