{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T22:33:50Z","timestamp":1769726030792,"version":"3.49.0"},"reference-count":38,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","license":[{"start":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T00:00:00Z","timestamp":1754265600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cosmet Laser Ther"],"published-print":{"date-parts":[[2025,8,4]]},"abstract":"\n BACKGROUND<\/jats:title>\n Eighth cranial nerve schwannomas represent a rare pathological condition, and their sporadic unilateral multifocal presentation is even more uncommon. Here, the authors present a rare case of multifocal intravestibulocochlear and intracranial vestibular schwannomas (VSs) and review analogous cases in the existing literature.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n A 54-year-old female patient presented to the authors\u2019 clinic in March 2024 with complaints of left-sided hearing loss, tinnitus, and vertigo. Gadolinium-enhanced MRI revealed a Koos grade III VS localized in the cerebellopontine angle (CPA) with extension in the internal auditory canal and a coexisting intravestibulocochlear schwannoma. CT imaging showed no cochlear fundus dilatation or bone erosion. The patient underwent a left transotic approach with blind sac closure of the external auditory canal. No continuity was observed between the inner ear and intrameatal-CPA VSs, confirming the presence of two distinct lesions.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n This case emphasizes the importance of a preoperative radiological evaluation and the necessity of a multidisciplinary team to ensure optimal surgical treatment and complete tumor resection.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE25116<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case25116","type":"journal-article","created":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T06:35:54Z","timestamp":1754289354000},"source":"Crossref","is-referenced-by-count":0,"title":["Multifocal intravestibulocochlear and intracranial vestibular schwannomas: illustrative case"],"prefix":"10.3171","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1538-5316","authenticated-orcid":true,"given":"Valentina","family":"Foscolo","sequence":"first","affiliation":[{"name":"Otolaryngology Unit, Department of Translational Biomedicine and Neurosciences (DiBraiN), University \u201cAldo Moro\u201d of Bari, Puglia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4812-229X","authenticated-orcid":true,"given":"Francesco","family":"Salonna","sequence":"additional","affiliation":[{"name":"Otolaryngology Unit, Department of Translational Biomedicine and Neurosciences (DiBraiN), University \u201cAldo Moro\u201d of Bari, Puglia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4012-9637","authenticated-orcid":true,"given":"Vito","family":"Pontillo","sequence":"additional","affiliation":[{"name":"Otolaryngology Unit, Department of Translational Biomedicine and Neurosciences (DiBraiN), University \u201cAldo Moro\u201d of Bari, Puglia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2819-3938","authenticated-orcid":true,"given":"Raffaella","family":"Messina","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Translational Biomedicine and Neurosciences (DiBraiN), University \u201cAldo Moro\u201d of Bari, Puglia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luigi de","family":"Gennaro","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Translational Biomedicine and Neurosciences (DiBraiN), University \u201cAldo Moro\u201d of Bari, Puglia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Signorelli","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Translational Biomedicine and Neurosciences (DiBraiN), University \u201cAldo Moro\u201d of Bari, Puglia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicola