Transtemporal facial nerve schwannoma without facial nerve paralysis

Surgical Management of PICA Aneurysm and Incidental Facial Nerve Schwannoma: Case Report

We report a patient with a posterior inferior cerebellar artery (PICA) aneurysm and an incidental facial nerve schwannoma at the cerebellopontine angle (CPA). A 46-year-old woman presented with the sudden onset of a severe headache, nausea, and vomiting. She had no other abnormal neurological symptoms and signs. Computed tomography (CT) showed hemorrhage in the fourth ventricle. Cerebral angiography demonstrated an aneurysm arising from the tonsillomedullary segment of the left PICA. A facial nerve schwannoma was incidentally found as the aneurysm was being clipped. The aneurysm was clipped via a left transcondylar approach. Subsequently, the schwannoma (2 x 3 x 2 mm) was resected from the facial nerve fascicles, and the facial nerve was preserved. Postoperatively, the patient developed mild to moderate dysfunction of the facial nerve (House-Brackmann grade III [H-B III]) but her hearing was intact. Both a facial nerve schwannoma involving the CPA and an aneurysm involving the PICA can be managed through the transcondylar approach. An asymptomatic facial nerve schwannoma can be resected safely with minimal facial nerve dysfunction.

Facial nerve schwannoma of the cerebellopontine angle: a diagnostic challenge

Facial nerve schwannomas are rare lesions that may involve any segment of the facial nerve. Because of their rarity and the lack of a consistent clinical and radiological pattern, facial nerve schwannomas located at the cerebellopontine angle (CPA) and internal auditory canal (IAC) represent a diagnostic and therapeutic challenge for clinicians. In this report, a case of a CPA/IAC facial nerve schwannoma is presented. Contemporary diagnosis and management of this rare lesion are analyzed.

Facial Nerve Schwannoma Presenting as a Mass in the Middle Cranial Fossa: Typical Neuroradiological Patterns for a Preoperative Diagnosis

Facial nerve schwannoma is a rare primary neurogenic tumour that may originate anywhere along the VIIth nerve course. The clinical presentation is highly dependent on the location of the lesion along the nerve course and this makes the pre-operative diagnosis difficult without radiologic examination. The most common presentation is facial palsy and even though tumours are responsible for only 5% of facial palsies, if a patient does not recover within six months a complete work-up for neoplasm is recommended. On the basis of clinical presentation and imaging characteristics radiologists should try to make a preoperative diagnosis, to help in the patient's management and possibly to plan the surgical approach. We describe the case of a successful preoperative diagnosis of facial nerve schwannoma. The aim is to describe the main CT and MRI findings which may help the radiologist to establish a correct differential diagnosis.