Revised Surgical Strategy to Preserve Facial Function After Resection of Facial Nerve Schwannoma

Background Three patients with large intratemporal facial schwannomas underwent tumor removal and facial nerve reconstruction with hypoglossal anastomosis. The surgical strategy for the cases was tailored to the location of the mass and its extension along the facial nerve. Aim To provide data on the different clinical aspects of facial nerve schwannoma, the appropriate planning for management, and the predictive outcomes of facial function. Patients Three patients with facial schwannomas (two men and one woman, ages 45, 36, and 52 years, respectively) who presented to the clinic between 2009 and 2015 were reviewed. They all had hearing loss but normal facial function. All patients were operated on with radical tumor removal via mastoidectomy and subtotal petrosectomy and simultaneous cranial nerve (CN) 7– CN 12 anastomosis. Results Multiple segments of the facial nerve were involved ranging in size from 3 to 7 cm. In the follow-up period of 9 to 24 months, there was no tumor recurrence. Facial function was scored House-Brackmann grades II and III, but two patients are still in the process of functional recovery. Conclusion Conservative treatment with sparing of the nerve is considered in patients with small tumors. Excision of a large facial schwannoma with immediate hypoglossal nerve grafting as a primary procedure can provide satisfactory facial nerve function. One of the disadvantages of performing anastomosis is that there is not enough neural tissue just before the bifurcation of the main stump to provide neural suturing without tension because middle fossa extension of the facial schwannoma frequently involves the main facial nerve at the stylomastoid foramen. Reanimation should be processed with extensive backward mobilization of the hypoglossal nerve.

Download Full-text

Management of Facial Nerve Schwannoma in Patients With Favorable Facial Function

The Laryngoscope ◽

10.1097/mlg.0b013e31804b1a51 ◽

2007 ◽

Vol 117 (6) ◽

pp. 1063-1068 ◽

Cited By ~ 24

Author(s):

Jong Dae Lee ◽

Sung Huhn Kim ◽

Mee Hyun Song ◽

Ho-Ki Lee ◽

Won-Sang Lee

Keyword(s):

Facial Nerve ◽

Facial Nerve Schwannoma ◽

Facial Function

Download Full-text

A Large Intratemporal Facial Nerve Schwannoma Presenting as an Occluding External Auditory Canal Mass

Ear Nose & Throat Journal ◽

10.1177/01455613211016706 ◽

2021 ◽

pp. 014556132110167

Author(s):

Jin-Yu Zhu ◽

Bei-Bei Yang

Keyword(s):

Facial Nerve ◽

Surgical Resection ◽

External Auditory Canal ◽

Treatment Process ◽

Function Recovery ◽

Facial Nerve Schwannoma ◽

Slow Growing ◽

Facial Function ◽

Better Than

Facial nerve schwannomas are rare, benign, slow-growing tumors that can occur in any segment of the facial nerve, although 71% of cases are intratemporal. Surgical resection can lead to facial nerve injury. Facial function recovery after reanimation is usually not better than House-Brackmann (HB) grade III. Thus, for cases of intratemporal facial nerve schwannomas (IFNSs) with favorable facial function (HB grade I or II), observation by periodic magnetic resonance imaging is the mainstay of management. Here, we present a case of a large IFNS with normal facial function in which the mass fully occluded the external auditory canal. The occlusion caused squamous debris to accumulate, potentially leading to cholesteatoma. Faced with this therapeutic dilemma, we chose surgical resection with the patient’s informed consent. Stripping surgery was achieved with normal postoperative facial function. There was no postoperative facial paralysis or recurrence at 2-year follow-up. We describe the experience of diagnosis and treatment process for this case, and discuss the possibility of total resection of the tumor with preserving the integrity of facial nerve.

Download Full-text

Intraparotid facial nerve schwannoma: literature review and classification proposal

The Journal of Laryngology & Otology ◽

10.1017/s0022215107006937 ◽

2007 ◽

Vol 121 (8) ◽

pp. 707-712 ◽

Cited By ~ 29

Author(s):

D Marchioni ◽

M Alicandri Ciufelli ◽

L Presutti

Keyword(s):

