Diagnostic Value of Preoperative Electrodiagnostic Analysis in a Patient with Facial Palsy and a Large Vestibular Schwannoma: Case Report.

Myung Chul Yoo

doi:10.3390/diagnostics12020542

Abstract

Although radiologic methods confirm the diagnosis of patients with large vestibular schwannomas, these methods usually indicate only the size of the tumor and its possible nerve compression. Electrodiagnostic methods can reveal the functional state of the nerves, particularly the trigeminal and facial nerves, as well as providing a basis for objectively evaluating nerve injury. Due to the lack of an established objective evaluation method, electrodiagnostic methods were utilized to assess injury to the cranial nerve in a patient with a large vestibular schwannoma. A 79-year-old woman presented with a one-month history of right facial palsy, vertigo, dizziness, right postauricular pain, and right-sided hearing disturbance. Physical examination suggested injuries to the facial and vestibulocochlear nerves. Magnetic resonance imaging identified a vestibular schwannoma and showed that the tumor mass was affecting the brainstem, including the fourth ventricle, resulting in mild obstructive hydrocephalus. Preoperative electrodiagnostic evaluation identified asymptomatic trigeminal neuropathy accompanying a vestibular schwannoma. The patient underwent surgery, consisting of a suboccipital craniotomy with additional gamma knife radiosurgery. Postoperatively, she demonstrated significant recovery from right facial palsy and partial improvement of her neurologic symptoms. Large vestibular schwannomas with facial paralysis may be accompanied by additional entrapment neuropathy. Routine preoperative electrophysiological evaluation is recommended to establish a definitive diagnosis and evaluate the function of the trigeminal nerve, facial nerve, and brainstem in patients with large and compressive vestibular schwannomas.

Highlights

Vestibular schwannomas, called acoustic neuromas, are benign, slow-growing tumors that typically arise from the Schwann cells that form the vestibular portion of the vestibulocochlear nerve sheath [1]
As a vestibular schwannoma grows, it can expand from its origin within the internal auditory canal (IAC) and extend into the brainstem or the cerebellopontine angle (CPA)
This study describes the use of electrodiagnostic techniques to predict damage to the trigeminal and facial nerves in a patient with a large vestibular schwannoma

Summary

Introduction

Vestibular schwannomas, called acoustic neuromas, are benign, slow-growing tumors that typically arise from the Schwann cells that form the vestibular portion of the vestibulocochlear nerve sheath [1]. These tumors are relatively common, accounting for 6–8% of all intracranial tumors and 80% of cerebellopontine angle (CPA) tumors [2,3]. A study of 1000 patients with vestibular schwannomas showed that 17% experienced trigeminal nerve disturbances, with major symptoms that included facial numbness (paresthesia), hypoesthesia, and pain [7]. This study describes the use of electrodiagnostic techniques to predict damage to the trigeminal and facial nerves in a patient with a large vestibular schwannoma

Case Presentation

Discussion

Findings

Conclusions