Case Of Facial Schwannoma Research Articles

Clinical analysis of 32 cases of facial nerve schwannomas

Objective:To elucidate the clinical characteristics, surgical strategy, facial nerve repair methods and outcomes of facial nerve schwannomas（FNS）. Methods:The clinical data of patients with FNS treated between January 2010 and December 2018 at Sun Yat-sen Memorial Hospital of Sun Yat-sen University were retrospectively collected, including the sidedness of FNS, clinical manifestations, imaging data, the extent of tumor, clinical management, preoperative and postoperative facial nerve function. Results:The major clinical manifestations of the 32 patients with FNS were facial palsy（27, 84.4%）, hearing loss（27, 84.4%）, tinnitus（22, 68.8%）, ear mass（15, 46.9%）, and stuffy feeling in the ear（13, 40.6%） respectively. Thirty patients were preoperatively diagnosed with FNS and 2 patients were misdiagnosed. 31 patients underwent resection of FNS, except one patient who was selected for long-term follow-up observation. The choice of surgical approach was based on the location, extent and auditory function of the FNS involved as well as the patient's wishes. The surgical approach was decided based on the location and extent of the tumor: 9 patients were operated via the inferior temporal fossa type A（Fisch A） approach; 8 patients were operated via the mastoid approach; 7 patients were operated via the enlarged mastoid approach; 3 patients were operated via the combined mastoid-cranial middle fossa approach; 1 patient was operated via the cranial middle fossa approach; 3 patients were operated via the combined Fisch A-cranial middle fossa approach. 28 patients（87.5%） had FNS with multiple segments of facial nerve involved. The most involved segment was the vertical segment of the facial nerve（26, 81.3%）. 15 patients underwent facial nerve repair simultaneously, including 7 cases of auricular nerve-facial nerve graft and 8 cases of facial nerve-sublingual nerve anastomosis. 4 cases had improved facial nerve function after auricular nerve-facial nerve graft and 2 cases had improved function after facial nerve-sublingual nerve anastomosis. Among patients who underwent facial nerve repair,the best outcome was H-B Ⅲ. Conclusion:The patients with FNS mainly presented with facial palsy and hearing loss. Temporal bone CT and cranial MR plain & enhanced scan served well to confirm the diagnosis. The improvement rate of postoperative facial nerve function was significantly higher in patients who underwent nerve repair than in those who did not. Hence, facial nerve repair should be considered. Compared with facial nerve-sublingual nerve anastomosis, auricular major nerve-facial nerve graft might be a better choice for improving postoperative facial nerve function.

Multicentric Intra/Extracranial Cystic Facial Nerve Schwannoma: Case Report and Review of Literature.

To report a case of facial nerve schwannoma which presented a diagnostic and management challenge because of unusual multicentric cystic presentation. A 25-year-old female patient with a history of deep facial pain, parotid gland swelling and normal facial function showed multiple expansive cystic lesions of the temporal bone and parotid gland which turned out to be multicentric cystic facial nerve schwannomas. One should be keep this diagnosis in mind when dealing with a cystic lesions of the temporal bone and parotid gland.

Long-term results of Gamma Knife radiosurgery for facial nerve schwannomas

ABSTRACT Objective Long-term outcomes of eleven cases of facial nerve schwannoma were evaluated and the related literature was reviewed to determine the efficacy of Gamma Knife radiosurgery for treating patients with facial nerve schwannoma. Methods Eleven patients with facial nerve schwannoma (7 women and 4 men; mean age, 44.2 years; range, 19–73 years) underwent Gamma Knife radiosurgery. The most common symptoms were facial palsy (n = 10) and hearing loss (n = 7). Five patients presented with headache. Two patients had undergone prior resection. The patients’ clinical and radiographic data were evaluated retrospectively. Results For the 11 cases of facial nerve schwannoma, mean tumor volume was 3.1 cm3 (range, 0.4–7.4 cm3) and the mean marginal dose applied was 11.9 Gy (range, 11–13 Gy). The mean follow-up period was 84.3 months (range, 66–117 months). Tumor control was achieved in all patients. At the time of writing, four patients experienced tumor volume regression and the other seven were in stable condition. During follow-up, nine patients experienced no change in their facial function, two experienced deteriorated facial function, and none developed new facial palsy. Ten patients who had serviceable hearing prior to Gamma Knife radiosurgery retained their hearing. Conclusions Gamma Knife radiosurgery achieves excellent results with respect to tumor control for 7 years on average. In addition, Gamma Knife radiosurgery provides good results in facial nerve and hearing function at long term. Our series demonstrates that Gamma Knife radiosurgery is an effective and safe treatment for patients with either primary or residual facial nerve schwannoma.

