Cerebellopontine angle paraganglioma masquerading as vestibular schwannoma

Paragangliomas are slow-growing, extra-adrenal neuroendocrine tumors with rare intracranial presentation. Although benign, they can be locally aggressive tumors causing bone destruction and compression related symptoms. We report the case of a 19 years old, normotensive female who presented with headache and vertigo for the past six months. Her examination showed right-sided conductive hearing loss and signs of cranial nerve X, vagus nerve palsy. Neuroimaging revealed a lobulated, extra-axial mass measuring 5.4 x 4.2 x 6.8 cm in right cerebellopontine angle (CPA). Subtotal surgical resection was achievable. Histopathology was suggestive of benign, non-secretory paraganglioma. The diagnosis of primary CPA was reached after ruling out other sources of paraganglioma in abdomen, pelvis and thorax. Radiotherapy was advised on follow up visit with no new post-operative deficits seen. Primary CPA paraganglioma should be included in the list of differentials of CPA lesions. Surgical excision in the absence of preoperative embolization of paraganglioma can be successful.