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

2008 ◽  
Vol 87 (10) ◽  
pp. 574-577 ◽  
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.

scholarly journals Gamma Knife surgery for facial nerve schwannomas

2014 ◽  
Vol 121 (Suppl_2) ◽  
pp. 116-122 ◽  
Author(s):  
Ju Hyung Moon ◽  
Won Seok Chang ◽  
Hyun Ho Jung ◽  
Kyu Sung Lee ◽  
Yong Gou Park ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Gamma Knife ◽  
Functional Outcomes ◽  
Gamma Knife Surgery ◽  
Tumor Control ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
The Mean ◽  
Clinical Records ◽  
Facial Nerve Schwannoma

ObjectThe aim of this study was to evaluate the tumor control rate and functional outcomes after Gamma Knife surgery (GKS) among patients with a facial nerve schwannoma.MethodsThe authors reviewed the radiological data and clinical records for 14 patients who had consecutively undergone GKS for a facial nerve schwannoma. Before GKS, 12 patients had facial palsy, 7 patients had hearing disturbance, and 5 patients had undergone partial or subtotal tumor resection. The mean and median tumor volumes were 3707 mm3 and 3000 mm3, respectively (range 117–10,100 mm3). The mean tumor margin dose was 13.2 Gy (range 12–15 Gy), and the mean maximum tumor dose was 26.4 Gy (range 24–30 Gy). The mean follow-up period was 80.7 months (range 2–170 months).ResultsControl of tumor growth was achieved in all 12 (100%) patients who were followed up for longer than 2 years. After GKS, facial nerve function improved in 2 patients, remained unchanged in 9 patients, and worsened in 3 patients. All patients who had had serviceable hearing at the preliminary examination maintained their hearing at a useful level after GKS. Other than mild tinnitus reported by 3 patients, no other major complications developed.ConclusionsGKS for facial nerve schwannomas resulted in excellent tumor control rates and functional outcomes. GKS might be a good primary treatment option for patients with a small- to medium-sized facial nerve schwannoma when facial nerve function and hearing are relatively preserved.

scholarly journals Facial Nerve Meningioma: A Case Mimicking Facial Nerve Schwannoma

2020 ◽  
pp. 014556132096258
Author(s):  
Wei Gao ◽  
Dingjing Zi ◽  
Lianjun Lu
Keyword(s):  
Facial Nerve ◽  
Internal Auditory Canal ◽  
Growth Patterns ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Nerve Reconstruction ◽  
Radiological Features ◽  
Facial Nerve Reconstruction ◽  
Facial Nerve Schwannoma ◽  
Grade Iii

Facial nerve meningioma is exceedingly rare and tends to affect the geniculate ganglion. We present a case of facial nerve meningioma located in the internal auditory canal with a “labyrinthine tail,” mimicking facial nerve schwannoma. The clinical and radiological features, growth patterns, and surgical management were reviewed. Progressive facial paralysis was the main syndrome, similar to other facial nerve tumors. When facial nerve function is worse than House-Brackmann grade III, surgical resection should be performed with facial nerve reconstruction.

Retreatment of vestibular schwannomas with Gamma Knife surgery

2008 ◽  
Vol 109 (Supplement) ◽  
pp. 144-148 ◽  
Author(s):  
Sheri Dewan ◽  
Georg Norén
Keyword(s):  
Facial Nerve ◽  
New England ◽  
Gamma Knife ◽  
Radiation Effects ◽  
Gamma Knife Surgery ◽  
Vestibular Schwannomas ◽  
Tumor Control ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Proton Beam Radiotherapy