The Schwannoma of the facial nerve in the extra-skull segment – a case report

The aim of the report is to present a rare case of facial schwannoma in the parotid gland. Schwannomas are benign, well-defined tumors arising from Schwann cells that form myelin sheaths of peripheral, cranial or spinal nerves. 25-45% of them are located within the head and neck, mainly in the parapharyngeal space. The intraparotid location is rare. The etiology of cancer is unknown. Preoperative diagnosis, both radiological and cytological, is difficult and often does not give the correct diagnosis. Radiologically, a multiform adenoma is usually suspected, and the fine needle biopsy is non-diagnostic. Due to the rarity and benign nature of the tumor, there is a debate about the need for surgical treatment.

Clinical diagnosis and surgical management of 110 cases of facial nerve schwannomas

Objective: To elucidate the clinical behavior, causes of misdiagnosis, surgical management, and outcomes of facial nerve schwannomas (FNS). Methods: A retrospective review in Chinese People's Liberation Army General Hospital from January 1, 2002 to December 31, 2015 was carried out and evaluated 110 patients with FNS, including 50 males and 60 females, aged 16-67 years old. The appropriate surgical strategy was selected based on each patient's clinical manifestations, facial nerve function, and imaging characteristics. After surgery, patients received follow-up visits to assess their facial nerve functions, with the effect of treatment compared to the reality before surgery. The Kruskal-Wallis H test was used to distinguish between the pre- and post-operation facial nerve functions in patients who had different facial nerve functions before the operations. Results: 110 cases of FNS mainly presented with facial paralysis, hearing loss, tinnitus, otalgia, dizziness, and facial spasm. 20 of the cases were misdiagnosed as Bell's Palsy, 6 were mistaken for chronic otitis media/cholesteatoma with radical mastoidectomy, 3 were mistaken for Meniere's disease, 1 was misdiagnosed as petrous bone cholesteatoma, and 4 were mistaken for acoustic neuroma. 81.8 % (90/110) of the patients had multiple segments of the facial nerve, including the vertical segment of the facial nerve, accounting for 65.5% (72/110), followed by the labyrinthine/geniculate segment, for 61.8% (68/110), and the horizontal segment, for 55.5% (61/110). The appropriate surgical approaches were chosed based on the sizes and scopes of the tumors evaluated by imaging: transmastoid approach in 73 cases, translabyrinthe approach in 14 cases, middle cranial fossa approach in 13 cases, retrosigmoid approach in 3 cases, transmastoid-middle cranial fossa approach in 3 cases, and transmastoid-neck approach in 4 cases, with all the patients undergoing a total/subtotal resection of the tumor. Eighty-seven patients had their facial nerves reconstructed. Among them, 6 received facial nerve end-to-end anastomosis, 55 received great auricular nerve graft, and 26 were subjected to facial nerve-hypoglossal nerve anastomosis. Because of long histories, facial muscle atrophies, or other reasons, the remaining patients were not received facial nerve reconstruction. The House-Brackmann(H-B) grading scale was used to evaluate the facial nerve function pre- and post-operation. Patients with better facial nerve functions and shorter history of facial paralysis before operation would get relatively better facial nerve function. The before and after operation comparisons revealed that the recovery of the facial nerve functions in patients with H-B Ⅰ-Ⅲ was better than the improvement in patients with H-B Ⅳ-Ⅴ. The difference was statistically significant (Kruskal-Wallis H test, H=8.508, P<0.05). Conclusions: The diagnosis of patients with unknown facial paralysis, hearing loss, and tinnitus should take into account the possibility of FNS. CT and other imaging examinations of the temporal bone can avoid misdiagnosis and determine the tumor size and extent of lesions, as well as provide the basis for the choice of the surgical approach. After tumors have been completely resected, facial nerve reconstruction can be performed simultaneously, according to the defect of the nerve.

