Facial Nerve Grafting in the Cerebellopontine Angle

Introduction: Even if the rate of anatomical facial nerve preservation in cerebellopontine surgery has progressively increased, there are still a significant number of patients requiring an anatomical reconstruction. However, it can be a demanding task to use microsutures in the cerebellopontine angle, due to the constant pulsation of the cerebrospinal fluid. We describe an alternative technique for grafting the facial nerve in the cerebellopontine angle using only fibrin glue.

Materials and Methods: The most important factor in order to correctly achieve the grafting is to provide an adequate supporting surface to the entire length of the graft. For this purpose we use in sequence the brainstem, the trigeminal nerve, and the anterior wall of the internal auditory canal. Fibrin glue applied along the graft allows us to secure the graft itself to the supporting surface, reducing the possibility of a displacement produced by the cerebrospinal fluid pulsation.

Results: Even if the number of cases is still small (18), the results are comparable to those obtained by means of microsutures, with more than 60% of the cases recovering to grade III after 1 year.

Conclusions: An alternative grafting technique in the cerebellopontine angle is presented. Even if further evaluation is required, the preliminary results are comparable to those obtained with microsutures. However, in our hands the technique appears much easier and is less time-consuming.