Abstract
Facial nerve schwannomas involving posterior and middle fossas are quite rare. Here, we report an unusual case of cerebellopontine angle facial schwannoma that involved the middle cranial fossa, two years after the first operation. A 53-year-old woman presented with a 3-year history of a progressive left side hearing loss and 6-month history of a left facial spasm and palsy. Magnetic resonance imaging (MRI) revealed 4.5 cm diameter of left cerebellopontine angle and small middle fossa tumor. The tumor was subtotally removed via a suboccipital retrosigmoid approach. The tumor relapsed towards middle cranial fossa within a two-year period. By subtemporal approach with zygomatic arch osteotomy, the tumor was subtotally removed except that in the petrous bone involving the facial nerve. In both surgical procedures, intraoperative monitoring identified the facial nerve, resulting in preserved facial function. The tumor in the present case arose from broad segment of facial nerve encompassing cerebellopontine angle, meatus, geniculate/labyrinthine and possibly great petrosal nerve, in view of variable symptoms. Preservation of anatomic continuity of the facial nerve should be attempted, and the staged operation via retrosigmoid and middle fossa approaches using intraoperative facial monitoring, may result in preservation of the facial nerve.
Highlights
Facial nerve schwannomas are rare and constitute less than 1% of all intrapetrous mass lesions,[1,2] and estimated at only 1.9% of all intracranial schwannomas.[3]
After total removal of the tumor including petrous portion, direct facial nerve anastomosis or hypoglossal-facial nerve anastomosis are mandatory in most cases, but such intervention are not without risk, occasionally result
In a large series of facial nerve schwannoma McMonagle suggested that facial nerve function were better in patients in whom no removal, decompression or subtotal removal was undertaken.[9]
Summary
Facial nerve schwannomas are rare and constitute less than 1% of all intrapetrous mass lesions,[1,2] and estimated at only 1.9% of all intracranial schwannomas.[3] Facial schwannomas extending into both the cerebellopontine angle and middle cranial fossa are extremely rare and occurs in only 3% of all cases.[4,5,6] Most of such tumors appear simultaneously in both sites. There have been no precise reports of cerebellopontine angle facial schwannoma relapsing towards middle cranial fossa. We report an unusual case of cerebellopontine angle facial schwannoma that involved the middle cranial fossa, two years after the first operation
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