Subtemporal "Interdural" Surgical Approach for "Giant" Facial Nerve Neurinomas.

Abstract

The management issues of 15 cases of giant and dumbbell-shaped facial neurinomas that extended both in the middle and posterior cranial fossa are reported. During the period 2002 to June 2017, we surgically treated 15 cases of giant and dumbbell shaped facial neurinomas: 10 males and 5 females ranging from 17-59 years (average 34.2 years). Average duration of facial nerve weakness before seeking surgical relief was 49.46 months. Fourteen patients had varying degrees of hearing disturbance. Seven patients had ataxia. The sizes of the tumor ranged from 5.2-8 cm (average being 6.2 cm). The tumors were in an "interdural" location, both in the middle and in the posterior cranial fossa. An extradural subtemporal "interdural" approach was used to resect the tumor in both compartments. The dural cover of the tumor provided a well-defined surgical plane of dissection. Tumor recurrence was observed in 3 cases. The tumor was interdural even at the time of recurrence. Understanding the fact that the facial nerve neurinomas are interdural in nature and soft and necrotic in character can allow quick and safe surgery with a relatively small surgical exposure.