Evolution in the management of facial nerve schwannoma

Wilkinson, Eric P.; Hoa, Michael; Slattery, William H.; Fayad, Jose N.; Friedman, Rick A.; Schwartz, Marc S.; Brackmann, Derald E.

doi:10.1002/lary.22141

Cited by 105 publications

(136 citation statements)

References 23 publications

Supporting

Mentioning

124

Contrasting

Unclassified

Order By: Relevance

“…Microsurgical resection can be undertaken to decompress the nerve, 1,17,27 debulk or strip the tumor from the nerve, 12,17,19 or achieve a complete FNS resection with cable grafting or primary anastomosis. 4,22,25 In a cohort of FNS patients with reasonable facial nerve function, Wilkinson et al compared decompression in 21 patients with observation in 15, and they found no significant difference in facial nerve function between the 2 groups after approximately 3 years of follow-up.…”

Section: Resectionmentioning

confidence: 99%

“…4,22,25 In a cohort of FNS patients with reasonable facial nerve function, Wilkinson et al compared decompression in 21 patients with observation in 15, and they found no significant difference in facial nerve function between the 2 groups after approximately 3 years of follow-up. 27 Thus, bony decompression alone does not appear to facilitate preservation of facial nerve function. Tumor resection carries with it the potential for a surgical cure, but it is almost always associated with temporary or permanent facial nerve weakness.…”

Section: Resectionmentioning

confidence: 99%

See 1 more Smart Citation

Gamma Knife radiosurgery for facial nerve schwannomas: a multicenter study

Sheehan

Kano

et al. 2015

JNS

View full text Add to dashboard Cite

F acial nerve schwannomas (FNSs) are rare tumors accounting for 1.9% of all intracranial neuromas and 0.8% of intrapetrous tumors.1 FNS can arise from any segment of the facial nerve, starting at its origin in the cerebellopontine angle and extending to its extracranial components.2 While such neuromas can mimic the radiographic features of the more common vestibular schwannoma, patients with FNS typically present with signs and symptoms of facial nerve dysfunction.The optimal management strategy for FNS patients abbreviatioNs FNS = facial nerve schwannoma; GKRS = Gamma Knife radiosurgery; NAGKC = North American Gamma Knife Consortium; SRS = sterotactic radiosurgery. obJect Facial nerve schwannomas (FNSs) are rare intracranial tumors, and the optimal management of these tumors remains unclear. Resection can be undertaken, but the tumor's intimate association with the facial nerve makes resection with neurological preservation quite challenging. Stereotactic radiosurgery (SRS) has been used to treat FNSs, and this study evaluates the outcome of this approach. methods At 8 medical centers participating in the North American Gamma Knife Consortium (NAGKC), 42 patients undergoing SRS for an FNS were identified, and clinical and radiographic data were obtained for these cases. Males outnumbered females at a ratio of 1.2:1, and the patients' median age was 48 years (range 11-76 years). Prior resection was performed in 36% of cases. The mean tumor volume was 1.8 cm 3 , and a mean margin dose of 12.5 Gy (range 11-15 Gy) was delivered to the tumor. results At a median follow-up of 28 months, tumor control was achieved in 36 (90%) of the 40 patients with reliable radiographic follow-up. Actuarial tumor control was 97%, 97%, 97%, and 90% at 1, 2, 3, and 5 years postradiosurgery. Preoperative facial nerve function was preserved in 38 of 42 patients, with 60% of evaluable patients having HouseBrackmann scores of 1 or 2 at last follow-up. Treated patients with a House-Brackmann score of 1 to 3 were more likely to demonstrate this level of facial nerve function at last evaluation (OR 6.09, p = 0.006). Avoidance of temporary or permanent neurological symptoms was more likely to be achieved in patients who received a tumor margin dose of 12.5 Gy or less (log-rank test, p = 0.024) delivered to a tumor of ≤ 1 cm 3 in volume (log-rank test, p = 0.01). coNclusioNs Stereotactic radiosurgery resulted in tumor control and neurological preservation in most FNS patients. When the tumor is smaller and the patient exhibits favorable normal facial nerve function, SRS portends a better result. The authors believe that early, upfront SRS may be the treatment of choice for small FNSs, but it is an effective salvage treatment for residual/recurrent tumor that remain or progress after resection.

