Facial Nerve Neuroma

Abstract

Facial nerve neuromas are uncommon, slow-growing neoplasms that may occur anywhere along the course of the facial nerve from the brainstem to the facial muscles. The signs and symptoms are characteristic and vary with the anatomic site of origin. Surgery should not be attempted until a complete and thorough diagnostic examination has been completed. The surgeon should be prepared to perform a middle-cranial fossa or translabyrinthine approach in all cases, and must expect to do a nerve graft. The results of 37 patients treated by the author reveal that, under optimal conditions, patients who have had a facial nerve graft, can be expected to regain an average of 80 % facial nerve strength in almost every case. All patients who have had a facial nerve graft will have some degree of synkinesis. No graft was required in 3 patients, and a hypoglossal facial anastomosis was used for one. Facial function was completely normal in 2 patients, 16 had 80 – 90 % return, 5 patients had 50 – 80 % return, 4 had 20 – 50% return, one had no recovery at all and 9 recent patients have not reached the time for their expected recovery. Early diagnosis, prompt surgical removal and VII - VII Nerve graft for facial paralysis of ten or fewer years duration offers patients the best opportunity to avoid a permanent facial palsy.

Bilateral facial nerve schwannomas

“…Intratemporal facial schwannomas comprise 0.8% of all intrapetrous mass lesions [10] with approximately 300 cases reported in the available literature [9]. There are few accounts of bilateral facial schwannomas [1,3,4] and none that we could discover describing the computed tomographic (CT) and magnetic resonance imaging (MRI) findings with subsequent surgical resections of both tumors.…”

Surgical Findings to Differentiate Between Facial Nerve Schwannoma and Vestibular Schwannoma

“…Schwannomas of IAC or CPA arise mainly from the vestibular nerve, while the facial nerve is rarely involved. Several studies have reported facial nerve schwannomas that were initially diagnosed as VS [3,4,6]. However, no useful tools are available for the preoperative determination of the nerve origin of a schwannoma, when the tumor is confined to the IAC or CPA.…”

“…However, facial nerve schwannomas involving the internal auditory canal (IAC) or cerebellopontine angle (CPA) without extension to the labyrinthine segment or beyond have been reported [3,4]. …”

Facial Nerve Schwannoma Involving Middle Cranial Fossa: When the Unilateral Sensorineural Hearing Loss Guide to the Correct Diagnosis

“…Though most schwannomas usually originate in the labyrinthine and tympanic segments above the oval window [5], schwannomas can originate in any other portion of the nerve, such as the internal auditory canal (IAC) or extratemporal area [6].…”