2026 Poster Presentations
P109: SYMPTOMATIC INTERNAL CAROTID ARTERY STENOSIS FROM FACIAL NERVE SCHWANNOMA: A CASE REPORT
Theresa B Hennesy, MD; Ashley M Nassiri, MD, MBA; University of Colorado Department of Otolaryngology - Head & Neck Surgery
Background: Facial nerve schwannoma is typically managed conservatively given the risk of facial weakness associated with surgical resection. In cases of compression of critical structures, however, intervention may be required. Here, we present a case of large facial nerve schwannoma resulting in symptomatic internal carotid artery (ICA) stenosis.
Case Description: A 34-year-old male presented with an episode of severe headache, loss of consciousness associated with straining, and a right facial weakness (House-Brackmann 2/6). CT angiogram demonstrated significantly narrowed ICA lumen (Figure 1, Figure 2), initially suspected to be ICA dissection. MRI demonstrated a contrast-enhancing lesion consistent with a facial nerve schwannoma with a large middle cranial fossa component continuous with the geniculate ganglion with encasement of the ICA (Figure 3). Within two months of initial diagnosis, facial weakness progressed to House-Brackmann 4/6, and the patient continued to experience severe headache and loss of consciousness with straining.
Discussion: This case exemplifies a rare presentation of facial nerve schwannoma with ICA encasement resulting in chronic remodeling and symptomatic stenosis. Although facial schwannomas are typically managed conservatively, in this case, surgical resection with management of the ICA was considered to reduce the risk of stroke. Discussion will review middle fossa approach for tumor resection, surgical technique for management of the facial nerve, and special considerations for facial nerve rehabilitation options in this case, as direct nerve grafting is not feasible. Additionally, management options for carotid artery stenosis are presented, including endovascular options.
Conclusions: Symptomatic ICA stenosis is an unusual presentation for facial nerve schwannoma and may represent an indication for active treatment. Multi-disciplinary care with vascular intervention and facial nerve reanimation are required for comprehensive care in these cases.
Figure 1: CT angiogram demonstrating significant narrowing of right internal carotid artery at the level of the skull base (arrow).
Figure 2. Curved planar reformation (CPR) of CT angiogram demonstrating course of right common and internal carotid artery (A) vs. left common and internal carotid artery (B).
Figure 3: T1-weighted, post-gadolinium MRI demonstrating right middle cranial fossa enhancing lesion (arrow) involving the internal auditory canal and geniculate ganglion.