title: Small vestibular schwannomas presenting with facial nerve palsy.
abstract: OBJECTIVE
  To describe the surgical management and convalescence of two patients presenting with severe facial nerve weakness associated with small intracanalicular vestibular schwannomas (VS).
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Two adult female patients presenting with audiovestibular symptoms and subacute facial nerve paralysis (House-Brackmann Grade IV and V). In both cases, post-contrast T1-weighted magnetic resonance imaging revealed an enhancing lesion within the internal auditory canal without lateral extension beyond the fundus.
  Translabyrinthine exploration demonstrated vestibular nerve origin of tumor, extrinsic to the facial nerve, and frozen section pathology confirmed schwannoma. Gross total tumor resection with VIIth cranial nerve preservation and decompression of the labyrinthine segment of the facial nerve was performed. Both patients recovered full motor function between 6 and 8 months after surgery.
  
  
  CONCLUSIONS
  Although rare, small VS may cause severe facial neuropathy, mimicking the presentation of facial nerve schwannomas and other less common pathologies. In the absence of labyrinthine extension on MRI, surgical exploration is the only reliable means of establishing a diagnosis. In the case of confirmed VS, early gross total resection with facial nerve preservation and labyrinthine segment decompression may afford full motor recovery-an outcome that cannot be achieved with facial nerve grafting.
authors.affiliation: *Departments of Otolaryngology-Head and Neck Surgery, and †Neurologic Surgery, Vanderbilt University, Nashville, TN.
authors.forename: Mana
authors.initials: M
authors.lastname: Espahbodi
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Carlson
authors.forename: Te-Yung
authors.initials: TY
authors.lastname: Fang
authors.forename: Reid C
authors.initials: RC
authors.lastname: Thompson
authors.forename: David S
authors.initials: DS
authors.lastname: Haynes
mesh_terms: D019299:Decompression, Surgical; D005158:Facial Paralysis / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000150:complications* / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome