28 year old woman presented with sudden sensorineural hearing loss 6 years ago with profound hearing loss. 3 year history of progressive facial nerve dysfunction; on presentation House-Brachmann grade 5. (Severe palsy, including inability to close the eye)
Scans showing ‘bilobed’ tumour classic for a facial schwannoma extending both into the middle cranial fossa and the posterior cranial fossa. The tumour is extending close to the brainstem indicating the possibility of finding a proximal stump of normal facial nerve to allow cable grafting.
A translabyrinthine approach was chosen with close of the external auditory canal.
A proximal stump was identified following removal of the tumour. A greater auricular graft was taken with anastomosis at the brainstem and in the vertical segment of the facial nerve in the temporal bone.
