![]() Her hypoesthesia resolved much more slowly but did resolve completely by her 2-year postoperative anniversary. Her facial pain resolved rapidly and had completely resolved within 3 months. Postoperatively, the patient maintained facial pain and hypoesthesia acutely. We did not have a straightforward explanation for these trigeminal symptoms, but the out-of-the-ordinary presentation added additional motivation to obtain definitive histopathologic diagnosis of this mass. The patient's initial presentation of unilateral facial pain and hypoesthesia were puzzling, given the limited extension of the enhancing mass on preoperative imaging. At 3 years postoperatively, she has maintained a House-Brackmann grade 3/6 facial function, with persistent mild to moderate synkinesis but excellent complete volitional eye closure and symmetrical upper and lower branch volitional motor function and blink, and she is pleased with her result. At ∼ 2 years, her facial function recovery had progressed significantly to a House-Brackmann grade 3/6, and her upper eyelid gold weight was explanted. At ∼ 15 months, she began exhibiting minimal movement to the upper branches of the facial nerve, which progressed further over the ensuing 6 to 9 months. She maintained a dense facial paralysis for approximately 1 year from the date of her surgery. Intraoperatively, the patient underwent gold weight implantation of the ipsilateral upper eyelid at the conclusion of her tumor dissection. This approach would provide complete visualization of the IAC from fundus to porus, allow resection of mass and decompression of the IAC with no displacement of the facial nerve, and allow maximal opportunity for recovery of neural function of the facial nerve.ĭespite the lack of electrical stimulability to the facial nerve before, during, and at the conclusion of intracanalicular dissection, the patient ultimately had significant success as a result of her intervention. The surgical approaches were further characterized as middle fossa, retrosigmoid, and translabyrinthine approaches, with the usual advantages and admonitions specific to each approach described in detail.Īfter exhaustive consideration of all treatment options, and given the acute onset of symptoms, acute and complete paralysis of facial function, imaging characteristics of the IAC mass with potential to represent a malignant or metastatic process, and lack of histopathologic diagnosis of the IAC mass, the patient elected to proceed with resection of the IAC mass via a translabyrinthine approach. These included (1) observation and serial imaging of the IAC mass with primary medical treatment of facial paralysis (2) fractionated or hypofractionated radiotherapy treatment of the IAC mass (3) stereotactic radiotherapy treatment of the IAC mass (4) middle fossa approach for primary surgical decompression of the IAC and (5) surgical resection of the IAC mass for primary treatment of the mass, histopathologic diagnosis, and decompression of neural structures within the IAC. Final pathology of the resected mass revealed a blood vessel with mucinous degeneration of the medial layer of the vessel wall, with immunohistochemical staining confirming the presence and structure of aneurysmal blood vessel.Īll treatment options were discussed in complete detail with the patient and her husband. Intraoperatively, the internal auditory canal mass was resected with minimal difficulty, with intraoperative dissection notable for brisk bleeding at the medial base of the tumor just as the tumor was dissected off its medial fibrous attachments. The patient elected to proceed with translabyrinthine approach to the internal auditory canal for definitive resection of the mass as well as to decompress the neural structures of the internal auditory canal in an attempt to recover neural function, particularly of the facial nerve. Magnetic resonance imaging with contrast demonstrated a 6 × 7 mm peripherally enhancing lesion with lack of central uptake filling the right internal auditory canal. She demonstrated dense right-sided facial paralysis involving all branches of the facial nerve, left beating horizontal nystagmus, and anacusis of the right ear. A 72-year-old woman presented with sudden onset right facial paralysis, facial pain, hearing loss, and vertigo. We present the first case report of a labyrinthine artery aneurysm masquerading as an internal auditory canal tumor. ![]()
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