Management of Left Cerebello-Pontine Angle Tumour Using Intraoperative Neurophysiological Monitoring and Cavitron Ultrasonic Surgical Aspirator in a Pregnant Patient: A Case Report

Vestibular Schwannoma (VS) is a benign tumour of the vestibulocochlear nerve and accounts for nearly 85% of Cerebello-Pontine (CP) angle tumours. Its occurrence during pregnancy is infrequent, with only a few cases reported worldwide. Managing VS in pregnant patients presents unique challenges, as both maternal neurological status and foetal safety must be considered when deciding the timing and approach to surgery. We report the case of a 23-year-old primigravida at 12 weeks of gestation who presented with progressive headache, blurred vision, imbalance, and left-sided hearing loss. Neurological examination revealed bilateral papilloedema, left facial nerve involvement, sensorineural hearing loss, with Magnetic Resonance Imaging (MRI) brain showing a left CP angle tumour with hydrocephalus. The patient initially underwent an emergency right ventriculoperitoneal shunt for symptomatic relief, followed by a retromastoid suboccipital craniotomy for tumour excision under Intraoperative Neurophysiological Monitoring (IONM). The tumour was safely debulked using a Cavitron Ultrasonic Surgical Aspirator (CUSA), which allowed selective tumour removal with the preservation of critical neurovascular structures. The patient recovered without new neurological deficits, continued her pregnancy to term, and delivered a healthy baby via caesarean section. Histopathological examination confirmed VS, and postoperative MRI at six months showed gross total resection with no recurrence.