Object The response rate of vestibular schwannomas (VSs) to radiosurgery has reached the 97% level in several published series. When failure rarely occurs, some controversy has existed as to whether the tumor has to be resected or can be safely retreated with radiosurgery. The authors retrospectively studied the outcome of retreating 11 patients with Gamma Knife surgery (GKS). Methods The authors studied 11 patients at the New England Gamma Knife Center who had undergone GKS as a second radiosurgical treatment for VS from 1994 to 2007. One patient underwent proton-beam radiotherapy as the first treatment, and the other 10 patients had undergone GKS initially. Tumor control (size before and after the first and the second treatment) was evaluated using MR imaging to demonstrate the course after the 2 treatments. Facial nerve function (House–Brackmann grading system), trigeminal nerve function, hearing (Gardner–Robertson classification), and any adverse radiation effects were evaluated. The prescription dose was 12 Gy (11–13.2 Gy) for both treatments. Results Of the 11 patients, 2 showed increase, 1 had no change, and, in 8, the VS decreased in size after the retreatment. One tumor remained unchanged over the first 6 months, but demonstrated signs of internal necrosis. All patients demonstrated stable facial nerve function. Regarding facial numbness, 2 patients experienced increases, 8 no change, and 1 decreased numbness. There was no functional hearing prior to the second treatment in 10 patients, and hearing was impaired in 1 patient. Adverse radiation effects (slight peduncular edema) were seen in 2 patients after the second treatment, and 1 patient had edema after the first treatment as well. Conclusions Vestibular schwannomas can be retreated with GKS with good tumor control response and low risk of toxicity.

Medial acoustic neuromas: clinical and surgical implications

2014 ◽  
Vol 120 (5) ◽  
pp. 1095-1104 ◽  
Author(s):  
Ian F. Dunn ◽  
Wenya Linda Bi ◽  
Kadir Erkmen ◽  
Paulo A. S. Kadri ◽  
David Hasan ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Hearing Preservation ◽  
Growth Patterns ◽  
Maximum Diameter ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Class A ◽  
Acoustic Neuromas ◽  
Facial Function

Object Medial acoustic neuroma is a rare entity that confers a distinct clinical syndrome. It is scarcely discussed in the literature and is associated with adverse features. This study evaluates the clinical and imaging features, pertinent surgical challenges, and treatment outcome in a large series of this variant. The authors postulate that the particular pathological anatomy with its arachnoidal rearrangement has a profound implication on the surgical technique and outcome. Methods The authors conducted a retrospective analysis of 52 cases involving 33 women and 19 men who underwent resection of medial acoustic neuromas performed by the senior author (O.A.) over a 20-year period (1993–2013). Clinical, radiological, and operative records were reviewed, with a specific focus on the neurological outcomes and facial nerve function and hearing preservation. Intraoperative findings were analyzed with respect to the effect of arachnoidal arrangement on the surgeon's ability to resect the lesion and the impact on postoperative function. Results The average tumor size was 34.5 mm (maximum diameter), with over 90% of tumors being 25 mm or larger and 71% being cystic. Cerebellar, trigeminal nerve, and facial nerve dysfunction were common preoperative findings. Hydrocephalus was present in 11 patients. Distinguishing intraoperative findings included marked tumor adherence to the brainstem and frequent hypervascularity, which prompted intracapsular dissection resulting in enhancement on postoperative MRI in 18 cases, with only 3 demonstrating growth on follow-up. There was no mortality or major postoperative neurological deficit. Cerebrospinal fluid leak was encountered in 7 patients, with 4 requiring surgical repair. Among 45 patients who had intact preoperative facial function, only 1 had permanent facial nerve paralysis on extended follow-up. Of the patients with preoperative Grade I–II facial function, 87% continued to have Grade I–II function on follow-up. Of 10 patients who had Class A hearing preoperatively, 5 continued to have Class A or B hearing after surgery. Conclusions Medial acoustic neuromas represent a rare subgroup whose site of origin and growth patterns produce a distinct clinical presentation and present specific operative challenges. They reach giant size and are frequently cystic and hypervascular. Their origin and growth pattern lead to arachnoidal rearrangement with marked adherence against the brainstem, which is critical in the surgical management. Excellent surgical outcome is achievable with a high rate of facial nerve function and attainable hearing preservation. These results suggest that similar or better results may be achieved in less complex tumors.

