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Medial Migration of an Untreated Intracanalicular Vestibular Schwannoma ONLINE FIRST

Charlie Chia-Tsong Hsu, MBBS1; Trevor William Watkins, MBBS, FRANZCR1,2; Jennifer Sommerville, MBBS, FRANZCR1
[+] Author Affiliations
1Department of Medical Imaging, Princess Alexandra Hospital, Brisbane, Australia
2The University of Queensland, St Lucia, Queensland, Australia
JAMA Otolaryngol Head Neck Surg. Published online July 21, 2016. doi:10.1001/jamaoto.2016.1769
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This observation reports a case of a woman in her 60s with an untreated intracanalicular vestibular schwannoma that demonstrated medial migration on serial magnetic resonance imaging scans over the course of 30 months.

Medial migration of intracanalicular vestibular schwannoma (VS) with associated widening of the fundal cap is a rare phenomenon that, to our knowledge, has only been described in a patient following stereotactic radiation treatment. Herein, we present a case of a woman in her 60s with an untreated intracanalicular VS that demonstrated medial migration on serial magnetic resonance imaging (MRI) scans over the course of 30 months.

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Figure 1.
MRI IAC With Axial High-Resolution T2-SPACE Images

A, Baseline examination demonstrated a 6 mm right-sided intracanalicular VS (star). B, Serial imaging at 6 months; C, 18 months; and D, 30 months demonstrated growth and medial migration of the VS toward the cerebellopontine angle. On serial imaging (A-D) there was progressive buckling of the cisternal segment of the facial (black arrowheads) and vestibulocochlear nerves (yellow arrowheads). IAC, internal auditory canal; MRI, magnetic resonance imaging; SPACE, sampling perfection with application optimized contrasts using different flip angle evolution; VS, vestibular schwannoma.

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Figure 2.
Serial MRI IAC High Resolution T2-SPACE Images

A, Serial imaging at baseline; B, 6 months; C, 18 months; and D, 30 months showing progressive buckling of the cisternal segment of the facial (black arrowheads) and vestibulocochlear nerves (yellow arrowheads). Reformatted axial images [A-D] with the sagittal and coronal planes aligned parallel to the facial and vestibulocochlear nerves, respectively. IAC, internal auditory canal; MRI, magnetic resonance imaging; SPACE, sampling perfection with application optimized contrasts using different flip angle evolution; VS, vestibular schwannoma.

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