A. A.","family":"Quaranta","sequence":"additional","affiliation":[{"name":"Otolaryngology Unit, Department of Translational Biomedicine and Neurosciences (DiBraiN), University \u201cAldo Moro\u201d of Bari, Puglia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"1","key":"bib1","series-title":"Biomedicines","first-page":"32","article-title":"Tumor biology and microenvironment of vestibular schwannoma-relation to tumor growth and hearing loss","volume":"11","author":"Tesa\u0159ov\u00e1","year":"2022","unstructured":"Tesa\u0159ov\u00e1 MPeterkov\u00e1 L\u0160\u0165astn\u00e1 MTumor biology and microenvironment of vestibular schwannoma-relation to tumor growth and hearing loss. Biomedicines. 2022;11(1):32."},{"issue":"2","key":"bib2","series-title":"Audiol Neurootol","first-page":"121","article-title":"What is the site of origin of cochleovestibular schwannomas?","volume":"17","author":"Roosli","year":"2012","unstructured":"Roosli CLinthicum FHJrCureoglu SMerchant SN.What is the site of origin of cochleovestibular schwannomas? Audiol Neurootol. 2012;17(2):121-125."},{"issue":"2","key":"bib3","series-title":"Otol Neurotol","first-page":"160","article-title":"Intralabyrinthine schwannomas: diagnosis, management, and a new classification system","volume":"25","author":"Kennedy","year":"2004","unstructured":"Kennedy RJShelton CSalzman KLDavidson HCHarnsberger HR.Intralabyrinthine schwannomas: diagnosis, management, and a new classification system. Otol Neurotol. 2004;25(2):160-167."},{"issue":"1","key":"bib4","series-title":"Otol Neurotol","first-page":"3","article-title":"Revised classification of inner ear schwannomas","volume":"46","author":"Plontke","year":"2025","unstructured":"Plontke SKLloyd SKWFreeman SRMRevised classification of inner ear schwannomas. Otol Neurotol. 2025;46(1):3-9."},{"issue":"3","key":"bib5","series-title":"J Neurosurg","first-page":"506","article-title":"Neurotopographic considerations in the microsurgical treatment of small acoustic neurinomas","volume":"88","author":"Koos","year":"1998","unstructured":"Koos WTDay JDMatula CLevy DI.Neurotopographic considerations in the microsurgical treatment of small acoustic neurinomas. J Neurosurg. 1998;88(3):506-512."},{"issue":"5","key":"bib6","series-title":"Otol Neurotol","first-page":"580","article-title":"Unilateral multifocal inner ear and internal auditory canal or cerebellopontine angle cochleovestibular schwannomas-genetic analysis and management by surgical resection and cochlear implantation","volume":"45","author":"Plontke","year":"2024","unstructured":"Plontke SKHoffmann KCaye-Thomasen PUnilateral multifocal inner ear and internal auditory canal or cerebellopontine angle cochleovestibular schwannomas-genetic analysis and management by surgical resection and cochlear implantation. Otol Neurotol. 2024;45(5):580-586."},{"issue":"2","key":"bib7","series-title":"Otolaryngol Head Neck Surg","first-page":"146","article-title":"Facial nerve grading system","volume":"93","author":"House","year":"1985","unstructured":"House JWBrackmann DE.Facial nerve grading system. Otolaryngol Head Neck Surg. 1985;93(2):146-147."},{"issue":"9","key":"bib8","series-title":"Laryngoscope","first-page":"1133","article-title":"Histological acoustic tumor involvement of the VIIth nerve and multicentric origin in the VIIIth nerve","volume":"93","author":"Luetje","year":"1983","unstructured":"Luetje CMWhittaker CKCallaway LAVeraga G.Histological acoustic tumor involvement of the VIIth nerve and multicentric origin in the VIIIth nerve. Laryngoscope. 1983;93(9):1133-1139."},{"issue":"7","key":"bib9","series-title":"Laryngoscope","first-page":"1548","article-title":"Temporal bone histopathology in neurofibromatosis type 2","volume":"121","author":"Nam","year":"2011","unstructured":"Nam SILinthicum FHJrMerchant SN.Temporal bone histopathology in neurofibromatosis type 2. Laryngoscope. 2011;121(7):1548-1554."