32 year old gentleman presents with slowly progressive left sided facial weakness and conductive hearing loss. At presentation complete eye closure, and near symmetric appearance at rest.
Bilobed tumour consistent with a facial nerve schwannoma
This presents a difficult management dilemna as resection of the tumour will significantly worsen facial nerve function. There is no realistic option of cable grafting, with other options including VII-XII reanastomisis, nerve to masseter, cross facial grafting and other static manoevres.
Obviously the degree of brainstem compression must be closely monitored.