Vestibular schwannoma manifesting with hemifacial spasm in a young woman: clinical considerations and tumor removal with hearing preservation. 2-Dimensional operative video

Carlos Candanedo, MD, MSc,1 Marrigje A. de Jong, MD, MSc,2 Avner Michaeli, PhD,3 Samuel Moscovici, MD,1 José E. Cohen, MD,1 and Sergey Spektor, MD, PhD1
Departments of 1Neurosurgery and 2Otolaryngology–Head and Neck Surgery, Hadassah-Hebrew University Medical Center, Jerusalem; and 3Surgical Monitoring Services Ltd., Beit Shemesh, Israel

Abstract
Hemifacial spasm (HFS) is a rare presentation of vestibular schwannoma. The authors present their experience with a 27-year-old woman who presented with normal hearing and HFS, which was the single neurological manifestation of an 18-mm vestibular schwannoma. In this challenging situation, the treatment goals were maximal tumor removal with preservation of hearing and facial nerve function and cure of the HFS. The authors achieved these goals, performing complete tumor removal via a retrosigmoid approach, assisted with neurophysiological monitoring and a 45°-angle QEVO endoscope. In the video, they explain the clinical, radiological, and surgical considerations and demonstrate the surgical technique.

The video can be found here: https://stream.cadmore.media/r10.3171/2021.7.FOCVID2099
https://thejns.org/doi/abs/10.3171/2021.7.FOCVID2099

Keywords: endoscopic surgery, facial nerve, hearing preservation, hemifacial spasm, vestibular schwannoma, video