Pre-operative and per-operative factors conditioning long-term facial nerve function in vestibular schwannoma surgery through translabyrinthine approach

1998 ◽  
Vol 112 (5) ◽  
pp. 441-445 ◽  
Author(s):  
Olivier Deguine ◽  
André Maillard ◽  
Alain Bonafe ◽  
Hassan El Adouli ◽  
Michel Tremoulet ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Vestibular Schwannoma ◽  
Internal Auditory Canal ◽  
Stage Iv ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Stimulation Threshold ◽  
Translabyrinthine Approach ◽  
Facial Function

AbstractFacial nerve function was evaluated in 103 patients, after vestibular schwannoma removal through the translabyrinthine approach. The mean follow-up was 43 months (minimum six months). Grade I facial function was achieved in 100 per cent of stage I schwannomata compared with 36 per cent of stage IV schwannomata. Grade I or II facial function was found in 78 per cent of homogeneous schwannomata, compared with 48 per cent of heterogeneous schwannomata. Facial function was preserved in 89 per cent of cases, if the angle between the internal auditory canal and the schwannoma was >66°, compared with 54 per cent if the angle was <66°. There was 82 per cent of normal facial function when the nerve appeared normal after tumour removal, compared with 18 per cent when the nerve was traumatized. When the ratio (stimulation threshold at the internal auditory canal/stimulation threshold at brainstem) was <2, postoperative facial function was preserved in 87 per cent of cases, compared with 13 per cent when the ratio was >2.

scholarly journals Surgery versus radiosurgery for facial nerve schwannoma: a systematic review and meta-analysis of facial nerve function, postoperative complications, and progression

2020 ◽  
pp. 1-12
Author(s):  
Juliana Rotter ◽  
Victor M. Lu ◽  
Christopher S. Graffeo ◽  
Avital Perry ◽  
Colin L. W. Driscoll ◽  
...  
Keyword(s):  
Systematic Review ◽  
Facial Nerve ◽  
Meta Analysis ◽  
Management Strategies ◽  
Complication Rates ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Operative Outcomes ◽  
Facial Nerve Schwannoma

OBJECTIVEIntracranial facial nerve schwannomas (FNS) requiring treatment are frequently recommended for surgery or stereotactic radiosurgery (SRS). The objective of this study was to compare facial nerve function outcomes between these two interventions for FNS via a systematic review and meta-analysis.METHODSA search of the Ovid EMBASE, PubMed, SCOPUS, and Cochrane databases from inception to July 2019 was conducted following PRISMA guidelines. Articles were screened against prespecified criteria. Facial nerve outcomes were classified as improved, stabilized, or worsened by last follow-up. Incidence was pooled by random-effects meta-analysis of proportions.RESULTSThirty-three articles with a pooled cohort of 519 patients with FNS satisfied all criteria. Twenty-five articles described operative outcomes in 407 (78%) patients; 10 articles reported SRS outcomes in 112 (22%). In the surgical cohort, facial nerve function improved in 23% (95% CI 15%–32%), stabilized in 41% (95% CI 32%–50%), and worsened in 30% (95% CI 21%–40%). In the SRS cohort, facial nerve function was improved in 20% (95% CI 9%–34%), stable in 66% (95% CI 54%–78%), and worsened in 9% (95% CI 3%–16%). Compared with SRS, microsurgery was associated with a significantly lower incidence of stable facial nerve function (p < 0.01) and a significantly higher incidence of worsened facial nerve function (p < 0.01). Tumor progression and complication rates were comparable. Outcome certainty assessments were very low to moderate for all parameters.CONCLUSIONSUnfavorable facial nerve function outcomes are associated with surgical treatment of intracranial FNS, whereas stable facial nerve function outcomes are associated with SRS. Therefore, SRS should be recommended to patients with FNS who require treatment, and surgery should be reserved for patients with another indication, such as decompression of the brainstem. Further study is required to definitively optimize and validate management strategies for these rare skull base tumors.

