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Neurology India
Medknow Publications on behalf of the Neurological Society of India
ISSN: 0028-3886 EISSN: 1998-4022
Vol. 52, Num. 3, 2004, pp. 396-397

Neurology India, Vol. 52, No. 3, July-September, 2004, pp. 396-397

Letter To Editor

Middle cranial fossa schwannoma of the facial nerve

Shenoy SN, Munish GK, Raja A

Department of Neurosurgery, Kasturba Medical College and Hospital, Manipal - 576 119

Correspondence Address:Department of Neurosurgery, Kasturba Medical College and Hospital, Manipal - 576 119
shenoysn@yahoo.com

Code Number: ni04134

Sir,
A 24-year-old man presented on 12/05/97 with history of progressive right facial paresis and decreased hearing of one-year duration. On neurological evaluation, he had total infranuclear facial palsy and conductive hearing loss on the right side. His cranial CT scan revealed a homogenously enhancing isodense mass lesion arising from the middle cranial fossa. Surgery could not be done due to financial problems of the family.

On 03/07/2000, he presented again with the additional prob lem of ataxia. Repeat CT scan showed a significant increase in the size of the tumor with destruction of the underlying petrous bone [Figure - 1]. He underwent right temporal craniotomy and excision of the tumor. The tumor was approached extradurally and dissected circumferentially and was excised completely. It was arising from the geniculate ganglion of the facial nerve. The tumor-adjoining cranial nerves were saved. The bony defect in the petrous bone was repaired with temporalis fascia. At three years follow-up, the patient showed moderate improvement in facial function.

The facial nerve is the most frequently paralyzed motor nerve, with 95% of infranuclear palsies due to a pathological process within the temporal bone.[1] Neoplasms account for 5% of facial palsies and neurinomas comprise only a small fraction of these. Facial nerve schwannomas are postulated to arise from the nervus intermedius and its connection in the geniculate ganglion.[2] As the geniculate ganglion is anatomically located towards the anterior surface of the pyramid, the schwannomas originating here are partially located in the petrous bone and their bulk is in the middle cranial fossa.[3] Approximately 30 cases of facial nerve schwannomas presenting as middle cranial fossa lesions have been reported in the literature.[1],[3],[4] The clinical features depend upon the site of origin of the tumor on the facial nerve and the direction of its growth. The principal clinical features of facial nerve tumors are progressive facial nerve paresis and hearing loss.[5],[6] ,[7]

The management strategy for facial neurinoma consists of tumor removal and facial nerve reconstruction. The surgical approach to facial neurinoma is selected according to the location and extension of the tumor and state of hearing.[5],[6],[7] In these lesions, the facial nerve should be first identified in the fallopian canal, and the nerve can be followed through the tumor while performing decompression and excision. This technique shall probably enhance the chances of facial nerve preservation or reanimation. The greatest determinant of the outcome of facial nerve reconstruction is the duration and sever ity of pre-operative facial weakness.[1]

REFERENCES

1.Sherman JD, Dagnew E, Pensak ML, van Loveren HR, Tew JM. Facial nerve neuromas: Report of ten cases and review of the literature. Neurosurgery 2002;50:450-6.  Back to cited text no. 1    
2.Fisch V, Ruttner J. Pathology of intratemporal tumours involving the facial nerve. In Fisch V: Ed. Facial Nerve Surgery. Birmingham. Aesculapius 1977;448-56.  Back to cited text no. 2    
3.Kumon Y, Sakaki S, Ohta S, Ohue S, Nakagawa K, Tanaka K. Greater superficial petrosal nerve neurinoma. J Neurosurg 1999;91:691-6.  Back to cited text no. 3    
4.Devi BI, Panigrahi M, Jaiswal VK, Bhat DI, Das S, Das BS. Facial nerve neurinoma presenting as middle cranial fossa and cerebello pontine angle mass: A case report. Neurol India 2000;48:385-7.  Back to cited text no. 4    
5.King TT, Morrison AW. Primary facial nerve tumours within the skull. J Neurosurg 1990;72:1-8.  Back to cited text no. 5    
6.Lipkin AF, Coker NJ, Jenkins HA, Alford BR. Intracranial and intratemporal facial neuromas. [Review] Otolaryngol Head Neck Surg 1987;96:71-9.  Back to cited text no. 6    
7.Yamaki T, Morimoto S, Ohtaki M, Sakatani K, Sakai J, Himi T, et al. Intracranial facial nerve neuroma: Surgical strategy of tumour removal and functional reconstruction. Surg Neurol 1998;49:538-46.  Back to cited text no. 7    

Copyright 2004 - Neurology India

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