Diffusion tensor tractography in the preoperative precise identification of the course of facial nerve in a meningioma of the cerebellopontine angle – Technical implications

Abstract

Background: Facial paralysis remains as one of the major morbidities of surgery of cerebellopontine angle tumors. The preoperative standard Magnetic Resonance Image does not identify, with precision, the path of the facial nerve. Case description: The authors describe a case of a 56 years-old female with a cerebellopontine angle meningioma, submitted to preoperative Diffusion Tensor Tractography to identification of the course of the facial nerve, and correlate its position with the intraoperative findings. There was an accurate correlation between the path of the facial nerve revealed by preoperative DTT and the route of the nerve identified during surgery. Conclusion: The preoperative identification of the facial nerve seems to be possible by tractography in meningiomas of the cerebellopontine angle. It is possible that this technique may have utility in larger tumors, where the intraoperative identification of the facial path can be more difficult. Keywords: Cerebellopontine angle meningioma, Diffusion tensor tractography, Facial nerve, Vestibular schwannoma