A rare case of facial nerve schwannoma masked by a concomitant temporomandibular disorder pain

Abstract Facial nerve schwannoma (FNS) is an uncommon benign tumor that arises from the Schwann cells of the facial nerve (FN). Although rare, this is the most frequent type of FN tumor, potentially affecting any segment of the nerve. Nevertheless, a higher incidence of intracranial lesions and a predilection for the geniculate ganglion has been reported. Hearing loss, facial paresis and tinnitus are the most frequent symptoms. Conversely, pain, is not among the most prominent complaints and when present, it can be misdiagnosed as an orofacial pain of other source, including pain due to a temporomandibular disorder (TMD). In this paper, we describe a rare case of a patient presenting a FNS located in the intratemporal part and geniculate ganglion of the FN, which was initially masked by the symptoms of a coexistent TMD. It highlights the importance of considering intracranial tumors in the differential diagnosis of orofacial pains.

Diagnostic Paradox behind Facial Nerve Schwannoma

Background: Schwannomas are benign and slow growing tumors that arise from the Schwann cells which ensheath the axons of peripheral nerve, cranial nerve and autonomic nervous system. A schwannoma of facial nerve may originate from extra or intra cranial segments of the nerve. Most of the facial nerve schwannomas originate from intra-tympanic region. In decreasing order of their frequency, schwannomas were found along the tympanic, mastoid (vertical), labrynthine and meatal segments of the facial nerve. It is an extremely rare entity as malignant degeneration of schwannomas is not frequent. A high level of clinical suspicion with detailed neuro-otological and radiological studies play important role in preoperative diagnosis of schwannomas. Case presentation: We reported a case of 35-year-old male with progressive right sided facial asymmetry, sudden onset hearing loss and non-pulsatile tinnitus in right ear. The patient’s presentation and diagnostic examinations helped us to reach a provisional diagnosis though final diagnosis was done on the basis of histopathological examination of the excised tumor which was suggestive of facial nerve schwannoma. Conclusion: The rare and inconsistent clinical presentation and radiological pattern of facial schwannoma often leads to a delayed and indefinite diagnosis. The critical step in management of diverse lesion is diagnosis for the management of facial schwannoma. This report is about a challenging case of facial nerve schwannoma in intra-tympanic region which was diagnosed and managed in our institution.

Stripping surgery in facial nerve schwannomas with favorable facial nerve function

ObjectiveWe report 18 cases of facial nerve schwannomas in which stripping surgery was attempted to preserve facial nerve integrity and favorable facial nerve function. MethodsWe attempted stripping surgery on 18 cases of facial nerve schwannomas. Postoperative facial nerve function was evaluated. ResultsStripping surgery was successfully achieved in 11 cases, and facial nerve decompression was performed on the remaining 7 cases in which stripping surgery was impossible. Favorable facial nerve function was successfully maintained in all cases who underwent stripping surgery and 5 of 7 cases who underwent facial nerve decompression. ConclusionsIt was possible to accomplish stripping surgery in most cases with favorable facial nerve function, which maintained good facial nerve function after total tumor removal.

Stitchless fibrin glue-aided facial nerve grafting after cerebellopontine angle schwannoma removal: technique and results in 15 cases.

To evaluate the results of facial nerve (FN) grafting using great auricular cable graft and fibrin glue without suturing to palliate FN disruption after removal of large cerebellopontine angle (CPA) vestibular schwannoma (VS) or facial nerve schwannoma (FNS). To assess whether tumor size and origin influenced the results. Retrospective review of all patients having undergone removal of FNS/VS and needing intraoperative FN repair between 2001 and 2011. FN was rehabilitated using great auricular nerve cable graft and fibrin glue (Tisseal) without stitching suture. All data recorded were reviewed to access age, sex, tumor type, and tumor size according to the Koos classification and presenting symptoms. FN function was evaluated preoperatively and at 18 months using the House-Brackmann (HB) grading system. Among the 595 patients operated for CPA schwannomas in this period, 15 patients (2.5%) underwent FN repair, including 7 cases of FNS and 8 cases of VS. Tumor removal was total in all cases. FN recovery was HB3 in 13 cases (86.7%) and HB4 in 2. The mean time to the first clinical signs of facial reinnervation was 10 months (6-12 mo). No significant relation was found between postoperative facial function and tumor size or type, even if all cases of preoperative FP were noted in FNS. Immediate FN reconstruction with fibrin glue-aided greater auricular nerve graft can effectively restore FN function with excellent outcomes. The results seem better than those observed by other authors using sutured grafts or delayed hypoglossal-facial nerve anastomosis.

