Commentary “Surgical Management of PICA Aneurysm and Incidental Facial Nerve Schwannoma: Case Report”

The authors present an unusual case report of a coincidental occurrence of a ruptured peripheral PICA aneurysm on the same side as an incidental small schwannoma arising on the cisternal segment of the facial nerve. The aneurysm was clipped appropriately through the transcondylar approach. Given that PICA was not the origin of the aneurysm, it also could have been approached through the so-called paracondylar approach. However, I see no harm in using the approach that the authors selected.

I would have been hesitant to resect the incidentally discovered facial nerve schwannoma in the absence of intraoperative facial nerve and auditory nerve monitoring, which I assume were not available given that the planned surgery was aneurysmal clipping rather than a schwannoma resection. However, I cannot argue with a final outcome of normal facial nerve function after a temporary grade III House-Brackmann paresis. Nonetheless, it is also conceivable that the outcome may not have been as favorable.

Furthermore, it seems that both unusual pathologies must be assumed to have been related coincidentally rather than etiologically.