Facial Schwannoma Treatment via Cyberknife or Decompression

Abstract

Objective: Microsurgical excision of facial nerve schwannomas frequently results in facial paresis or paralysis of House-Brackmann Grade III or higher. This study’s objectives are: 1) describe alternatives to microsurgical excision of facial nerve schwannomas, specifically wide fallopian canal decompression and Cyberknife radiosurgery; and 2) describe clinical outcomes of these alternative therapies. Method: This is a case-control study of all patients undergoing excision, wide fallopian canal decompression, or Cyberknife radiosurgery at a tertiary academic referral center between 2002 and 2011. Main outcome measures were pre- and posttreatment facial nerve function, tumor control, and speech reception thresholds. Results: Eleven patients were identified (3 wide decompression, 2 Cyberknife treated, 4 observation, and 2 microsurgical excision), and mean posttreatment follow-up was 35 months. When compared with excision, all of the cases undergoing nonexcision treatments resulted in facial nerve function stable or improved, no tumor growth, and no changes in speech reception thresholds. Conclusion: While surgical excision of facial nerve schwannomas may be indicated in cases of poor facial function and impending complications, wide bony decompression, observation, and Cyberknife radiosurgery should be considered as alternative treatments to excision for patients with normal or good facial function who wish to maintain preoperative hearing thresholds.