Surgical Findings to Differentiate Between Facial Nerve Schwannoma and Vestibular Schwannoma

Lee, Jong Dae; Lee, Won-Sang

doi:10.3342/ceo.2014.7.3.157

Cited by 8 publications

(8 citation statements)

References 12 publications

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“…We should specifically note that the incidence of facial schwannomas mimicking vestibular schwannomas has previously been reported between 0.001% and 3.6% 1,4,6,11–14 . Although the true prevalence of mimetic intracranial facial schwannomas is unknown, our incidence of 7.9% is clearly an outlier to the literature.…”

Section: Discussionmentioning

confidence: 60%

“…We should specifically note that the incidence of facial schwannomas mimicking vestibular schwannomas has previously been reported between 0.001% and 3.6%. 1,4,6,[11][12][13][14] Although the true prevalence of mimetic intracranial facial schwannomas is unknown, our incidence of 7.9% is clearly an outlier to the literature. In this study, an intraoperative diagnosis of a facial schwannoma required real-time agreement of both our neurotologist and our neurosurgeon.…”

Section: Discussionmentioning

confidence: 79%

“…Unfortunately, when a facial schwannoma is medial to labyrinthine segment of the nerve, it can be easily confused with the more common vestibular schwannoma on preoperative imaging 3–19 . Because of this, a surgeon might only discover a facial schwannoma while exploring the internal auditory canal (IAC) of a patient initially thought to have a vestibular schwannoma.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4] Unfortunately, when a facial schwannoma is medial to labyrinthine segment of the nerve, it can be easily confused with the more common vestibular schwannoma on preoperative imaging. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Because of this, a surgeon might only discover a facial schwannoma while exploring the internal auditory canal (IAC) of a patient initially thought to have a vestibular schwannoma. If a facial schwannoma could be identified prior to treatment, it might prevent this unwelcome intraoperative finding and possibly prevent facial paresis.…”

Section: Introductionmentioning

confidence: 99%

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Preoperative Differences in Intracranial Facial Versus Vestibular Schwannomas: A Four Nerve Assessment

Klumpp

Arriaga

2021

The Laryngoscope

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Objectives Assesses whether preoperative functional testing can distinguish vestibular schwannomas from facial nerve schwannomas medial to the labyrinthine segment. Study Design Retrospective cohort. Methods Retrospectively review surgically managed intracranial facial and vestibular schwannomas between January 2015 and December 2019 at two tertiary care centers. Patients with neurofibromatosis 2 and surgery for recurrence were excluded. Preoperative functional testing to include House‐Brackmann scores, electroneuronography (ENoG), cervical vestibular evoked myogenic potentials (cVEMP), caloric testing, acoustic brainstem responses (ABRs), acoustic reflexes, and audiograms was compared between the two groups of schwannomas. Results Twelve facial and 128 vestibular schwannomas met inclusion criteria. In only one case was a facial schwannoma diagnosed preoperatively from imaging. No statistically significant difference was found in preoperative House‐Brackmann scores, ENoG, cVEMP, caloric testing, ABRs, or acoustic reflexes. Pure tone average was worse in the vestibular schwannoma group (63 dB [95% CI: 58–68 dB] vs. 46 dB [95% CI: 34–58 dB], P = .01), and the difference was more apparent in the lower frequencies. Word recognition score was better in the facial schwannoma group (66% [95% CI: 45–86%] vs. 41% [95% CI: 34–47%], P = .02). Conclusion Specialized preoperative functional evaluation of the nerves of the internal auditory canal cannot reliably predict the presence of an intracranial facial schwannoma. Hearing is better in facial schwannomas, particularly in the lower frequencies. This should raise the index of suspicion for an intracranial facial schwannoma, especially in candidates for hearing preservation vestibular schwannoma surgery. Level of Evidence 3 Laryngoscope, 131:2098–2105, 2021

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Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 79%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Preoperative Differences in Intracranial Facial Versus Vestibular Schwannomas: A Four Nerve Assessment

Klumpp

Arriaga

2021

The Laryngoscope

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“…For patients who had a decrease of the facial function after surgery, the indication of surgery was for tumor size growth, invaliding dizziness or misdiagnosis with the more common vestibular schwannoma. As a matter of fact, FNS is diagnosed intraoperatively in 3.2% of cases [28].…”

Section: Discussionmentioning

confidence: 99%

Intratemporal facial nerve schwannoma: clinical presentation and management

Lahlou

Nguyen

Russo

et al. 2015

Eur Arch Otorhinolaryngol

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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.

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Delayed Facial Nerve Dysfunction Following CyberKnife® Radiosurgery for Vestibular Schwannoma

Johns,

Ahn,

Rashid

et al. 2024

The Laryngoscope

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ObjectiveThe incidence and risk factors for facial nerve dysfunction (FND) following CyberKnife® therapy for vestibular schwannoma (VS) remain poorly understood. This study investigates whether differential radiation doses to vulnerable segments of the facial nerve may be associated with FND outcomes.MethodsPatients were identified who underwent CyberKnife® radiosurgery for VS at a single institution. Basic demographics, tumor characteristics, and facial nerve function were collected. Total radiation doses to tumor, internal auditory canal (IAC), and labyrinthine segment of facial nerve (LSFN) were evaluated.ResultsSix out of 64 patients experienced FND following CyberKnife® treatment for VS (9.38%, 6/64). Patients with FND were compared to those without FND (control). Of the 64 patients, complete radiation records were obtained for 30 patients (6 FND vs. 24 control). There were no significant differences in demographic or tumor characteristics between control and FND cohorts. More severe FND (HB ≥ 4) had significantly larger tumors (3.74 vs. 1.27 cm3, p = 0.037) with directionally decreased time to FND (3.50 vs. 33.5 months, p = 0.106) than patients with HB < 4, respectively. There were directionally, nonsignificant differences between maximum radiation doses to the LSFN (2492.4 vs. 2557.0 cGy, p = 0.121) and IAC (2877.3 vs. 2895.5 cGy, p = 0.824) between the control and FND cohorts, respectively.ConclusionsFND may represent an underrecognized sequelae of CyberKnife® radiosurgery for VS that can occur many months following treatment. Further studies are needed to elucidate the effect of differential radiation exposure to the facial nerve with FND following treatment.Level of EvidenceIII (Retrospective Cohort Study) Laryngoscope, 2024

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Surgical Findings to Differentiate Between Facial Nerve Schwannoma and Vestibular Schwannoma

Cited by 8 publications

References 12 publications

Preoperative Differences in Intracranial Facial Versus Vestibular Schwannomas: A Four Nerve Assessment

Preoperative Differences in Intracranial Facial Versus Vestibular Schwannomas: A Four Nerve Assessment

Intratemporal facial nerve schwannoma: clinical presentation and management

Delayed Facial Nerve Dysfunction Following CyberKnife® Radiosurgery for Vestibular Schwannoma

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