Commentary

The authors present an interesting case of a 56-year-old woman with a right-sided cerebellopontine facial nerve neuroma that extended into the internal auditory canal. The authors chose the retrosigmoid approach to preserve preoperative hearing. Intraoperatively, they found that the tumor involved the facial nerve as evidenced by the presence of the vestibular and cochlear nerves as shown on intact intraoperative photograph. These nerves were displaced superoposteriorly. The authors indicated that complete resection was achieved. That they could achieve a sural nerve graft is truly surprising, especially given that the tumor extended almost a centimeter into the internal auditory canal. Whether the anastomosis will provide some recovery of facial function remains to be seen. Not surprisingly, the patient had complete facial paralysis.

It is easy to play armchair quarterback; however, if we find what appears to be a facial neuroma during an approach to a cerebellopontine angle tumor, we seldom recommend obtaining a biopsy of these tumors, let alone resecting them. In our experience and that of others, complete facial paralysis would be guaranteed. If these small, benign tumors were to enlarge, radiosurgery or possibly open surgery could be considered.