Management of Facial Nerve Schwannoma: A Multicenter Study of 50 Cases

Adrien A. Eshraghi; Natalie Oker; Emre Ocak; Benjamin Verillaud; Thomas Babcock; Domitille Camous; Adam Kravietz; Jacques Morcos; Philippe Herman; Romain Kania

doi:10.1055/s-0038-1670687

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

J Neurol Surg B Skull Base 2019; 80(04): 352-356
DOI: 10.1055/s-0038-1670687

Original Article

Georg Thieme Verlag KG Stuttgart · New York

Management of Facial Nerve Schwannoma: A Multicenter Study of 50 Cases

Authors

Adrien A. Eshraghi

¹Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, United States

³Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, United States
Natalie Oker

²Department of Otolaryngology, Lariboisière University Hospital, Paris Diderot University, APHP, Paris Sorbonne Cité, Paris, France
Emre Ocak

¹Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, United States
Benjamin Verillaud

²Department of Otolaryngology, Lariboisière University Hospital, Paris Diderot University, APHP, Paris Sorbonne Cité, Paris, France
Thomas Babcock

¹Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, United States
Domitille Camous

²Department of Otolaryngology, Lariboisière University Hospital, Paris Diderot University, APHP, Paris Sorbonne Cité, Paris, France
Adam Kravietz

¹Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, United States
Jacques Morcos

³Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, United States
Philippe Herman

²Department of Otolaryngology, Lariboisière University Hospital, Paris Diderot University, APHP, Paris Sorbonne Cité, Paris, France
Romain Kania

²Department of Otolaryngology, Lariboisière University Hospital, Paris Diderot University, APHP, Paris Sorbonne Cité, Paris, France

Abstract

Objective In the management of facial nerve schwannoma (FNS), surgical tumor resection is now often being replaced with more conservative approaches, such as observation with serial imaging or stereotactic radiosurgery (SRS). Given the scarcity of these lesions, determining the optimal management of FNS remains challenging and subject of debate with multiple treatment approaches supported in the literature.

Methods A retrospective chart review was performed in two academic centers for patients diagnosed with FNS between 1996 and 2017. The clinical presentation, treatment modalities employed, tumor control rates, and facial nerve function (FNF) outcomes (House–Brackmann system) were assessed and analyzed.

Results The study comprised 50 adult patients. Initial treatment modalities included observation with serial clinicoradiologic review in 27 patients (54%), surgery in 17 patients (34%), and SRS in 6 patients (12%). The FNF were decreased in more than half of the patients who had surgery. Nonetheless, more than 80% of the patients who were initially managed with observation or SRS had stable or improved FNF.

Conclusion A prevailing trend toward more conservative treatment modalities for FNS has evolved over time, providing relatively long-term preservation of FNF. As there are multiple management options available, it is of paramount importance that the treating physician be familiar with all treatment modalities and outcomes and counsel patients appropriately. The surgery should be reserved for large tumors and poor FNF at initial presentation or follow-up while watchful observation with imaging is the treatment of choice for rest of the patients.

Keywords

facial nerve schwannoma - outcome - radiosurgery - observation

Full Text

References

References
1 Jacob JT, Driscoll CL, Link MJ. Facial nerve schwannomas of the cerebellopontine angle: the Mayo Clinic experience. J Neurol Surg B Skull Base 2012; 73 (04) 230-235
2 Kubota Y, Kawamata T, Kubo O, Kasuya H, Muragaki Y, Hori T. Large facial nerve schwannomas without facial palsy: case reports and review of the literature. Neurosurg Rev 2005; 28 (03) 234-238
3 Hassouny K, Aderdour L, Benhoummad O. , et al. Bilateral facial nerve schwannoma: a case report. Rev Laryngol Otol Rhinol (Bord) 2014; 135 (4-5): 215-217
4 Sah SK, Guo YY, Mahaseth N, Chen Y, Du S, Li Y. Facial nerve schwannomas: a case series with an analysis of imaging findings. Neurol India 2018; 66 (01) 139-143
5 House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg 1985; 93 (02) 146-147
6 Chung JW, Ahn JH, Kim JH, Nam SY, Kim CJ, Lee KS. Facial nerve schwannomas: different manifestations and outcomes. Surg Neurol 2004; 62 (03) 245-252 , discussion 452
7 Bacciu A, Nusier A, Lauda L, Falcioni M, Russo A, Sanna M. Are the current treatment strategies for facial nerve schwannoma appropriate also for complex cases?. Audiol Neurootol 2013; 18 (03) 184-191
8 Lahlou G, Nguyen Y, Russo FY, Ferrary E, Sterkers O, Bernardeschi D. Intratemporal facial nerve schwannoma: clinical presentation and management. Eur Arch Otorhinolaryngol 2016; 273 (11) 3497-3504
9 Kania RE, Herman P, Tran Ba Huy P. Vestibular-like facial nerve schwannoma. Auris Nasus Larynx 2004; 31 (03) 212-219
10 Bacciu A, Medina M, Ben Ammar M. , et al. Intraoperatively diagnosed cerebellopontine angle facial nerve schwannoma: how to deal with it. Ann Otol Rhinol Laryngol 2014; 123 (09) 647-653
11 Lee JD, Lee WS. Surgical findings to differentiate between facial nerve schwannoma and vestibular schwannoma. Clin Exp Otorhinolaryngol 2014; 7 (03) 157-159
12 Dort JC, Fisch U. Facial nerve schwannomas. Skull Base Surg 1991; 1 (01) 51-56
13 Perez R, Chen JM, Nedzelski JM. Intratemporal facial nerve schwannoma: a management dilemma. Otol Neurotol 2005; 26 (01) 121-126
14 Wilkinson EP, Hoa M, Slattery III WH. , et al. Evolution in the management of facial nerve schwannoma. Laryngoscope 2011; 121 (10) 2065-2074
15 Yang W, Zhao J, Han Y. , et al. Long-term outcomes of facial nerve schwannomas with favorable facial nerve function: tumor growth rate is correlated with initial tumor size. Am J Otolaryngol 2015; 36 (02) 163-165
16 Shi W, Jain V, Kim H. , et al. Fractionated stereotactic radiotherapy for facial nerve schwannomas. J Neurol Surg B Skull Base 2016; 77 (01) 75-80
17 Hasegawa T, Kato T, Kida Y. , et al. Gamma Knife surgery for patients with facial nerve schwannomas: a multi-institutional retrospective study in Japan. J Neurosurg 2016; 124 (02) 403-410
18 Sheehan JP, Kano H, Xu Z. , et al. Gamma Knife radiosurgery for facial nerve schwannomas: a multicenter study. J Neurosurg 2015; 123 (02) 387-394
19 Moon JH, Chang WS, Jung HH, Lee KS, Park YG, Chang JH. Gamma Knife surgery for facial nerve schwannomas. J Neurosurg 2014; 121 (Suppl): 116-122
20 Carlson ML, Deep NL, Patel NS. , et al. Facial nerve schwannomas: review of 80 cases over 25 years at Mayo Clinic. Mayo Clin Proc 2016; 91 (11) 1563-1576
21 McRackan TR, Rivas A, Wanna GB. , et al. Facial nerve outcomes in facial nerve schwannomas. Otol Neurotol 2012; 33 (01) 78-82