Objective: In this case report, delayed facial palsy developed in a patient without any direct manipulation of the main part of the facial nerve during an anterior petrosal approach. We discuss putative etiologies and management techniques that may help avoid this problem.
Clinical presentation: A 21-year-old woman underwent anterior petrosectomy for gross total resection of a low-grade chondrosarcoma. Six days later, the patient presented with left-sided facial weakness in the emergency department.
Results: Examination revealed evidence of House-Brackmann grade V/VI left-sided facial palsy, and repeat magnetic resonance imaging revealed diffuse enhancement of the contents of the internal auditory canal that was not present immediately after surgery. After a 10-day course of acyclovir and a tapering dose of methylprednisolone, the facial palsy slowly diminished and resolved 2 months after the onset.
Conclusion: This unique development of delayed facial palsy after an isolated anterior petrosal approach is evidence that this complication should be considered when dissecting along the floor of the middle fossa. Exposure of the intracranial or intracanalicular segment of the facial nerve is not necessary for delayed facial palsy to develop. Proposed mechanisms (ie, viral reactivation, vasospasm, neural edema) of this condition remain unproven. Prognosis for recovery has been reported to be excellent, with or without treatment.