Large vestibular schwannoma and facial nerve preservation: Surgical technique and nuances

Vestibular schwannoma is one of the common surgeries in clinical practice. Large vestibular schwannomas present with hearing loss, and surgical excision is the mainstay of treatment [1-5]. So, in these patients pre-serving the facial nerve function and brainstem decompression is the aim. However, controversies still exist regarding the extent of tumor decompression. With advancements in microsurgical techniques and intraoperative monitoring technologies, the gross total resection (GTR) of these tumors has become the preferred goal for many. However, with attempted GTR, the chances of cranial nerve morbidities especially, permanent facial nerve injury, increases significantly. Though the tumor size is one of the main predictors of facial nerve preservation, many studies even report >80% chances of good to excellent facial nerve preservation in this subset of patients. A thorough understanding of the CP angle anatomy, meticulous microsurgical techniques, and intraoperative monitoring can increase the chances of anatomical and physiological preservation of the facial nerve. Many operative videos of Vestibular schwannoma exist in the archives of the neurosurgical journals, but the technique and nuances of facial nerve preservation are not clearly demonstrated in those. Herein, the authors present a video of right vestibular schwannoma surgery managed through the right Retromastoid suboccipital craniectomy approach, highlighting the facial nerve.