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Contributor:
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Dr. Chris Ekong
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Consultants:
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Dr. Michael Schwartz
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Age: 34
Sex: Male
History: Presented with right intracanalicular acoustic neuroma 2 1/2 years ago. He had no useful hearing pre-op. Had surgery for the tumor. Facial nerver was believed to be anatomically intact but it has not been functioning since the 2nd post op day. Hypoglosso-facial anastomisis was done one year post op. A follow up MRI has been done.
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MRI of Brain (T2 High Resolution axial images) showing right recurrent acoustic neuroma.
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I performed right posterior fossa craniotomy for acoustic neuroma on the above named on March 19, 1998. He had presented at the time with a 2.5 cm by 2 cm right acoustic neuroma. At the endof the procedure I was certain that the facial nerve was anatomically intact. However apart from the functioning of the facial nerve in the first 48 hours or so he never did get any return on function of the facial nerve. He also did not have any useful hearing on that side. After waiting about a year for right facial nerve function I went on to perform right hypoglosso-facial anastomosis. A follow-up MRI ofthe brain has shown a small (3.5 mm) recurrence of the right neuroma. Is he a good candidate for repeat surgery, radiosurgery or observation? If you feel that radiosurgery would be the best option I would be glad to send him to Toronto for the same. Thank you for your help.
Yours sincerely,
Chris
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Dear Chris:
May Tsao and I have just reviewed the images and discussed this case. The tumor recurrence is small and indistinct. From a radiotherapy perspective, one could follow the tumor to be certain that it is growing. Even if it doubled in size, it would still be easy to treat. Since we have no hearing and no facial function, a radical exenteration of the porus acusticus culd be made without additional morbidity. If you or the patient wish to pursue the radiotherapy option, we will be happy to review new images made 6 months after the ones on the website.
Best Regards,
Mike S
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