Intermediate Nerve Schwannomas

  • Christian Scheller
  • Alex Alfieri
  • Elmar Peschke
  • Christian Strauss
Part of the Tumors of the Central Nervous System book series (TCNS, volume 7)


The intermediate nerve is rarely addressed as site of tumor origin in ­cerebellopontine surgery. This chapter presents typical clinical, electrophysiological and radiological signs of an intermediate nerve schwannoma. The authors describe the special surgical techniques in these rare entities with an emphasis on the intraoperative electrophysiological monitoring. In conclusion it is possible to detect the intermediate nerve as site of tumor origin during cerebellopontine surgery using selective direct nerve stimulation and multi-channel recordings. Subsequently, more intermediate nerve schwannomas may be identified as tumor origin by detailed intraoperative electrophysiological examination.


Facial Nerve Internal Auditory Canal Vestibular Schwannomas Brainstem Auditory Evoke Potential Geniculate Ganglion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Ashram YA, Jackler RK, Pitts LH, Yingling CD (2005) Intraoperative electrophysiological identification of the nervus intermedius. Otol Neurotol 26:274–279PubMedCrossRefGoogle Scholar
  2. Bischoff B, Romstöck J, Fahlbusch R, Buchfelder M, Strauss C (2008) Intraoperative brainstem auditory evoked potential pattern and perioperative vasoactive treatment for hearing preservation in vestibular schwannoma surgery. J Neurol Neurosurg Psychiatry 79:170–175PubMedCrossRefGoogle Scholar
  3. Fagan PA, Misra SN, Doust B (1993) Facial schwannoma of the cerebellopontine angle and the internal auditory canal. Laryngoscope 103:442–446PubMedCrossRefGoogle Scholar
  4. House JW, Brackmann DE (1986) Facial nerve grading system. Otolaryngol Head Neck Surg 93:146–147Google Scholar
  5. Irving RM, Viani L, Hardy DG, Baguley DM (1995) Nervus intermedius function after vestibular schwannoma removal: clinical features and pathophysiological mechanisms. Laryngoscope 105:809–813PubMedCrossRefGoogle Scholar
  6. King TT, Morrison AW (1990) Primary facial nerve tumors within the skull. J Neurosurg 72:1–8PubMedCrossRefGoogle Scholar
  7. Kudo A, Suzuki M, Kubo N, Kuroda K, Ogawa A, Iwasaki Y (1996) Schwannoma arising from the intermediate nerve and manifesting as hemifacial spasm. J Neurosurg 84:277–279PubMedCrossRefGoogle Scholar
  8. Last TJ (1990) Anatomy regional and applied, 8th edn. Churchill Livingstone, Edinburgh, pp 640–642Google Scholar
  9. Lee KS, Britton BH, Kelly DL Jr (1989) Schwannoma of the facial nerve in the cerebellopontine angle presenting with hearing loss. Surg Neurol 32:231–234PubMedCrossRefGoogle Scholar
  10. Lipkin AF, Coker NJ, Jenkins HA, Alford BR (1987) Intracranial and intratemporal facial schwannoma. Otolaryngol Head Neck Surg 96:71–79PubMedGoogle Scholar
  11. Lopes O, Castro NP, Quintanillia Ribeiro FA, Pialarissi PR (1978) Neurinoma of the facial nerve. ORL J Otorhinolaryngol Relat Spec 40:254–262PubMedCrossRefGoogle Scholar
  12. O’Donoghue GM, Brackmann DE, House JW, Jackler RW (1989) Schwannomas of the facial nerve. Am J Otol 10:49–54PubMedGoogle Scholar
  13. Oh CS, Chung IH, Lee KS, Tanaka S (2003) Morphological study on the rootlets comprising the root of the intermediate nerve. Anat Sci Int 78:111–113PubMedCrossRefGoogle Scholar
  14. Prell J, Rampp S, Romstöck J, Fahlbusch R, Strauss C (2007) Train time as a quantitative electromyographic parameter for facial nerve function in patients undergoing surgery for vestibular schwannoma. J Neurosurg 106:826–832PubMedCrossRefGoogle Scholar
  15. Rhoton A, Kobayashi S, Hollinshead WH (1968) Nervus intermedius. J Neurosurg 29:609–618PubMedCrossRefGoogle Scholar
  16. Romstöck J, Strauss C, Fahlbusch R (2000) Continuous electromyography monitoring of motor cranial nerves during cerebellopontine angle surgery. J Neurosurg 93:586–593PubMedCrossRefGoogle Scholar
  17. Scheller C, Strauss C, Fahlbusch R, Romstöck J (2004) Delayed facial nerve paresis following acoustic neuroma resection and postoperative vasoactive treatment. Zentralbl Neurochir 65:103–107PubMedCrossRefGoogle Scholar
  18. Scheller C, Richter HP, Engelhardt M, Koenig R, Antoniadis G (2007) The influence of prophylactic vasoactive treatment on cochlear and facial nerve functions following vestibular schwannoma surgery: a prospective and open-label randomized pilot-study. Neurosurgery 61:92–97PubMedCrossRefGoogle Scholar
  19. Scheller C, Rachinger J, Prell J, Kornhuber M, Strauss C (2008) Schwannoma of the intermediate nerve. J Neurosurg 109:144–148PubMedCrossRefGoogle Scholar
  20. Shambaugh GE, Arenberg IK, Barney PL, Valvassori GE (1969) Facial neurilemmomas: a study of four diverse cases. Arch Otolaryngol 90:742–755PubMedCrossRefGoogle Scholar
  21. Sherman JD, Dagnew E, Pensak ML, van Loveren HR, Tew JM (2002) Facial nerve schwannomas. Report of 10 cases and review of the literature. Neurosurgery 50:450–456PubMedGoogle Scholar
  22. Strauss C, Prell J, Rampp S, Romstöck J (2006a) Split facial nerve course in vestibular schwannomas. J Neurosurg 105:698–705PubMedCrossRefGoogle Scholar
  23. Strauss C, Romstöck J, Fahlbusch R, Rampp S, Scheller C (2006b) Preservation of facial nerve function after postoperative vasoactive treatment in vestibular schwannoma surgery. Neurosurgery 59:577–584PubMedCrossRefGoogle Scholar
  24. Symore L, Cheesman AD, Kawauchi M, Bordi L (1993) Schwannomas of the facial nerve: a report of 12 cases. Br J Neurosurg 7:13–22CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2012

Authors and Affiliations

  • Christian Scheller
    • 1
  • Alex Alfieri
    • 1
  • Elmar Peschke
    • 2
  • Christian Strauss
    • 1
  1. 1.Department of NeurosurgeryMartin Luther University of Halle-WittenbergHalleGermany
  2. 2.Institute of AnatomyMartin Luther University of Halle-WittenbergHalleGermany

Personalised recommendations