Facial Nerve Schwannomas: Manchester Skull Base Team Experience

Objective: There is no consensus for the management of facial nerve schwannomas (FNS). We aim to provide a structured approach to their management based on a large series over a 19-year period. Study Design: Retrospective review. Patients/material and Methods: Overall 28 FNS patients were included in the study. Mean age at diagnosis was 46.4 years (range, 22-73). Mean duration of follow-up was 48 months (range, 3-144). Results: Facial weakness was the presenting symptom in 16 patients (57%). Most patients had multisegment involvement; the internal acoustic canal (IAC) was most commonly affected (68%). Fourteen patients were initially managed conservatively; 14 patients received primary surgical intervention. Two patients failed conservative management due to deterioration in facial nerve function and underwent surgery. No patients opted for stereotactic radiotherapy. Ten patients had primary nerve grafting (HB score outcome III/IV in 7/10 patients after mean follow-up of 34 months) and five patients had a staged VII/XII transposition (HB outcome IV in 2/4 patients and HB outcome V in the other two patients [mean follow-up of 25 months, one patient missing data]). Conclusions: The philosophy of our unit in managing FNS is to preserve facial function wherever possible. There is strong evidence from this study that such an approach is valid given the high proportion of patients who had preservation of facial function over the follow-up period and the small number of tumors that showed significant growth.