Dorsal displacement of the facial nerve in vestibular schwannoma surgery

Gustavo S Jung; Joel Fernando Sanabria Duarte; Afonso H de Aragão; Ronaldo Pereira Vosgerau; Ricardo Ramina

doi:10.3171/2021.7.FOCVID2182

Dorsal displacement of the facial nerve in vestibular schwannoma surgery

Neurosurg Focus Video. 2021 Oct 1;5(2):V9. doi: 10.3171/2021.7.FOCVID2182. eCollection 2021 Oct.

Authors

Gustavo S Jung¹, Joel Fernando Sanabria Duarte², Afonso H de Aragão², Ronaldo Pereira Vosgerau³, Ricardo Ramina¹

Affiliations

¹ Department of Neurological Surgery, Skull Base Division.
² Department of Neurological Surgery, Post-Graduate Program; and.
³ Department of Radiology, Neuroradiology Division, Neurological Institute of Curitiba, Paraná, Brazil.

Abstract

The course of the facial nerve (FN) has been extensively investigated in patients with vestibular schwannomas (VSs). FN running dorsally to the tumor capsule accounts for less than 3% of the cases. Diffusion tensor imaging (DTI)-based fiber tracking helps to preoperatively identify the FN. During surgery, a higher risk of injury is associated with the dorsal location of the FN. The authors demonstrate the nuances and tricks to identify and preserve a dorsal displaced FN during resection of a large VS, T3b according to the Hannover classification, through the retrosigmoid-transmeatal approach. The video can be found here: https://stream.cadmore.media/r10.3171/2021.7.FOCVID2182.

Keywords: acoustic neuroma; facial nerve; facial palsy; vestibular schwannoma.