},{"issue":"8","key":"bib10","series-title":"J Med Genet","first-page":"557","article-title":"Multiple synchronous sites of origin of vestibular schwannomas in neurofibromatosis Type 2","volume":"52","author":"Stivaros","year":"2015","unstructured":"Stivaros SMStemmer-Rachamimov AOAlston RMultiple synchronous sites of origin of vestibular schwannomas in neurofibromatosis Type 2. J Med Genet. 2015;52(8):557-562."},{"issue":"6","key":"bib11","series-title":"Otol Neurotol","first-page":"1241","article-title":"Unilateral double vestibular schwannoma","volume":"26","author":"Kennedy","year":"2005","unstructured":"Kennedy RJSalzman KLShelton C.Unilateral double vestibular schwannoma. Otol Neurotol. 2005;26(6):1241-1242."},{"issue":"1","key":"bib12","series-title":"Acta Otorhinolaryngol Ital","first-page":"34","article-title":"Double localization of a unilateral sporadic vestibular schwannoma","volume":"28","author":"Barbara","year":"2008","unstructured":"Barbara MRonchetti FManni VMonini S.Double localization of a unilateral sporadic vestibular schwannoma. Acta Otorhinolaryngol Ital. 2008;28(1):34-37."},{"issue":"2","key":"bib13","series-title":"J Neurol Surg Rep","first-page":"e106","article-title":"Multiple unilateral vestibular schwannomas: segmental NF2 or sporadic occurrence?","volume":"77","author":"Carlson","year":"2016","unstructured":"Carlson MLVan Gompel JJ.Multiple unilateral vestibular schwannomas: segmental NF2 or sporadic occurrence? J Neurol Surg Rep. 2016;77(2):e106-e108."},{"issue":"8","key":"bib14","series-title":"Laryngoscope","first-page":"1657","article-title":"Hearing preservation microsurgery in vestibular schwannomas: worth attempting in \u201clarger\u201d tumors?","volume":"132","author":"Wallerius","year":"2022","unstructured":"Wallerius KPMacielak RJLawlor SKHearing preservation microsurgery in vestibular schwannomas: worth attempting in \u201clarger\u201d tumors? Laryngoscope. 2022;132(8):1657-1664."},{"issue":"9","key":"bib15","series-title":"Laryngoscope","first-page":"1605","article-title":"Inner ear extension of vestibular schwannomas","volume":"113","author":"Falcioni","year":"2003","unstructured":"Falcioni MTaibah ADi Trapani GKhrais TSanna M.Inner ear extension of vestibular schwannomas. Laryngoscope. 2003;113(9):1605-1608."},{"issue":"8","key":"bib16","series-title":"Laryngoscope","first-page":"1957","article-title":"Primary inner ear schwannomas: a case series and systematic review of the literature","volume":"123","author":"Van Abel","year":"2013","unstructured":"Van Abel KMCarlson MLLink MJPrimary inner ear schwannomas: a case series and systematic review of the literature. Laryngoscope. 2013;123(8):1957-1966."},{"issue":"2","key":"bib17","series-title":"J Neurol Surg B Skull Base","first-page":"196","article-title":"Intralabyrinthine schwannomas: disease presentation, tumor management, and hearing rehabilitation","volume":"80","author":"Choudhury","year":"2019","unstructured":"Choudhury BCarlson MLJethanamest D.Intralabyrinthine schwannomas: disease presentation, tumor management, and hearing rehabilitation. J Neurol Surg B Skull Base. 2019;80(2):196-202."},{"issue":"2","key":"bib18","series-title":"Am J Otol","first-page":"70","article-title":"The transotic approach to resection of difficult acoustic tumors of the cerebellopontine angle","volume":"2","author":"Jenkins","year":"1980","unstructured":"Jenkins HAFisch U.The transotic approach to resection of difficult acoustic tumors of the cerebellopontine angle. Am J Otol. 1980;2(2):70-76."},{"issue":"1","key":"bib19","series-title":"Otol Neurotol","first-page":"10","article-title":"Cochlear implantation with sporadic inner ear schwannomas: outcomes in 106 patients from an international multi-institutional study","volume":"46","author":"Marinelli","year":"2025","unstructured":"Marinelli JPRahne TDornhoffer JRCochlear implantation with sporadic inner ear schwannomas: outcomes in 106 patients from an international multi-institutional study. Otol Neurotol. 