Intratemporal Facial Nerve Schwannoma: A Management Dilemma

Perez, Ronen; Chen, Joseph M.; Nedzelski, Julian M.

doi:10.1097/00129492-200501000-00022

Cited by 71 publications

(78 citation statements)

References 9 publications

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“…Most untreated FNSs grow an average of 1.4 mm per year in the absence of treatment. 19 In a series of 13 patients followed conservatively for a median duration of 6 years (range 1-19 years), 38% had facial nerve functional deterioration. 19 While the timing and choice of approaches remain the subject of considerable debate, treatment of some form is generally required for patients with an FNS.…”

Section: Discussion the Diagnosis And Natural History Of Fnsmentioning

confidence: 99%

“…Microsurgical resection can be undertaken to decompress the nerve, 1,17,27 debulk or strip the tumor from the nerve, 12,17,19 or achieve a complete FNS resection with cable grafting or primary anastomosis. 4,22,25 In a cohort of FNS patients with reasonable facial nerve function, Wilkinson et al compared decompression in 21 patients with observation in 15, and they found no significant difference in facial nerve function between the 2 groups after approximately 3 years of follow-up.…”

Section: Resectionmentioning

confidence: 99%

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Gamma Knife radiosurgery for facial nerve schwannomas: a multicenter study

Sheehan

Kano

et al. 2015

JNS

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F acial nerve schwannomas (FNSs) are rare tumors accounting for 1.9% of all intracranial neuromas and 0.8% of intrapetrous tumors.1 FNS can arise from any segment of the facial nerve, starting at its origin in the cerebellopontine angle and extending to its extracranial components.2 While such neuromas can mimic the radiographic features of the more common vestibular schwannoma, patients with FNS typically present with signs and symptoms of facial nerve dysfunction.The optimal management strategy for FNS patients abbreviatioNs FNS = facial nerve schwannoma; GKRS = Gamma Knife radiosurgery; NAGKC = North American Gamma Knife Consortium; SRS = sterotactic radiosurgery. 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 cm 3 , 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 HouseBrackmann 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, 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 cm 3 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.

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Section: Discussion the Diagnosis And Natural History Of Fnsmentioning

confidence: 99%

Section: Resectionmentioning

confidence: 99%

Gamma Knife radiosurgery for facial nerve schwannomas: a multicenter study

Sheehan

Kano

et al. 2015

JNS

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show abstract

“…In a recent study, a cohort of 13 patients was followed conservatively (12). It has been shown that facial nerve deterioration was observed in 38% of patients during a median follow-up period of 6 years (range, 1-19 yr).…”

Section: Timing and Modalities Of Treatmentmentioning

confidence: 99%

Gamma Knife Surgery for Facial Nerve Schwannomas

Cf¹,

Gp²,

Tamura³

et al. 2008

Progress in Neurological Surgery

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“…Uncommonly, facial nerve schwannomas extend to involve the middle cranial fossa by means of direct upward spread through the roof of the temporal bone or anterior spread through the facial hiatus for the greater superficial petrosal nerve (12) . These are extremely slow growing (6) . Facial weakness is most common symptom (7) .…”

Section: Discussionmentioning

confidence: 99%

“…Recurrence is rare. Some authors believe that it is possible to surgically remove these tumors while sparing the nerve (6) . Some emphasize the necessity of an 'en masse` tumour-nerve removal and use of a cable graft from greater auricular nerve (13,14) , or a hypoglossal facial nerve anastomosis (15) to repair the defect.…”

Section: Discussionmentioning

confidence: 99%