Case Detail

History: A 55 years old woman presented with hemifacial numbness. She had a history of brain surgery in 1997 for resection of a cavernous sinus tumor. Histopathological diagnosis was neurinoma. No adjuvant treatment was done. There are no new symptom or sign. Recently, she underwent imaging for fullness of ear. On imaging, there is a large infratemporal mass in continuity with intracranial cavernous sinus tumor.

Question: Do recommend surgery? What are your approach and timing? Do you recommend radiotherapy-radiosurgery? Is total removal possible for intracranial part?

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Name	Date	Opinion	Result
Keyvan Tayebi Meybodi	7/6/2021	either endoscopically or open surgery is possible.	Surgery
Masoumeh Najafi	7/7/2021	According to minimall symptoms and benign behavior of the tumor close follow up and serial imaging is my recommendation.	Follow-up
Amin Jahanbakhshi	7/7/2021	I think this is a difficult case for decision making. Reasons are: Lack of a clear evidence on rate of tumor growth, almost non-symptomatic presentation (numbness is due to the previous surgery) and the fact that total removal of intracranial part, is not very likely. Anyway, I recommend surgery of the infratemporal compartment and followup for intracranial part. If progression occurs, radiosurgery is preferable. It seems that there is also a lower cranial nerve shwannoma in the left CPA that should be followed.	Surgery
Sara Soltanzadeh	7/7/2021	A few months of follow up with imaging to observe the growth pace, seems rational. In the case of tumor progression and symptom developing, surgical resection or radiosurgery would be recommended. Due to the intracranial part, radiosurgery(or FSRT) might be more feasible.	Follow-up
Dr.Marzieh Gomar	7/7/2021	The most likely diagnosis for good behavior and the location of the lesion is schwannoma. It is possible to resect the lesion?	No Opinion
Sarvazad Sotoudeh	7/7/2021	If the new lesion is highly suspicious to previous diagnosis, maximal surgical resection is recommended. If not, biopsy is better approach.	Surgery
Mousareza Anbarlouei	7/7/2021	In my opinion surgery is the first step (preferred approach is endoscopy)	Surgery and Adjuvant treatment