2025;46(1):10-18."},{"issue":"1","key":"bib1","series-title":"Biomedicines","first-page":"32","article-title":"Tumor biology and microenvironment of vestibular schwannoma-relation to tumor growth and hearing loss","volume":"11","author":"Tesa\u0159ov\u00e1","year":"2022","unstructured":"Tesa\u0159ov\u00e1 MPeterkov\u00e1 L\u0160\u0165astn\u00e1 MTumor biology and microenvironment of vestibular schwannoma-relation to tumor growth and hearing loss. Biomedicines. 2022;11(1):32."},{"issue":"2","key":"bib2","series-title":"Audiol Neurootol","first-page":"121","article-title":"What is the site of origin of cochleovestibular schwannomas?","volume":"17","author":"Roosli","year":"2012","unstructured":"Roosli CLinthicum FHJrCureoglu SMerchant SN.What is the site of origin of cochleovestibular schwannomas? Audiol Neurootol. 2012;17(2):121-125."},{"issue":"2","key":"bib3","series-title":"Otol Neurotol","first-page":"160","article-title":"Intralabyrinthine schwannomas: diagnosis, management, and a new classification system","volume":"25","author":"Kennedy","year":"2004","unstructured":"Kennedy RJShelton CSalzman KLDavidson HCHarnsberger HR.Intralabyrinthine schwannomas: diagnosis, management, and a new classification system. Otol Neurotol. 2004;25(2):160-167."},{"issue":"1","key":"bib4","series-title":"Otol Neurotol","first-page":"3","article-title":"Revised classification of inner ear schwannomas","volume":"46","author":"Plontke","year":"2025","unstructured":"Plontke SKLloyd SKWFreeman SRMRevised classification of inner ear schwannomas. Otol Neurotol. 2025;46(1):3-9."},{"issue":"3","key":"bib5","series-title":"J Neurosurg","first-page":"506","article-title":"Neurotopographic considerations in the microsurgical treatment of small acoustic neurinomas","volume":"88","author":"Koos","year":"1998","unstructured":"Koos WTDay JDMatula CLevy DI.Neurotopographic considerations in the microsurgical treatment of small acoustic neurinomas. J Neurosurg. 1998;88(3):506-512."},{"issue":"5","key":"bib6","series-title":"Otol Neurotol","first-page":"580","article-title":"Unilateral multifocal inner ear and internal auditory canal or cerebellopontine angle cochleovestibular schwannomas-genetic analysis and management by surgical resection and cochlear implantation","volume":"45","author":"Plontke","year":"2024","unstructured":"Plontke SKHoffmann KCaye-Thomasen PUnilateral multifocal inner ear and internal auditory canal or cerebellopontine angle cochleovestibular schwannomas-genetic analysis and management by surgical resection and cochlear implantation. Otol Neurotol. 2024;45(5):580-586."},{"issue":"2","key":"bib7","series-title":"Otolaryngol Head Neck Surg","first-page":"146","article-title":"Facial nerve grading system","volume":"93","author":"House","year":"1985","unstructured":"House JWBrackmann DE.Facial nerve grading system. Otolaryngol Head Neck Surg. 1985;93(2):146-147."},{"issue":"9","key":"bib8","series-title":"Laryngoscope","first-page":"1133","article-title":"Histological acoustic tumor involvement of the VIIth nerve and multicentric origin in the VIIIth nerve","volume":"93","author":"Luetje","year":"1983","unstructured":"Luetje CMWhittaker CKCallaway LAVeraga G.Histological acoustic tumor involvement of the VIIth nerve and multicentric origin in the VIIIth nerve. Laryngoscope. 1983;93(9):1133-1139."},{"issue":"7","key":"bib9","series-title":"Laryngoscope","first-page":"1548","article-title":"Temporal bone histopathology in neurofibromatosis type 2","volume":"121","author":"Nam","year":"2011","unstructured":"Nam SILinthicum FHJrMerchant SN.Temporal bone histopathology in neurofibromatosis type 2. Laryngoscope. 2011;121(7):1548-1554."