Cerebellopontine angle facial schwannoma relapsing towards middle cranial fossa

  • Takafumi Nishizaki | nishiza@jeans.ocn.ne.jp Department of Neurosurgery, Ube Industries Central Hospital, Japan.
  • Norio Ikeda Department of Neurosurgery, Ube Industries Central Hospital, Japan.
  • Shigeki Nakano Department of Neurosurgery, Ube Industries Central Hospital, Japan.
  • Takanori Sakakura Department of Neurosurgery, Ube Industries Central Hospital, Japan.
  • Masaru Abiko Department of Neurosurgery, Ube Industries Central Hospital, Japan.
  • Tomomi Okamura Department of Neurosurgery, Ube Industries Central Hospital, Japan.

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.

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Published
2011-05-02
Section
Case Reports
Keywords:
facial schwannoma, cerebellopontine angle, middle cranial fossa, facial nerve preservation.
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How to Cite
Nishizaki, T., Ikeda, N., Nakano, S., Sakakura, T., Abiko, M., & Okamura, T. (2011). Cerebellopontine angle facial schwannoma relapsing towards middle cranial fossa. Clinics and Practice, 1(2), e32. https://doi.org/10.4081/cp.2011.e32

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