A 2-Staged Approach for Resection of Giant Dumbbell Shaped Facial Nerve Schwannoma With Facial Nerve Preservation.
Rachel Blue, Yan Zhou, Samuel Gubbles et al.
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Case in brief
A 37-year-old man with four years of left-sided hearing loss and worsening balance had intact facial function. MRI and CT showed a 7.5-cm dumbbell-shaped lesion spanning the posterior and middle cranial fossae, consistent with facial nerve schwannoma. Resection was performed in two stages, using retrosigmoid and middle fossa approaches. Near-total resection was achieved, with facial nerve function preserved at House-Brackmann grade I.
What made this case unusual
The giant tumor occupied both the posterior and middle fossae, yet near-total resection preserved normal facial function.
Diagnostic / clinical pearl
In facial nerve schwannoma surgery, functional fascicles may be identified by direct electrophysiologic stimulation at a lower threshold; their location relative to the tumor can inform nerve-preserving resection.