SURGICAL VIDEO Left Transtemporal Approach for Resection of Cranial Nerve VI and VII Neurofibroma Tumors With Reconstruction of Cranial Nerve VII Using a Sural Nerve Interposition Graft: Watch now at http://links.lww.com/NEU/A896 3-Dimensional Operative Video The 3-D video can be viewed at http://links.lww.com/NEU/A896. Jayson A. Neil, MD,* Clough Shelton, MD,‡ William T. Couldwell, MD, PhD* Disclosure *Department of Neurosurgery and ‡Division of Otolaryngology, Department of Surgery, University of Utah, Salt Lake City, Utah The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article. A transmastoid/transpetrosal/middle fossa approach may provide access to nerve tumors on different cranial nerves. The case Acknowledgments presented involved a 4-year-old boy who had progressive left facial We thank Vance Mortimer for helping with the video production and Kristin weakness, House-Brackmann grade V on presentation, and a long- Kraus, MSc, for editorial assistance. standing abducens nerve (left lateral rectus) palsy. Contrast- enhanced magnetic resonance imaging demonstrated tumors involving both the sixth and seventh cranial nerves, as well as multiple cavernous malformations. The technique demonstrated is COMMENT a left transmastoid/transpetrosal/middle fossa approach for resection of the sixth and seventh cranial nerve tumors. The abducens nerve his 3-dimensional video nicely illustrates the approach to a VI and VII tumor in the prepontine cistern was resected through the petrous T nerve neurofibroma and reconstruction of the resected VII nerve with apex, and the facial nerve tumor was resected from the fallopian an interposition sural nerve graft. A House-Brackmann grade III recovery canal within the temporal bone. The facial nerve was reconstructed is an outstanding result for a case of this nature and underscores the with an interpositional sural nerve graft. Neuromonitoring used technical expertise visualized on the video. This degree of facial rean- during the case included motor evoked potential and somatosensory imation is a very important issue for any patient, but particularly for evoked potential monitoring. There were no complications. At a child. 1 year postoperatively, the patient’s facial weakness continues to improve, and he was at House-Brackmann grade III on last visit. Daniel L. Barrow Postoperative imaging at 1 year demonstrates no visible tumor. Atlanta, Georgia OPERATIVE NEUROSURGERY VOLUME 12 | NUMBER 4 | DECEMBER 2016 | 393 Copyright © Congress of Neurological Surgeons. Unauthorized reproduction of this article is prohibited.
Operative Neurosurgery – Oxford University Press
Published: Dec 1, 2016
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