Middle fossa approach for a pediatric facial nerve meningioma

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  • 1 Departments of Neurological Surgery,
  • 2 Surgery, Division of Otolaryngology, Head and Neck Surgery, and
  • 3 Neurosciences and Pediatrics, University of California, San Diego, California
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Pediatric cerebellopontine angle (CPA) meningiomas are extremely rare and are usually treated with a retrosigmoid surgical approach or radiation. The authors present the use of a middle fossa approach for the treatment of a symptomatic CPA meningioma in a 22-month-old female. The patient initially presented at 17 months with isolated progressive, long-standing right-sided facial weakness. MRI demonstrated a 5.0 × 5.0–mm right CPA lesion just superior to the cisternal segment of cranial nerve (CN) VII, which demonstrated growth on interval imaging. At 22 months of age she underwent a successful middle fossa craniotomy, including wide exposure of the porus acusticus, allowing for a gross-total resection with preservation of CNs VII and VIII. Pathological analysis revealed a WHO grade I meningioma. The patient remained neurologically stable on follow-up. The middle fossa approach can be used to safely access the CPA in properly selected pediatric patients.

ABBREVIATIONS BAER = brainstem auditory evoked response; CN = cranial nerve; CPA = cerebellopontine angle; IAC = internal auditory canal.

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Contributor Notes

Correspondence Michael L. Levy: University of California, San Diego, CA. mlevy@rchsd.org

INCLUDE WHEN CITING Published online August 28, 2020; DOI: 10.3171/2020.5.PEDS2034.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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