Abstract:
Background: Vestibular schwannomas are benign, slow-growing tumors originating from Schwann cells. Retro-sigmoid craniotomy is a common surgical approach for their resection but can result in rare complications, including vertebral artery pseudoaneurysms and arteriovenous (AV) fistulas, which can pose diagnostic and therapeutic challenges.
Case Presentation: A 43-year-old male presented with vertigo, headache, and right-sided hearing loss, diagnosed with a vestibular schwannoma. He underwent elective right retro-sigmoid craniotomy for tumor resection. Postoperatively, he developed transient neurological deficits and was discharged in stable condition. However, on the tenth postoperative day, he presented with drowsiness and seizure-like episodes. Imaging revealed a vertebral artery pseudoaneurysm and an AV fistula between the vertebral artery and sigmoid sinus. Endovascular treatment with a covered stent successfully excluded the pseudoaneurysm while maintaining distal vascular flow.
Outcome: The patient was discharged in a stable condition and recovered well post-procedure. This case highlights the importance of advanced imaging and timely image-guided endovascular intervention in managing rare vascular complications of neurosurgery.