Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA.
Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA.
World Neurosurg. 2022 Aug;164:253-255. doi: 10.1016/j.wneu.2022.05.089. Epub 2022 May 26.
Carefully preserving facial nerve function is crucial when using the translabyrinthine approach for vestibular schwannoma surgery. Nerve preservation can only be accomplished by employing rigorous surgical methods and having a thorough understanding of the relevant anatomy, including any variations. Anatomical variations in the path of the facial nerve are infrequent but are most commonly encountered in association with congenital abnormalities of the temporal bone or ossicles. We present a rare case of vestibular schwannoma with a bifurcated facial nerve having 2 origins at the brainstem. The patient underwent a right-sided microsurgical excision using the right translabyrinthine approach. Postoperative recovery went smoothly, resulting in a House-Brackmann scale of Grade I. This case emphasizes the importance of identifying and preserving the facial nerve during vestibular schwannoma resection. To avoid injury, intraoperative neurostimulation should be used to positively identify the facial nerve and its anatomical variations along its entire course.
当使用经迷路入路进行前庭神经鞘瘤手术时，仔细保护面神经功能至关重要。只有通过采用严格的手术方法，并对相关解剖结构有透彻的了解，包括任何变异，才能实现神经保护。面神经的解剖变异并不常见，但最常见于颞骨或听小骨的先天性异常。我们报告了一例罕见的前庭神经鞘瘤病例，其面神经呈分叉状，有 2 个起源于脑干。患者接受了右侧经迷路入路的右侧显微切除术。术后恢复顺利，House-Brackmann 分级为 I 级。该病例强调了在前庭神经鞘瘤切除过程中识别和保护面神经的重要性。为避免损伤，术中神经刺激应用于正面识别面神经及其在整个过程中的解剖变异。
