Intratemporal facial nerve schwannoma: clinical presentation and management

Abstract

Facial nerve schwannoma is the most common facial nerve tumor, but its therapeutic strategy remains debated. The aim of this study is to analyze the facial nerve function and the hearing outcomes after surgery or wait-and-scan policy in a facial nerve schwannoma series. A monocentric retrospective review of medical charts of patients followed for an intratemporal facial nerve schwannoma between 1988 and 2013 was performed. Twenty-two patients were included. Data were extracted pertaining to the following variables: patient demographics, tumor localization, clinical and imaging features, facial nerve function and hearing levels, and details of surgical intervention. The majority of tumors were located at the geniculate ganglion. Initial symptoms were mainly facial palsy and hearing loss. The average follow-up was 4.8 ± 4.5 years. Nineteen patients underwent surgery, and three patients were observed. After surgery, 11 patients had a stable or improved facial nerve function (57.9 %), and 8 patients had a worsened facial nerve function (42.1 %). Facial nerve function was in the majority of cases a HB grade III, depending on surgical strategy. No patient presented a postoperative HB grade V or VI. Regarding the hearing, it remained stable after surgery in 52.6 % of cases, and improved in 10.5 % of cases. Among monitored patients, facial nerve function and hearing remained stable. Surgery for facial nerve schwannoma is a safe and effective option in the treatment of these tumors.

Management of Facial Nerve Schwannoma: A Multicenter Study of 50 Cases

“…This was consistent with the previous reports. [6][7][8] Accurate diagnosis is crucial in FNs as it will completely change the treatment plan. The most common pathologies to consider in differential diagnosis are VS in case of CPA localization, salivary gland tumor in case of intraparotid localization, and paraganglioma or hemangioma in case of middle ear localization.…”

Geniculate Ganglion Tumors

“…20,22 The complete tumor resection remains the curative treatment for GG tumors, and its indication depends on the preoperative facial nerve function. 3 Indeed, since a FN interruption is necessary in most of the cases to achieve a complete resection, most of the authors advocate surgery when the FN function is at least HB III, 3,20,21,23 or worse. A conservative approach with dissection of the FN was possible in one schwannoma as proposed by others.…”

“…2 It is a benign, encapsulated, slow growing lesion arising from the Schwann cells, that can involve any of the different segments of the FN, the geniculate ganglion (GG) being the most frequent segment involved. 3 FN hemangiomas encompass 0.7% of petrous bone tumors 4 and they have been nowadays reclassified in the group of vascular malformations. 5 As schwannomas, hemangiomas are mainly located in the GG.…”

Cholesteatoma Mimicking Facial Neurinoma: A Case Report

“…The geniculate ganglion fossa is the most common location for facial nerve neurinoma [3,4]. They have reported that facial neurinoma originating in the geniculate ganglion fossa often shows extension to the tympanic and/or labyrinthine segments and that isolated involvement of the geniculate ganglion fossa at the time of the presentation is very rare.…”