CT-Based Intraoperative Navigation for Quick Identification of the Stylomastoid Foramen During Hypoglossal-Facial Nerve Anastomosis.

Abstract

To present the ability of standard intraoperative neuronavigation to reliably identify the stylomastoid foramen, thus providing a quick and effective recognition of the facial nerve at its exit from the skull base. We describe the technical nuances of this procedure by presenting two surgical cases who underwent hypoglossal-facial nerve anastomosis for complete facial nerve palsy occurring post removal of a giant vestibular schwannoma 6 months earlier. CT-based neuronavigation allowed a quick and reliable identification of the stylomastoid foramen and of the facial nerve at its exit from the skull. The entire procedure lasted for 3 hours. Three months after the anastomosis, the first signs of facial muscle reinnervation were visible. The use of neuronavigation during hypoglossal-facial nerve anastomosis is a simple and cost-effective strategy to decrease operative duration and increase surgical effectiveness.