Neurilemmoma of the facial nerve

Greater superficial petrosal nerve neurinoma. Case report

The authors report a case of middle cranial fossa neurinoma arising from the left greater superficial petrosal nerve in a 21-year-old woman who presented with a left-sided otitis media that chronically recurred over a period of 5 years. On examination, the patient had a left-sided mild conductive hearing impairment and a slight disturbance in tear secretion on the left side, with sensory disturbance in the left palate. Three-dimensional computerized tomography scans clearly demonstrated the enlargement of the foramen lacerum and foramen ovale, and heavily T2-weighted magnetic resonance images revealed the tumor's location along with the course of the greater superficial petrosal nerve and its extension into the tympanic cavity. Following complete surgical excision of the tumor and tympanoplasty via a middle cranial fossa approach, the patient retained useful hearing without facial palsy.

Intracranial Facial Neuromas: Total Tumor Removal with Facial Nerve Preservation: A New Surgical Technique

Neuromas of the facial nerve are uncommon tumors. The majority of cases involve the intratemporal and parotid areas. Since their description in 1930, there have been only 26 cases of intracranial facial neuroma reported in the world literature. Of these, 19 involved the middle cranial fossa, and only seven tumors extended into or originated in the posterior cranial fossa. In this location, the seventh nerve is surrounded by a very delicate and thin arachnoid casing. Thus, although these tumors are encapsulated, there is usually no obvious plane of separation between the tumor and perineurium. As a result, the seventh nerve has been sacrificed routinely.

Two patients with posterior fossa facial neuromas underwent total tumor removal with a new surgical technique permitting preservation of the nerve fascicles via a translabyrinthine approach. Each patient has good recovery of seventh nerve function with no evidence of recurrence six and nine years later, respectively. Leaving the nerve fascicles intact appears to result in good reinnervation following total tumor removal. The potential value of this technique is best considered in the context of diagnostic and therapeutic options for facial neuromas in general. Neurotologists should find this a useful addition to their surgical armamentarium for selected cases.

Intracranial and intratemporal facial neuroma

Primary tumors of the facial nerve are relatively rare and have a variety of presenting symptoms. This article reviews 248 cases of facial neuroma in the world's literature and adds seven cases that were managed at the Baylor College of Medicine. Facial weakness was most common symptom, with facial spasm or tics, hearing loss, and masses in the external auditory canal also being frequently seen. At surgery, the tympanic, vertical, and labyrinthine segments were the most commonly involved areas. On the basis of this review, general principles have been drawn up to help the clinician in diagnosis and management of this (at times) difficult problem.

Intrapetrous neurinomas of the facial nerve. Report of three cases

Three cases of intrapetrous neurinomas of the facial nerve are reported and their diagnostic and surgical problems are discussed. Two of them revealed rare intracranial extensions and the other was a typical intrapetrous expansion of the tumor. The literature of intracranial neurinomas of the facial nerve is reviewed in detail.

Neurinomas of the facial nerve. Report of three cases

Three cases of neurinomas of the facial nerve are reported. Two of them originated from the labyrinthine portion of the nerve and the other from the vertical portion. Neurinomas of the first part of the facial nerve can be suspected preoperatively since they seem to give rise to specific clinical and radiological manifestations that can be distinguished from tumors of other portions of the nerve, the petrous bone area, or the cerebellopontine angle. The reported cases of neurinomas of the facial nerve are reviewed and analyzed.

Neurinoma of the labyrinthine portion of the facial nerve. Case report

✓ A case is reported in which the diagnosis of a neurinoma and its growth from the labyrinthine part of the facial nerve were established preoperatively on the basis of functional disturbances of the intermedius nerve and characteristic radiological changes. Specific tests for differential function of the facial nerve are discussed and the relation of the site of origin to symptoms in comparable reported cases analyzed.