Clinical case: suboccipital craniotomy and total microsurgical removal of a right-sided acoustic schwannoma using intraoperative neuromonitoring

Thursday,  15  Май  2025

A patient named Dinara sought care at the National Center for Neurosurgery with complaints of severe headaches, hearing and vision loss, gait instability, and general weakness. MRI revealed a mass in the right cerebellopontine angle compressing the brainstem, with signs of secondary obstructive hydrocephalus.

Earlier, on the advice of relatives, she had undergone treatment in Tashkent, where a right-sided suboccipital craniectomy and subtotal microsurgical tumor removal were performed. She paid 2.5 million tenge out of pocket for the surgery and medications. However, the tumor was not completely removed, and doctors recommended follow-up treatment with Gamma Knife radiosurgery.

After temporary improvement, her condition worsened again, with a sharp decline in vision. Dinara then turned to the National Center for Neurosurgery in Astana, hoping for radiosurgical treatment. However, MRI showed that the tumor had reached giant dimensions — 5.03 × 4.58 × 3.71 cm — making Gamma Knife treatment impossible.

She was hospitalized free of charge under the state quota system within the Mandatory Social Health Insurance framework. The Center’s team performed a highly complex procedure: repeat suboccipital craniotomy and total microsurgical removal of a right-sided acoustic schwannoma using intraoperative neuromonitoring.

The surgery was successful. In the postoperative period, there were no neurological deficits. The patient recovered quickly and was transferred to the ward.

“I didn’t know such a large clinic existed in Astana. If I had come here right away, I could have avoided significant expenses and a repeat surgery. After the operation at the Center, I feel much better — the weakness is gone, and my sensation is preserved,” Dinara shared.

The operation was performed by experienced neurosurgeons Aidos Moldabekov and Aidos Kurmanakhunov. According to the doctors, the successful outcome was made possible by the correct surgical strategy, advanced equipment, and a multidisciplinary approach.

The National Center for Neurosurgery continues to demonstrate that high-tech, effective treatment is available in Kazakhstan — free of charge under the social insurance system and delivered at a high professional level.