Vestibular schwannoma atypically invading temporal bone.

Area of Science:

• Neuro-oncology
• Neurosurgery
• Otolaryngology

Background:

• Vestibular schwannomas (VS) are typically confined to the internal auditory canal (IAC).
• Temporal bone invasion by VS is exceptionally rare, posing unique surgical challenges.

Observation:

• A 51-year-old man presented with a unilateral VS causing extensive temporal bone destruction beyond the IAC.
• The tumor extended anteriorly to the carotid canal and inferiorly to the jugular foramen.
• Histopathology confirmed a benign schwannoma with significant facial nerve compression and temporal bone erosion.

Findings:

• A combined translabyrinthine and lateral suboccipital approach enabled successful resection of the invasive VS.
• Facial nerve function was preserved despite severe compression and distortion by the tumor and eroded bone.

Implications:

• This case demonstrates that even extensive temporal bone invasion by VS can be managed surgically with favorable outcomes.
• Early detection and meticulous intraoperative facial nerve dissection with monitoring are crucial for preventing nerve dysfunction in such complex cases.