Radiologic Characteristics in a Case of Facial Nerve with Multisegment Involvement

Facial nerve schwannomas are rare benign neoplasms that originate from Schwann cells at any point along the course of the facial nerve. Only few studies have reviewed the natural course of the facial nerve schwannomas. The tumor is usually very slow-growing, and the growth rate was estimated as 0.7-2.6 mm/year. Clinically, the patients may present with wide range of facial dysfunction, ranging from asymptomatic to total facial palsy. Other possible symptoms include hearing loss, vestibular dysfunction or palpable parotid mass, depending on the size and location of the tumor. Implementation of high resolution magnetic resonance (MR) imaging with gadolinium enhancement has enabled detailed examination along the whole length of facial nerve, and multisegment involvement has been highlighted as a distinct feature of the facial nerve schwannomas. Computed tomography (CT) studies and MR imaging play pivotal roles in evaluating the extent of the benign tumor. Although surgical exploration and pathologic evaluation confirms the disease ex-tent, expectant management is a feasible treatment option and the timing of surgical intervention remains to be individualized to each patient. Thus, information provided by imaging studies is crucial for optimal treatment planning. We report a case of facial nerve schwannoma that involves multiple segments along the nerve from the internal auditory canal to intraand extra-temporal portions. CT and MR studies have demonstrated distinct features of the disease in different segments of the involved facial nerve.

Facial Schwannomas: Various Presentations and their Management with Literature Review

Facial schwannomas or neuromas are rare entity. They often are confused with vestibular schwannomas on imaging, especially if they are limited to the cisternal segment of the facial nerve. Awareness regarding this entity is paramount for the early diagnosis and correct management which may differ from patient to patient. We share the different clinical presentations of this rare benign tumour and discuss their management strategies in light of the affected segment of the nerve. The results were analyzed along with review of literature. Three cases of facial schwannomas were analyzed retrospectively during last 4years and their presentation, imaging, preferred surgical approaches, intra-operative findings and post grafting results are discussed. All three patients underwent surgical excision with sural nerve cable grafting and have no recurrence till date. However, the facial paresis remained the same in one of the cases while improvement was observed in two patients. The improvement was delayed in one patient as documented by electromyography of facial muscles. Facial schwannomas are slow growing tumours with low incidence. Usual presentations can sometimes be masked. Appropriate management decision needs to be arrived after considering three determinants i.e. the patient's age, hearing status and the severity of facial paresis (House-Brackmann grading). Nerve reconstruction after excision should be performed in each case and sometimes the results may be delayed. It is thus important to keep a close surviellance during the follow up and to perform the electrophysiological tests frequently so as to detect the earliest signs of regeneration (which can be delayed up to 18months).

A case of facial nerve schwannoma found during surgery having a preoperative diagnosis of parotid pleomorphic adenoma

A case of facial nerve schwannoma found during surgery having a preoperative diagnosis of parotid pleomorphic adenoma

Nonvestibular Schwannomas of the Head and Neck

Alper Ceylan MD, Assoc. Prof. Gazi University Medical Faculty Otorhinolaryngology Department, Ankara, Turkey Email: aceylan@gazi.edu.tr Phone: +90 312 202 64 25 Website: http://websitem.gazi.edu.tr/aceylan Objective: To assess the clinical presentation, location, nerve of origin, diagnosis and treatment of the nonvestibular head and neck schwannomas. Materials and methods: The clinical records of 15 patients with nonvestibular head and neck schwannomas treated at a single institution between 1982 and 2008 were reviewed retrospectively. Results: Eleven (73%) of 15 patients presented with symptoms secondary to mass effect. Facial nerve was the most common localization of schwannoma origin occurring in 6 patients (40%). All schwannomas were resected totally except the one in the pterygopalatin fossa. Three cases of facial schwannoma were found incidentally during chronic otitis media surgery. Conclusion: Facial nerve is one of the most commonly involved localizations for nonvestibular head neck schwannomas. This study indicated that extraordinary sites such as lingual, posterior pharyngeal wall and the suboccipital region may also be the origin of schwannoma. Schwannomas may also be encountered incidentally during chronic otitis media surgery. Complete tumor removal is often achieved, but subtotal resection may be indicated for patients with special indications. Nonvestibular Schwannomas of the Head and Neck Alper Ceylan MD, Fatih Celenk MD, Metin Yilmaz MD, Ozan Gokdogan MD, Erdogan Inal MD Gazi University Medical Faculty Otorhinolaryngology Department, Ankara, Turkey

