Extradural Subtemporal Transpetrosal Approach to Facial Nerve Schwannoma

Objective: Facial nerve schwannoma (FNS) are rare tumors usually presenting as a cerebellopontine angle (CPA) mass. Rarely, FNS can present as significant mass in the middle cranial fossa. They are usually approached using intradural procedures; however, we decompressed the tumor through an extradural procedure and could decompress it significantly without any morbidity. Clinical Presentation: A 15-year-old female presented with progressive right-sided facial weakness, followed by left-sided hearing loss since the last 1 year. She was evaluated and it was found that she had an FNS involving the posterior and middle cranial fossa, with a significant tumor in the middle cranial fossa. Surgical Management: Extradural subtemporal combined with a transpetrosal approach was used for tumor decompression; some of the residual tumor in the left cerebellopontine cistern was managed by a postoperative gamma knife surgery to preserve the facial nerve functions. Conclusions: FNS can be one of the rare differential diagnoses of a tumor in the middle cranial fossa base and can be managed effectively by an extradural approach.