Anterolateral to the CPA, the internal auditory canal (IAC), a bony channel situated along the posterior face of the petrous bone, transmits the facial nerve from the CPA to the temporal bone and ultimately the face, and the vestibulocochlear nerve (VCN) from the cochlea and vestibular apparatus to the brainstem. The CPA contains cranial nerves V-VIII, the superior cerebellar artery (SCA), anterior inferior cerebellar artery (AICA), and draining veins. The cerebellopontine angle (CPA) is a cerebrospinal fluid-filled, triangular space located at the junction of the lateral pons and anterior cerebellum. She was not offered radiosurgery, and she elected conservative management. There was no evidence of a schwannoma on the repeat MRI. Repeat MRI demonstrated a loop of the anterior inferior cerebellar artery (AICA) compressing the vestibulocochlear nerve within the right IAC. She was originally diagnosed with a vestibular schwannoma on magnetic resonance imaging (MRI) and was referred to our institution for Gamma Knife radiosurgery. The current report represents an attempt to understand this clinical entity as discussed in the current literature.Ĭase summary: A 77-year-old female with a long history of progressive right-sided hearing loss and episodic vertigo developed unilateral right SSNHL, tinnitus, vertigo, and disequilibrium. Underlying pathophysiologic factors surrounding microvascular compression of the vestibulocochlear nerve are poorly understood and make treatment recommendations, especially the option of microvascular decompression, difficult if not controversial. We present a patient with unilateral sudden sensorineural hearing loss (SSNHL) who was found to have a vascular loop in the ipsilateral internal auditory canal (IAC), and we review the literature regarding this association.
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