Unusual instance of cerebellopontine angle medulloblastoma with an extra-axial feature: A singular case study
In a recent case, a 22-year-old male patient with no significant medical history was admitted to the emergency department due to several episodes of vomiting and headaches over the past two weeks. A cranial computed tomography (CT) scan revealed a solid, spontaneously hyperdense mass in the left posterior fossa, and a subsequent brain MRI revealed a well-defined voluminous extra-axial mass in the left cerebellopontine angle (CPA), measuring 37 × 48 × 30 mm.
Medulloblastoma, a high-grade malignant tumor, accounts for one-third of posterior fossa tumors in childhood and approximately one-third of these tumors occur as extra-axial masses in the CPA. However, in adulthood, medulloblastomas represent less than 1% of primary brain tumors, and extra-axial medulloblastomas in the CPA are exceptionally rare, posing significant diagnostic and therapeutic challenges.
Diagnosing extra-axial medulloblastomas can be challenging due to their rare location and overlapping radiological features with other CPA tumors, such as vestibular schwannomas. Imaging techniques like MRI are crucial for identifying the tumor's location and extent, but distinguishing medulloblastoma from other CPA tumors can be difficult.
Accurate diagnosis often requires histological examination, which can be difficult due to the tumor's rare location and potential for misinterpretation with other tumor types. The case presented is of a CPA medulloblastoma diagnosed in a 22-year-old male, underscoring the importance of comprehensive diagnostic possibilities when interpreting radiological images.
Surgical intervention is a primary treatment option for many tumors in the CPA, but it must be carefully planned for extra-axial medulloblastomas. Techniques like retrosigmoid or translabyrinthine approaches are used depending on the tumor's size and location, with the goal of minimizing neurological deficits.
After surgery, chemotherapy and radiation therapy are often employed for medulloblastomas, especially if there is residual tumor or metastatic disease. The choice of chemotherapy agents and radiation techniques depends on the patient's age, tumor characteristics, and extent of disease.
Given the rarity of this condition, a multidisciplinary team approach is essential for designing an effective treatment strategy, incorporating inputs from neurosurgeons, neuro-oncologists, radiologists, and other specialists. This approach ensures that the patient receives the most appropriate and comprehensive care possible.
Continuous advances in neuro-oncology and neurosurgical techniques are crucial for improving outcomes in such rare and complex conditions. As more cases of extra-axial medulloblastomas in the CPA are reported and studied, our understanding of this rare tumor will continue to grow, leading to improved diagnostic and treatment strategies.
Despite being exceptionally rare in adulthood, this 22-year-old patient's health-and-wellness condition was diagnosed as an extra-axial medulloblastoma, a neurological-disorder that poses diagnostic challenges due to its similarities with other CPA tumors. The treatment strategy for this condition requires a multidisciplinary team approach, considering the patient's health-and-wellness, and the specific characteristics of the medical-condition, such as cancer – in this case, medulloblastoma.
