J Neurol Surg B Skull Base 2021; 82(S 02): S65-S270
DOI: 10.1055/s-0041-1725487
Presentation Abstracts
Poster Abstracts

Primary Intracanalicular Facial Nerve Malignant Neoplasm: A Case Report

Samuel H. Smith
1   Department of Otolaryngology, University of Tennessee Health Science Center, Memphis, Tennessee, United States
,
L. Madison Michael
2   Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States
,
Robert J. Yawn
1   Department of Otolaryngology, University of Tennessee Health Science Center, Memphis, Tennessee, United States
› Author Affiliations
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    Objectives: This study was aimed to review the incidence, clinical presentation, and management of facial nerve sarcomas. The clinical, radiologic, and pathologic features are discussed here with a description of middle fossa and transmastoid approach for surgical resection.

    Study Design: Present study is a case report and literature review.

    Methods: The case of a patient with an acute onset facial paralysis, vertigo, and profound sensorineural hearing loss, ultimately found to have an intracanalicular, primary, high-grade sarcoma of the facial nerve is reviewed. The clinical, radiologic, and pathologic features of the disease are reviewed as well as the approach for surgical resection.

    Results: A 39-year-old female with no significant prior medical history and no history of radiation exposure presented with acute left facial paralysis. Over several days, she also developed ipsilateral profound sensorineural hearing loss and vertigo. Symptoms were unchanged after a course of high dose corticosteroids. Magnetic resonance imaging demonstrated an intracanalicular lesion measuring approximately 1 cm in length with T1-weighted contrast enhancement ([Fig. 1]). Surgical excision was performed via combined transmastoid-middle cranial fossa approach and a mass lesion involving the facial nerve was identified. The lesion appeared to be intrinsic to the facial nerve and thus was resected from the cisternal to tympanic segments to ensure adequate margins. The distal facial nerve could be stimulated, and sural nerve cable graft was placed. Final pathology was reviewed at multiple institutions and was diagnosed as a high-grade sarcoma. Posttreatment radiation was completed, and the patient currently has no signs of recurrence.

    Conclusion: Primary sarcoma involving the facial nerve is a rare entity with few reports in the literature. Aggressive surgical resection with adjuvant treatment along with close surveillance is advocated for this type of tumor.

    Zoom Image
    Fig. 1 Preoperative axial T1 weighted, post contrast MRI demonstrating left sided intracanalicular mass of the internal acoustic canal. MRI, magnetic resonance imaging.

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    No conflict of interest has been declared by the author(s).

    Publication History

    Article published online:
    12 February 2021

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    Zoom Image
    Fig. 1 Preoperative axial T1 weighted, post contrast MRI demonstrating left sided intracanalicular mass of the internal acoustic canal. MRI, magnetic resonance imaging.