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.