Intracranial facial neuromas: total tumor removal with facial nerve preservation: a new surgical technique.

Neuromas of the facial nerve are uncommon tumors. The majority of cases involve the intratemporal and parotid areas. Since their description in 1930, there have been only 26 cases of intracranial facial neuroma reported in the world literature. Of these, 19 involved the middle cranial fossa, and only seven tumors extended into or originated in the posterior cranial fossa. In this location, the seventh nerve is surrounded by a very delicate and thin arachnoid casing. Thus, although these tumors are encapsulated, there is usually no obvious plane of separation between the tumor and perineurium. As a result, the seventh nerve has been sacrificed routinely. Two patients with posterior fossa facial neuromas underwent total tumor removal with a new surgical technique permitting preservation of the nerve fascicles via a translabyrinthine approach. Each patient has good recovery of seventh nerve function with no evidence of recurrence six and nine years later, respectively. Leaving the nerve fascicles intact appears to result in good reinnervation following total tumor removal. The potential value of this technique is best considered in the context of diagnostic and therapeutic options for facial neuromas in general. Neurotologists should find this a useful addition to their surgical armamentarium for selected cases.