The patient  came to the clinic with long history of headache and hearing loss for 2 years and progressive weak left facial nerve and left abducens and blurring vision both eyes with diplopea and swallowing difficulty for 3 years and ataxic gait. The patient was embolized 6 months ago without result and she progressed after that visual scatomas.  On examination, beside the above mentioned findings, she had atrophy of the left side of the tongue with loss of taste and sensation of the left side of the tongue. She had hiccup and abnormal breathing pattern. Several MRIs performed over the last 3 years, showing the progression of the mass with total involvement of the left transverse sinus with the inferior petrosal vein and the IJV down to the med cervical region. The mass was giant and compressing the brain stem with mild secondary hydrocephalus.

The tumor was resected with removal of the tumorous facial nerve, which was reconstructed by graft to bridge from the brainstem down to its trifurcation.

The completely damaged facial nerve was anastomosed  using a graft between the brainstem down to its trifurcation. The placement of the proximal stitches was a difficult task, but the stitches could be held in place.

The patient was followed by me for 10 years and the last time was seen by me 2013 and her left facial nerve was acceptable and showing no signs of recurrence.

The last time she came 21-June-2017 after falling down to the head  with neck pain, with MRI done the same day showing no recurrence of the tumor with further improvement of the facial nerve with no atrophy of the tongue.

This is the 10th similar case I have with these data and were operated, but for my regret, they escaped the video documentation during the last 20 years. I will try to seek the available material later.

For more information about glumos jugulare tumors, click here! 

Here was used avoidance of cosmetic deformity during the approach. For more details click here!

It seems that it is the first time in my life, I do anastamoses between the intracranial facial nerve with the distal non-tumorous peripheral part using sural grafts. Mostly this act happens one time in the life.

The patient was reoperated 3 days later for CSF leak, but in reality the purpose of surgery is to inspect the condition of the graft.