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Facial Nerve Schwannomas: Review of 80 Cases Over 25 Years at Mayo Clinic

Published:October 05, 2016DOI:https://doi.org/10.1016/j.mayocp.2016.07.007

      Abstract

      Objective

      To elucidate the long-term clinical behavior, treatment, and outcomes of sporadic facial nerve schwannoma (FNS) in a large cohort of patients managed in the post–magnetic resonance imaging era.

      Patients and Methods

      Retrospective review at a single tertiary health care system (January 1, 1990, through December 31, 2015), evaluating 80 consecutive patients with sporadic FNS.

      Results

      Ninety-eight patients with FNS were identified; 10 with incomplete data and 8 with neurofibromatosis type 2 were excluded. The remaining 80 patients (median age, 47 years; 58% women) were analyzed. Forty-three (54%) patients presented with asymmetrical hearing loss, 33 (41%) reported facial paresis, and 21 (26%) reported facial spasm. Seventeen (21%) exhibited radiologic features mimicking vestibular schwannoma, 14 (18%) presented as a parotid mass, and 5 (6%) were discovered incidentally. Factors predictive of facial nerve paresis or spasm before treatment were female sex and tumor involvement of the labyrinthine/geniculate and tympanic facial nerve segments. The median growth rate among growing FNS was 2.0 mm/y. Details regarding clinical outcome according to treatment modality are described.

      Conclusion

      In patients with FNS, female sex and involvement of the labyrinthine/geniculate and tympanic segments of the facial nerve predict a higher probability of facial paresis or spasm. When isolated to the posterior fossa or parotid gland, establishing a preoperative diagnosis of FNS is challenging. Treatment should be tailored according to tumor location and size, existing facial nerve function, patient priorities, and age. A management algorithm is presented, prioritizing long-term facial nerve function.

      Abbreviations and Acronyms:

      AAOHNS (American Academy of Otolaryngology-Head and Neck Surgery), CPA (cerebellopontine angle), CT (computed tomography), FNS (facial nerve schwannoma), GTR (gross total resection), HB (House-Brackmann), IAC (internal auditory canal), MRI (magnetic resonance imaging), NF2 (neurofibromatosis type 2), SRS (stereotactic radiosurgery), STR (subtotal resection)
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