Synchronous Vestibular Schwannoma and Lipoma in Contralateral Ears First Reported Case

Abstract

Introduction: Vestibular schwanomma (VS) and lipomas are not uncommonly seen in ENT practice. However, the synchronous development of both pathologies in contralateral ears is rarely seen. We present a rare case of a patient with a left VS and a lipoma in the right internal auditory canal. This 61-year-old woman presented with intermittent episodes of pressure sensation affecting the head, vertigo, and reduced hearing, particularly noted in the left ear. The audiogram showed mild-to-moderate hearing loss bilaterally. On examination the cranial nerves were normal. Romberg test was positive. Unterberger test was positive to the right. Serial MRI IAM's revealed a left VS and a right internal acoustic meatus lipoma. Method: A literature search of the NHS databases was performed using the MsSH headings: VS, acoustic neuroma, and lipoma. Discussion: VS accounts for 6% of all intracranial neoplasms found in the cerebellopontine angle. Intracranial lipomas are far rarer accounting for 0.5 to 1% of intracranial neoplasms. Contrast enhanced T1-weighted MR imaging is considered the gold standard for detecting lesions in the internal acoustic canal. Surgical management is reserved for those with intractable clinical symptoms due to lipoma size. Microsurgical removal, radiosurgery, or conservative management are the options available to treat VS. Conclusion: Bilateral VS are commonly seen in association with neurofibromatosis type II and present a management challenge to the skull base surgeon.