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30-APRIL-2007 AMAL ADNAN AL-AZAB 36 YEARS RESIDUAL AFTER
EXCISION OF GIANT CLIVAL MENINGIOMA LEFT CLIVO-TEMPORAL WITH LEFT
FACIAL PARALYSIS.
Anamnesis
The patient came to the clinic
21-April-2007 complaining of complete paralysis of
the left facial nerve with deafness.
The patient was operated by me
15-January-2006 for
giant clival meningioma with involvement of the left
tentorium and massive hyperostosis of the left
temporal bone.
MRI and CT-scan performed
17-September-2007 showing no recurrence.
Considering that the facial
paralysis is complete within 17 months after the
first surgery, the patient sent to ECS and EMG,
which confirmed complete non-function of the left
facial nerve.
The left hypoglossal nerve was
exposed and the left facial nerve was drilled off
the canal for 10 mm depth and the hypoglossal nerve
was sharply cut just before the emergence of the
ansa cervicalis. It was rotated upward and direct
anastamoses was performed between the 2 nerves.
Smooth postoperative recovery.
Fig.-1: The anatomical
relationship of the facial and hypoglossal
nerves.
Fig-2: The anastamosis
performed. Fig-3: The tip of mastoid
returned.
Comments
So as to avoid cosmetic deformity, the
tip of the mastoid was kept intact, using osteotomes, which
was returned back at the end of the operation and fixed to
the muscle attachments above and below, avoiding by that the
formation of post auricular cavity.
Considering the absence of recurrence of the
tumor and more than 1 year of waiting for the nerve to recover,
without results bridge anastamoses was suggested.
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Notice: Not all operative activities
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