Revised Surgical Strategy to Preserve Facial Function After Resection of Facial Nerve Schwannoma

Abstract

Early nerve-sparing tumor resection is designed to minimize facial deficits associated with facial nerve schwannomas. This report aimed to determine optimal treatment approaches and timing in patients with facial nerve schwannomas, especially those with good facial function. Clinical decision making is complicated in patients with good facial nerve function because classical surgical treatment consists of excision of the tumor along with the involved nerve segment, followed by grafting or primary anastomosis, which can result in permanent facial deficits. Since 1995, we have conducted a nerve-preserving technique on 15 patients with facial nerve schwannomas to obtain better results after our experience with the 10 patients who underwent tumor resection and/or facial nerve reconstruction before 1995 and evaluated the surgical outcomes of all 25 patients between 1990 and 2008. The House-Brackmann (HB) grading system for facial nerve function was used to assess preoperative and postoperative functions with follow-up magnetic resonance imaging to monitor for tumor recurrence. At the final functional assessment, 7 patients had no change in facial function, 2 had improved, and 6 had worsened. Specifically, 4 patients had normal facial function, 8 had HB Grade II, and 3 had HB Grade III. To date, no clinical or radiologic evidence of recurrence has been detected in any of the patients, all of whom underwent postoperative enhanced magnetic resonance imaging at least 3 years after surgery. Facial nerve-preserving technique is recommended for resection of facial nerve schwannomas, especially in patients with good preoperative facial function. Compared with the resection-and-reconstruction technique, this method can prevent delays in presurgical deterioration of the neural fascicle and may result in better postoperative facial function.