},{"issue":"8","key":"bib10","series-title":"J Med Genet","first-page":"557","article-title":"Multiple synchronous sites of origin of vestibular schwannomas in neurofibromatosis Type 2","volume":"52","author":"Stivaros","year":"2015","unstructured":"Stivaros SMStemmer-Rachamimov AOAlston RMultiple synchronous sites of origin of vestibular schwannomas in neurofibromatosis Type 2. J Med Genet. 2015;52(8):557-562."},{"issue":"6","key":"bib11","series-title":"Otol Neurotol","first-page":"1241","article-title":"Unilateral double vestibular schwannoma","volume":"26","author":"Kennedy","year":"2005","unstructured":"Kennedy RJSalzman KLShelton C.Unilateral double vestibular schwannoma. Otol Neurotol. 2005;26(6):1241-1242."},{"issue":"1","key":"bib12","series-title":"Acta Otorhinolaryngol Ital","first-page":"34","article-title":"Double localization of a unilateral sporadic vestibular schwannoma","volume":"28","author":"Barbara","year":"2008","unstructured":"Barbara MRonchetti FManni VMonini S.Double localization of a unilateral sporadic vestibular schwannoma. Acta Otorhinolaryngol Ital. 2008;28(1):34-37."},{"issue":"2","key":"bib13","series-title":"J Neurol Surg Rep","first-page":"e106","article-title":"Multiple unilateral vestibular schwannomas: segmental NF2 or sporadic occurrence?","volume":"77","author":"Carlson","year":"2016","unstructured":"Carlson MLVan Gompel JJ.Multiple unilateral vestibular schwannomas: segmental NF2 or sporadic occurrence? J Neurol Surg Rep. 2016;77(2):e106-e108."},{"issue":"8","key":"bib14","series-title":"Laryngoscope","first-page":"1657","article-title":"Hearing preservation microsurgery in vestibular schwannomas: worth attempting in \u201clarger\u201d tumors?","volume":"132","author":"Wallerius","year":"2022","unstructured":"Wallerius KPMacielak RJLawlor SKHearing preservation microsurgery in vestibular schwannomas: worth attempting in \u201clarger\u201d tumors? Laryngoscope. 2022;132(8):1657-1664."},{"issue":"9","key":"bib15","series-title":"Laryngoscope","first-page":"1605","article-title":"Inner ear extension of vestibular schwannomas","volume":"113","author":"Falcioni","year":"2003","unstructured":"Falcioni MTaibah ADi Trapani GKhrais TSanna M.Inner ear extension of vestibular schwannomas. Laryngoscope. 2003;113(9):1605-1608."},{"issue":"8","key":"bib16","series-title":"Laryngoscope","first-page":"1957","article-title":"Primary inner ear schwannomas: a case series and systematic review of the literature","volume":"123","author":"Van Abel","year":"2013","unstructured":"Van Abel KMCarlson MLLink MJPrimary inner ear schwannomas: a case series and systematic review of the literature. Laryngoscope. 2013;123(8):1957-1966."},{"issue":"2","key":"bib17","series-title":"J Neurol Surg B Skull Base","first-page":"196","article-title":"Intralabyrinthine schwannomas: disease presentation, tumor management, and hearing rehabilitation","volume":"80","author":"Choudhury","year":"2019","unstructured":"Choudhury BCarlson MLJethanamest D.Intralabyrinthine schwannomas: disease presentation, tumor management, and hearing rehabilitation. J Neurol Surg B Skull Base. 2019;80(2):196-202."},{"issue":"2","key":"bib18","series-title":"Am J Otol","first-page":"70","article-title":"The transotic approach to resection of difficult acoustic tumors of the cerebellopontine angle","volume":"2","author":"Jenkins","year":"1980","unstructured":"Jenkins HAFisch U.The transotic approach to resection of difficult acoustic tumors of the cerebellopontine angle. Am J Otol. 1980;2(2):70-76."},{"issue":"1","key":"bib19","series-title":"Otol Neurotol","first-page":"10","article-title":"Cochlear implantation with sporadic inner ear schwannomas: outcomes in 106 patients from an international multi-institutional study","volume":"46","author":"Marinelli","year":"2025","unstructured":"Marinelli JPRahne TDornhoffer JRCochlear implantation with sporadic inner ear schwannomas: outcomes in 106 patients from an international multi-institutional study. 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