A small vestibular schwannoma with preoperative facial palsy treated via retrolabyrinthine approach

Facial nerve paralysis caused by a vestibular schwannoma is a rare but critical symptom; however, few reports have focused on preoperative facial nerve palsy from the viewpoint of treatment. In addition, its mechanism is not fully understood. We report a rare case of preoperative facial nerve palsy that improved after the surgical resection of a small vestibular schwannoma with hearing preservation. A small vestibular schwannoma within the internal auditory canal caused acute deafness and facial paralysis in a 51-year-old woman. Conservative treatment was initially administered, but severe hearing loss and facial paralysis persisted for 3 months after onset. Subsequently, we performed tumor resection using the retrolabyrinthine approach. The tumor, which compressed the cochlear and facial nerves, was almost completely removed under continuous intraoperative monitoring to preserve the facial nerve function. “Wait and scan” is generally recommended for vestibular schwannomas within the internal auditory canal. However, this case suggests that early successful surgery, at least in selected cases, can improve paralysis without hearing deterioration and maintain the patient's quality of life.