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Split facial nerve course in vestibular schwannomas
Christian Strauss1, Julian Prell, Stefan Rampp
1Department of Neurosurgery, Martin-Luther- University of Halle-Wittenberg, Halle, Germany. christian.strauss@medizin.uni-halle.de
Journal of Neurosurgery
|November 24, 2006
Summary
Vestibular schwannomas (VSs) can present a split facial nerve, posing surgical challenges. Advanced neurophysiological monitoring aids in preserving facial nerve function during VS surgery.
Area of Science:
- Neurosurgery
- Neurology
- Otolaryngology
Background:
- The facial nerve typically courses along the ventral surface of vestibular schwannomas (VSs) in over 90% of cases.
- Aberrant facial nerve courses, including splitting into two distinct bundles, are rare and previously described mainly for medial extrameatal tumors.
Purpose of the Study:
- To investigate the characteristics and surgical implications of a split facial nerve course in vestibular schwannomas.
- To evaluate the effectiveness of intraoperative neurophysiological monitoring in managing facial nerve splitting during VS surgery.
Main Methods:
- Retrospective analysis of 16 VS cases (out of 241) with distinct facial nerve splitting between 1996 and 2005.
- Detailed intraoperative neurophysiological monitoring using multichannel electromyography.
- Postoperative reevaluation of patients at 12 months.
Main Results:
- Distinct facial nerve splitting was confirmed in all 16 identified cases, with a mean tumor size of 27 mm.
- A smaller nerve portion ran parallel to the brainstem, crossing the tumor pole to the internal auditory canal, while the major portion followed the typical ventral course.
- The smaller portion innervated the orbicularis oris muscle, while the larger portion supplied the main facial nerve branches.
Conclusions:
- A split facial nerve in VS presents a significant surgical challenge.
- Extensive intraoperative neurophysiological monitoring is crucial for identifying aberrant nerve fibers, minimizing risks, and achieving excellent long-term facial nerve outcomes.
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