CASE DETAILS OF PATIENT FOR ABI 17 YRS / MALE Progressive hearing loss first noticed in 2005 Underwent a myringotomy

omy Pure tone Audiogram (9th October 2006): Bilateral moderate SNHL Was prescribed hearing aids Decreased Right sided corneal sensations with sluggish corneal reflex Mild Right LMN Facial palsy Decreased sensations along maxillary division of Left trigeminal nerve MRI Left Knee (30 Dec 2008): Left popliteal neurofibroma MRI Brain (28 January 2009): Bilateral T2 iso to hyperintense enhancing lesions along 7th & 8th Cranial nerves consistent with acoustic neuroma ( Right side: 3.0 X 1.9 cms diameter; Left side: 1.5 X 0.5 cms) Enhancing well defined lesion along right Meckels cave representing trigeminal neurinoma (15 X 5 mm) Small left sided trigeminal neurinoma in cisternal segment of left 5th cranial nerve ( small subcentimeter) Right anterior parafalcine enhancing lesion representing meningioma (2.0 X 1.0 cms diameter T1 & T2 isointense Diagnosed as Neurofibromatosis Type II Pure Tone Audiogram (16 April 2009) : B/L severe SNHL Right Tibial nerve (popliteal fossa) neurofibroma excised in April 2009

Right retromastoid, suboccipital craniectomy, subtotal excision of acoustic nerve tumor done on 2nd June 2009 Tumor seen above IX nerve enveloping part of PICA Nerve was stretched beneath lower pole of the tumor Attempt made to reduce the pressure by separating the tumor off the nerve and shrinking it by bipolar coagulation Bulk of the tumor was in the CP angle

Leptomeninges lifted off the visible segment of the postero-infero-lateral surface of the tumor. Subjacent capsular arteries were obliterated & divided. The capsule was divided and the tumor contents were excised, piecemeal CUSA used to reduce bulk of tumor Tumor excised along trigeminal nerve and the antero-superior pole. Medial and inferior shells of tumor left intact, to preserve VII & VIII nerves VII VIII nerves not seen Pure Tone Audiogram (July 2009): B/L Profound SNHL