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

Abstract

Objective In the management of facial nerve schwannoma (FNS), surgical tumor resection is now often being replaced with more conservative approaches, such as observation with serial imaging or stereotactic radiosurgery (SRS). Given the scarcity of these lesions, determining the optimal management of FNS remains challenging and subject of debate with multiple treatment approaches supported in the literature. Methods A retrospective chart review was performed in two academic centers for patients diagnosed with FNS between 1996 and 2017. The clinical presentation, treatment modalities employed, tumor control rates, and facial nerve function (FNF) outcomes (House–Brackmann system) were assessed and analyzed. Results The study comprised 50 adult patients. Initial treatment modalities included observation with serial clinicoradiologic review in 27 patients (54%), surgery in 17 patients (34%), and SRS in 6 patients (12%). The FNF were decreased in more than half of the patients who had surgery. Nonetheless, more than 80% of the patients who were initially managed with observation or SRS had stable or improved FNF. Conclusion A prevailing trend toward more conservative treatment modalities for FNS has evolved over time, providing relatively long-term preservation of FNF. As there are multiple management options available, it is of paramount importance that the treating physician be familiar with all treatment modalities and outcomes and counsel patients appropriately. The surgery should be reserved for large tumors and poor FNF at initial presentation or follow-up while watchful observation with imaging is the treatment of choice for rest of the patients.

Intratemporal Facial Nerve Schwannomas: A Review of 45 Cases in A Single Center

“…If the preoperative House–Brackmann grade is ≥3, total tumor resection and nerve transplant reconstruction are indicated. Similar opinions have been expressed in previous literature [ 16 , 17 ]. The facial nerve function after reconstruction improves as the period of facial nerve paralysis before surgery becomes shorter.…”

A Rare Case of an Undiagnosed Middle Ear Tumor Due to Late Referral

“…The main aim is to preserve facial function at the most favorable level for the longest period. Eshraghi et al concluded that wait and watch management results in the best facial nerves outcomes [7]. In patients with favorable facial nerve function (HB<III) and stable tumor size, observation with serial imaging is preferred until the facial nerve function deteriorates.…”

Middle fossa approach for a facial nerve schwannoma: how I do it

“…The main limitations of the MFA include the risk of seizures and possible language impairment in the dominant hemisphere secondary to excessive retraction of the temporal lobe, the difficulty in resecting larger tumors, the narrow surgical corridor offered, and the tight exposure of posterior fossa, which might limit the resection of lesions with a significant cisternal component projecting downwards to the lower CPA floor. The vestibule and the cochlea can be injured during drilling of the bone above the labyrinthine segment of the facial nerve at the lateral part of the IAM [ 1 , 4 , 9 , 10 ].…”