It was a regular day for Dr. Raghvendra Ramdasi, one of the most renowned skull-base neurosurgeons in Mumbai, when a 38-year-old patient walked into his clinic with imbalance and hearing loss. Dr. Ramdasi’s team initially thought it to be a textbook case of cerebellopontine angle (CPA) tumor, most likely a meningioma.
But the reality was far more complex and rarer.
This is a story of how a lesion that mimicked the symptoms of a vascular meningioma turned out to be a cavernous haemangioma and how the team achieved long-term control through a multimodal neurosurgical approach. This case also reinforces why some symptoms can be misleading and patients should rely on experienced and best neurosurgeon doctors in Mumbai for complete care and treatment.
Presenting A High-Risk Case That Demanded More Than Routine Thinking
For medical professionals, every case is unique, a person’s symptoms can vary based on their health history, their lifestyle and situations leading to the illness/trauma. Hence, the team has to take extra care and filter all possible symptoms to find the main ones.
After conducting initial consultation, dr. Ramdasi’s team made a list of all the symptoms that the patient was suffering from.
- Unsteady gait and severe imbalance
- Right-sided deafness for 4–6 weeks
- Excessive sleepiness over 4–5 days
- Recent-onset headaches
- Involvement of cranial nerves V to XI
These general symptoms weren’t quite answering questions, hence they dived further into their analysis by conducting an MRI. Here’s what the test results revealed:
- A large CPA lesion on the right side of the brain
- Prominent flow voids suggesting hypervascularity
- Intense perilesional edema
- Obstructive hydrocephalus
All the symptoms and results were pointing to a single issue – vascular meningioma. However, the team wasn’t satisfied with the results based on the patient’s conditioned and turned to Dr. Ramdasi for further investigation.
Intraoperative Surprise: This Was No Ordinary Meningioma
When it comes to medical diagnosis, it’s always best to leave no stone upturned. Further test investigations were conducted in the following two steps.
To relieve intracranial pressure, a left-sided VP shunt was first placed. This was followed by a right retrosigmoid craniotomy under real-time intraoperative neuromonitoring, a standard approach taken by most doctors for skull base neurosurgery in Mumbai.
What the team encountered was highly unexpected:
- Relentless bleeding
- Dense vascular channels
- Extremely adherent tumor planes
Given the high risk of damaging the brainstem and lower cranial nerves, a small remnant of the tumor was safely left behind, a move which would later aid the patient in healing.
Histopathology: Turns Out It Is A Cavernous Hemangioma, Not Meningioma
Thorough histopathology and expert analysis led the conclusion that the patient has been suffering from a cavernous hemangioma, a rare vascular formation.
This is an extremely rare diagnosis in CPA, as there are less than 25 cases of the same globally. The treatment for this diagnosis also posed a challenging task for Dr. Ramdasi.
For reference: PMID: 31911165 | PMID: 16472412 | PMID: 10782776
To ensure complete control, he performed stereotactic radiosurgery (SRS) for the remaining 6 weeks post the main radiosurgery operation.
Where Is the Patient Now?
5 years later, the patient has acquired complete recovery and full independence. We can see that:
- The residual lesion is very small and completely stable
- The patient has no neurological deficits
- He leads a fully independent life, without recurrence or complications
Key Clinical Learnings
From this case, one can conclude that:
- Not all CPA tumors are meningiomas or vestibular schwannomas
- On MRI, flow voids + edema + hypervascularity may point toward hemangioma
- Subtotal excision followed by adjuvant radiosurgery offers safer outcomes in high-risk zones
- Preserving function often outweighs radical resection in skull base surgery
More than the above, the biggest learning for medical professionals is to keep analysing and deep diving until they can confidently diagnose a health issue, or else, they may risk mis-diagnosing and endangering the patient.
Searching for the Best Neurosurgeon Doctor in Mumbai?
For experienced neurosurgeons, every patient is the same, whether they have a common head trauma or a rare illness.
“Our approach to treatment has always been providing non-negotiable care, dedication and quality to all patients.” – Dr. Raghvendra Ramdasi.
At our practice, we specialize in complex skull base tumors, brainstem lesions, and rare CPA tumors. Patients from across India trust our expertise in:
- Accurate diagnosis of rare brain lesions
- Advanced intraoperative monitoring
- Safe resection and adjunct SRS
- Long-term patient-centric follow-up
Whether you’re looking for doctors for brain tumor in Mumbai or seeking a second opinion for radiosurgery for brain tumor or anything else, we’re here to help.
Source: FG Newswire