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Background <p>Preserving facial nerve function during the gross total resection of a cystic vestibular schwannoma (CVS) is a significant surgical challenge. In this paper we describe our technical strategy to achieve this objective.</p> Method <p>A 59-year-old man with progressive left-sided hearing loss had a 2.9-cm partially cystic lesion in the left internal auditory canal (IAC) and cerebellopontine angle (CPA). A translabyrinthine approach was used with early facial nerve identification, sharp dissection, delayed cyst deflation, and continuous neuromonitoring.</p> Results <p>Gross total resection was achieved without facial nerve injury or brainstem violation.</p> Conclusion <p>With deliberate planning and technical execution, gross total resection of CVS is possible while preserving neurological function, even in anatomically distorted and adherent lesions. The senior author demonstrates technique of tumor dissection from the facial nerve, emphasizing gentle elevation of the tumor capsule away from the nerve while applying minimal traction, a key factor in achieving successful outcomes.</p>

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Nerve dissection technique to optimize functional outcome: resection of cystic vestibular schwannoma: how I do it

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月17日

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  • Mohammed Hasen,
  • Jihad Abdelgadir,
  • Jeffrey Nadel,
  • William T. Couldwell

摘要

Background

Preserving facial nerve function during the gross total resection of a cystic vestibular schwannoma (CVS) is a significant surgical challenge. In this paper we describe our technical strategy to achieve this objective.

Method

A 59-year-old man with progressive left-sided hearing loss had a 2.9-cm partially cystic lesion in the left internal auditory canal (IAC) and cerebellopontine angle (CPA). A translabyrinthine approach was used with early facial nerve identification, sharp dissection, delayed cyst deflation, and continuous neuromonitoring.

Results

Gross total resection was achieved without facial nerve injury or brainstem violation.

Conclusion

With deliberate planning and technical execution, gross total resection of CVS is possible while preserving neurological function, even in anatomically distorted and adherent lesions. The senior author demonstrates technique of tumor dissection from the facial nerve, emphasizing gentle elevation of the tumor capsule away from the nerve while applying minimal traction, a key factor in achieving successful outcomes.