Surgery versus Radiosurgery for Facial Nerve Schwannoma: Systematic Review and Meta-analysis of Facial Nerve Function

2020 ◽  
Author(s):  
Juliana Rotter ◽  
Victor M. Lu ◽  
Avital Perry ◽  
Christopher S. Graffeo ◽  
Matthew L. Carlson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Facial Nerve ◽  
Meta Analysis ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Facial Nerve Schwannoma

scholarly journals Gamma Knife radiosurgery for facial nerve schwannomas: a multicenter study

2015 ◽  
Vol 123 (2) ◽  
pp. 387-394 ◽  
Author(s):  
Jason P. Sheehan ◽  
Hideyuki Kano ◽  
Zhiyuan Xu ◽  
Veronica Chiang ◽  
David Mathieu ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Stereotactic Radiosurgery ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Rank Test ◽  
Tumor Control ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Log Rank Test

OBJECT Facial nerve schwannomas (FNSs) are rare intracranial tumors, and the optimal management of these tumors remains unclear. Resection can be undertaken, but the tumor’s intimate association with the facial nerve makes resection with neurological preservation quite challenging. Stereotactic radiosurgery (SRS) has been used to treat FNSs, and this study evaluates the outcome of this approach. METHODS At 8 medical centers participating in the North American Gamma Knife Consortium (NAGKC), 42 patients undergoing SRS for an FNS were identified, and clinical and radiographic data were obtained for these cases. Males outnumbered females at a ratio of 1.2:1, and the patients’ median age was 48 years (range 11–76 years). Prior resection was performed in 36% of cases. The mean tumor volume was 1.8 cm3, and a mean margin dose of 12.5 Gy (range 11–15 Gy) was delivered to the tumor. RESULTS At a median follow-up of 28 months, tumor control was achieved in 36 (90%) of the 40 patients with reliable radiographic follow-up. Actuarial tumor control was 97%, 97%, 97%, and 90% at 1, 2, 3, and 5 years postradiosurgery. Preoperative facial nerve function was preserved in 38 of 42 patients, with 60% of evaluable patients having House-Brackmann scores of 1 or 2 at last follow-up. Treated patients with a House-Brackmann score of 1 to 3 were more likely to demonstrate this level of facial nerve function at last evaluation (OR 6.09, 95% CI 1.7–22.0, p = 0.006). Avoidance of temporary or permanent neurological symptoms was more likely to be achieved in patients who received a tumor margin dose of 12.5 Gy or less (log-rank test, p = 0.024) delivered to a tumor of ≤ 1 cm3 in volume (log-rank test, p = 0.01). CONCLUSIONS Stereotactic radiosurgery resulted in tumor control and neurological preservation in most FNS patients. When the tumor is smaller and the patient exhibits favorable normal facial nerve function, SRS portends a better result. The authors believe that early, upfront SRS may be the treatment of choice for small FNSs, but it is an effective salvage treatment for residual/recurrent tumor that remain or progress after resection.

Long-term outcomes of patients with primary or residual vestibular schwannoma treated with LINAC-based stereotactic radiosurgery: a single-centre experience

2020 ◽  
pp. 1-7
Author(s):  
Patricia Sebastian ◽  
Subhashini John ◽  
Jebakarunya Reddy ◽  
Sunitha Susan Varghese ◽  
Harshad Arvind Vanjare ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Stereotactic Radiosurgery ◽  
Response To Treatment ◽  
Complication Rates ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Tumour Control ◽  
Prior Surgery ◽  
Facial Function

Abstract Aim: Vestibular schwannomas (VS) are benign slow-growing tumours treated either with microsurgery or stereotactic radiosurgery (SRS) or both. The aim of this study was to correlate the outcome factors—tumour control and adverse factors—facial nerve function and hearing loss with patient and treatment factors. Materials and methods: A retrospective review of the records of 98 patients with 99 VS treated from June 2007 to June 2014, all patients receiving Linear Accelerator (LINAC)-based SRS. Results: Median follow-up period was 5·6 years (range: 1–12 years). The response to treatment was stable disease in 37 (37·4%), regression in 46 (46·5%), asymptomatic minimal progression in 9 (9·1%) and symptomatic progression in 5 (5%) and unknown in 2 (2%) patients. There was no evidence of SRS induced tissue damage on magnetic resonance scans for any. Hearing preservation rate after SRS was 92%. The patients who developed worsening of facial function were predominantly in the cohort that had prior surgery. Findings: SRS is an effective modality to treat VS lesser than 3 cm in size. Tumour control rate was 95% with a median follow-up period of 5·6 years. The complication rates were 8% each for facial function worsening and worsening of hearing. Prior surgery was a statistically significant factor that affected facial nerve function deterioration.

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