Facial Nerve ◽

Functional Outcomes ◽

Therapeutic Decision ◽

Pathological Characteristics ◽

Variable Section ◽

Pathological Evaluation ◽

Therapeutic Decision Making ◽

Facial Nerve Schwannoma ◽

Facial Function ◽

Supply Information

AbstractObjective:The aim of this review was to assess and describe the pathological characteristics of intraparotid facial nerve schwannoma, in order to facilitate correct prognostic evaluation and appropriate therapeutic decision making.Study design and setting:The literature was reviewed regarding involvement of the various portions of the facial nerve. A classification is proposed, based on anatomical and pathological evaluations, which can supply important information on facial functional outcomes.Results:From this study, two important characteristics of facial nerve schwannoma emerged: the schwannoma may be capable of surgical dissection from the facial nerve, leaving the latter anatomically preserved; or it may be tightly bound to the nerve, in which case it must be removed along with a variable section of nerve tract, followed by reconstruction.Conclusions:The extent of the neoplasm and the involvement of different branches of the facial nerve are very important elements to consider when evaluating prognosis and therapy.Significance:To emphasise the usefulness of a classification, based on anatomical and pathological evaluation, which can supply information about post-operative facial function.

Download Full-text

An Alternative Treatment for Facial Nerve Tumors: Short-Term Results of Radiotherapy

Ear Nose & Throat Journal ◽

10.1177/014556130808701011 ◽

2008 ◽

Vol 87 (10) ◽

pp. 574-577 ◽

Cited By ~ 11

Author(s):

Todd A. Hillman ◽

Douglas A. Chen ◽

Russell Fuhrer

Keyword(s):

Facial Nerve ◽

Medical Records ◽

The Other ◽

Tumor Control ◽

Nerve Function ◽

Facial Nerve Function ◽

Short Term ◽

Hearing Results ◽

Facial Nerve Schwannoma ◽

Facial Function

A review of medical records of patients undergoing radiotherapy for facial nerve tumors was undertaken to determine subsequent facial nerve results, hearing results, and tumor control. Two patients with facial nerve tumors received this treatment. Facial nerve function remains excellent in one patient and significantly improved in the other. Neither tumor demonstrated growth. Current philosophies of facial nerve schwannoma management attempt to balance tumor control with facial nerve function. Radiotherapy for these tumors appears to preserve short-term facial function and may be a viable alternative to surgical management.

Download Full-text

Facial nerve schwannoma in the cerebellopontine cistern. Findings on high resolution CT and MR cisternography

British Journal of Neurosurgery ◽

10.1080/02688699943376 ◽

1999 ◽

Vol 13 (5) ◽

pp. 512-515 ◽

Cited By ~ 1

Author(s):

N. Yokota ◽

T. Yokoyama ◽

S. Nishizawa

Keyword(s):

High Resolution ◽

Facial Nerve ◽

Mr Cisternography ◽

High Resolution Ct ◽

Facial Nerve Schwannoma

Download Full-text

Surgical Management of Intracranial Facial Nerve Schwannoma

Skull Base ◽

10.1055/s-2007-984206 ◽

2007 ◽

Vol 17 (S 1) ◽

Author(s):

E. Sauvaget ◽

J. Cornelius ◽

R. Kania ◽

P. Herman ◽

P. Tran Ba Huy

Keyword(s):

Facial Nerve ◽

Surgical Management ◽

Facial Nerve Schwannoma

Download Full-text

Facial Nerve Schwannoma: The Rare/Great Mimicker of Vestibular Schwannoma/Neuroma

Indian Journal of Radiology and Imaging ◽

10.1055/s-0041-1734356 ◽

2021 ◽

Author(s):

Deepthi Pathapati ◽

Kiran Barla ◽

Monal Dayal ◽

Rajitha Gati ◽

Praveen Kumar Lakota

Keyword(s):

Facial Nerve ◽

Schwann Cells ◽

Benign Tumors ◽

Facial Weakness ◽

Vestibulocochlear Nerve ◽

Seventh Nerve ◽

Clinical Presentations ◽

Topographical Anatomy ◽

Facial Nerve Schwannoma ◽

Early Surgical Intervention

AbstractSchwannomas are benign tumors arising from Schwann cells which are a protective casing of nerves, composing myelin sheath and can develop in any nerve where Schwann cells are present. Most common are vestibulocochlear nerve schwannomas. Facial nerve schwannomas (FNSs) are uncommon tumors involving seventh nerve of which geniculate ganglion involvement is most common. Clinical presentations and the imaging appearances of FNSs are influenced by the topographical anatomy of the facial nerve and vary according to the segments involved. We report a case of 73-year-old man presenting with right side facial weakness of lower motor neuron type involvement. Computed tomography and magnetic resonance imaging are clinching the diagnosis. An early diagnosis is important in containing the disease facilitating early surgical intervention.

Download Full-text