title: Surgical Management of PICA Aneurysm and Incidental Facial Nerve Schwannoma: Case Report.
abstract: We report a patient with a posterior inferior cerebellar artery (PICA) aneurysm and an incidental facial nerve schwannoma at the cerebellopontine angle (CPA). A 46-year-old woman presented with the sudden onset of a severe headache, nausea, and vomiting. She had no other abnormal neurological symptoms and signs. Computed tomography (CT) showed hemorrhage in the fourth ventricle. Cerebral angiography demonstrated an aneurysm arising from the tonsillomedullary segment of the left PICA. A facial nerve schwannoma was incidentally found as the aneurysm was being clipped. The aneurysm was clipped via a left transcondylar approach. Subsequently, the schwannoma (2 x 3 x 2 mm) was resected from the facial nerve fascicles, and the facial nerve was preserved. Postoperatively, the patient developed mild to moderate dysfunction of the facial nerve (House-Brackmann grade III [H-B III]) but her hearing was intact. Both a facial nerve schwannoma involving the CPA and an aneurysm involving the PICA can be managed through the transcondylar approach. An asymptomatic facial nerve schwannoma can be resected safely with minimal facial nerve dysfunction.
authors.affiliation: Department of Neurosurgery, Rui-Jin Hospital, Shanghai Jiao-Tong University College of Medicine, Shanghai, People's Republic of China.
authors.forename: Liu-Guan
authors.initials: LG
authors.lastname: Bian
authors.forename: Qing-Fang
authors.initials: QF
authors.lastname: Sun
authors.forename: Wuttipong
authors.initials: W
authors.lastname: Tirakotai
authors.forename: Wei-Guo
authors.initials: WG
authors.lastname: Zhao
authors.forename: Helmut
authors.initials: H
authors.lastname: Bertalanffy
authors.forename: Jian-Kang
authors.initials: JK
authors.lastname: Shen