show abstract

Section: Resectionmentioning

confidence: 99%

Section: Resectionmentioning

confidence: 99%

Gamma Knife radiosurgery for facial nerve schwannomas: a multicenter study

Sheehan

Kano

et al. 2015

JNS

View full text Add to dashboard Cite

show abstract

“…19 With regard to tumor size, there was 93% tumor control rate, while 7% of patients had an increase in tumor size following GKS. All our patients who underwent GKS had normal to near-normal (HB 1 to 2) facial function preoperatively.…”

Section: 1718mentioning

confidence: 94%

“…In our series, three patients underwent tumor removal with preservation of nerve continuity and all of these tumors were relatively small. While some centers have advocated nerve preservation surgery by teasing the tumor off the facial nerve as a method to preserve normal facial function, 3,4,9,[19][20][21] this has not been our experience. In the three patients of our series who underwent tumor removal with preservation of nerve continuity, the final facial nerve outcome decreased in all patients to HB 3 from HB 1 to 2.…”

Section: 1718mentioning

confidence: 96%

Facial Nerve Schwannomas of the Cerebellopontine Angle: The Mayo Clinic Experience

Jacob¹,

Driscoll²,

Link³

2012

J Neurol Surg B

View full text Add to dashboard Cite

“…Despite recent microsurgical techniques, it is still challenging to avoid deterioration of facial nerve function after complete resection. 4,23,24,30 Tumor resection with nerve reconstruction results in facial nerve recovery of HouseBrackmann (HB) Grade III at best. 24,27,28 Consequently, observation using serial follow-up imaging has been the primary course of management for most asymptomatic patients or those with mild facial palsy.…”

mentioning

confidence: 99%

Gamma Knife surgery for patients with facial nerve schwannomas: a multiinstitutional retrospective study in Japan

Hasegawa

Kato

Kida

et al. 2016

JNS

View full text Add to dashboard Cite

obJective The aim of this study was to explore the efficacy and safety of stereotactic radiosurgery for patients with facial nerve schwannomas (FNSs). methods This study was a multiinstitutional retrospective analysis of 42 patients with FNSs treated with Gamma Knife surgery (GKS) at 1 of 10 medical centers of the Japan Leksell Gamma Knife Society (JLGK1301). The median age of the patients was 50 years. Twenty-nine patients underwent GKS as the initial treatment, and 13 patients had previously undergone surgery. At the time of the GKS, 33 (79%) patients had some degree of facial palsy, and 21 (50%) did not retain serviceable hearing. Thirty-five (83%) tumors were solid, and 7 (17%) had cystic components. The median tumor volume was 2.5 cm 3 , and the median prescription dose to the tumor margin was 12 Gy. results The median follow-up period was 48 months. The last follow-up images showed partial remission in 23 patients and stable tumors in 19 patients. Only 1 patient experienced tumor progression at 60 months, but repeat GKS led to tumor shrinkage. The actuarial 3- and 5-year progression-free survival rates were 100% and 92%, respectively. During the follow-up period, 8 patients presented with newly developed or worsened preexisting facial palsy. The condition was transient in 3 of these patients. At the last clinical follow-up, facial nerve function improved in 8 (19%) patients, remained stable in 29 (69%), and worsened in 5 (12%; House-Brackmann Grade III in 4 patients, Grade IV in 1 patient). With respect to hearing function, 18 (90%) of 20 evaluated patients with a pure tone average of ≤ 50 dB before treatment retained serviceable hearing. coNclusioNs GKS is a safe and effective treatment option for patients with either primary or residual FNSs. All patients, including 1 patient who required repeat GKS, achieved good tumor control at the last follow-up. The incidence of newly developed or worsened preexisting facial palsy was 12% at the last clinical follow-up. In addition, the risk of hearing deterioration as an adverse effect of radiation was low. These results suggest that GKS is a safe alternative to resection.

show abstract

Evolution in the management of facial nerve schwannoma

Cited by 105 publications

References 23 publications

Gamma Knife radiosurgery for facial nerve schwannomas: a multicenter study

Gamma Knife radiosurgery for facial nerve schwannomas: a multicenter study

Facial Nerve Schwannomas of the Cerebellopontine Angle: The Mayo Clinic Experience

Gamma Knife surgery for patients with facial nerve schwannomas: a multiinstitutional retrospective study in Japan

Contact Info

Product

Resources

About