Management of Facial Nerve Schwannoma in Patients With Favorable Facial Function

We report six cases of facial nerve schwannomas in which surgical management allowed the preservation of facial nerve function. Specifically, this paper reports that a stripping surgery may provide favorable functional outcomes. A retrospective review of preoperative and postoperative data for six patients with facial nerve schwannoma that had normal facial nerve function or a House-Brackmann grade II facial palsy before the surgery. Stripping surgery, which removed the schwannoma from the remaining nerve fascicle, was attempted on the six patients. Postoperative facial nerve function and imaging (magnetic resonance imaging) were evaluated. Stripping surgery with gross total tumor removal of the mass was performed in four cases. In the two remaining cases, the stripping surgery was not possible, and decompression alone was performed. Favorable preservation of facial function was achieved in all six cases. It was possible to preserve facial function after surgery to remove facial nerve schwannoma. We suggest that stripping surgery, focused on the preservation of continuity of the facial nerve, may be attempted for facial nerve schwannoma in which favorable facial function has been preserved.

Facial nerve schwannomas: Different manifestations and outcomes

Background The purpose of this study was to provide data on the different clinical presentations of facial nerve schwannoma, the appropriate planning for the management of schwannoma of various origins, and the predictive outcomes of surgical management. Methods A retrospective study was conducted in a tertiary referral hospital. We reviewed 8 consecutive cases of facial nerve schwannoma diagnosed and managed between 1993 and 2001. Results Facial nerve schwannomas originated in the internal auditory canal (IAC) (2 cases), parotid gland (2 cases), intratemporal portion (3 cases), and stylomastoid foramen (1 case). Tumor of the stylomastoid foramen presented as an intra- and extratemporal mass. The initial presenting symptom of the 8 patients was facial nerve paralysis in 4 patients, hearing loss in 2, facial numbness in 1, and an infra-auricular mass in 1. Facial palsy occurred in 7 patients during the course of the disease. One patient with a mass in the parotid gland did not show facial palsy up to 1 year after presentation of the initial symptom (facial numbness). Facial nerve paralysis was most severe in intratemporal tumors and less severe in parotid tumors. The patients with IAC suffered from hearing loss and intermittent vertigo and showed decreased vestibular function. The patients with intratemporal tumors also complained of hearing loss. The tumors were completely removed by superficial parotidectomy for parotid tumors; the translabyrinthine approach for 1 IAC tumor and 1 intratemporal tumor; the middle fossa approach for the other IAC tumor; the transmastoid approach for mastoid tumors; and the infratemporal fossa approach for intratemporal and extratemporal tumors. End-to-end cable grafts for the facial nerve were performed in 5 out of 8 cases. In 2 cases, the facial nerve was preserved after the resection of the mass. One case showed complete loss of the peripheral branch of the facial nerve. Conclusions Facial nerve schwannoma can present in various ways. By examining the site of origin and the presenting symptoms and signs, we were able to diagnose facial nerve schwannoma preoperatively. According to the operative management of the facial nerve, the postoperative outcome of facial function could be estimated. Our finding could be pivotal in the management of the facial nerve schwannoma.

Facial nerve schwannoma in the inner auditory canal and geniculate ganglion

Schwannoma of the vestibular nerve is the most common tumor found in the inner auditory canal. If a schwannoma of the facial nerve is found unexpectedly during surgery, the original surgical plan may have to be changed. In our series, we describe the symptoms, diagnostic procedures and therapy of this infrequent, benign tumor. In particular, we want to analyse the influence of diagnostic techniques, such as magnetic resonance tomography and electrophysiology, on the diagnosis of these tumors. Between 1975 and 2001, we diagnosed 17 cases of facial nerve schwannoma in the inner auditory canal or the geniculate ganglion. All patients were treated surgically. In 16 cases, we used the enlarged middle fossa approach and in the remaining patient the translabyrinthine approach was used. In 11 cases, the facial nerve could be saved but in six the nerve had to be rebuilt with a transplant. During the first years of our study, palsy of the facial nerve was a frequent finding. In the later years, a hearing impairment and tinnitus became the most frequent symptoms. Advances in magnetic resonance imaging have, in many cases, facilitated the differentiation between schwannomas of the facial nerve and the vestibular nerve over the last years. Signal enhancement at the geniculate ganglion is important for the diagnosis of facial nerve schwannoma. In individual cases, we found significant findings using electrophysiological procedures. In three cases, the temporal delay was elongated. Based on these findings, the therapeutic procedures can be discussed together with the patients.

Facial nerve schwannoma in the cerebellopontine cistern. Findings on high resolution CT and MR cisternography

We report a case of facial nerve schwannoma originating in the cerebellopontine cistern, diagnosed by cochlear sensorineural hearing loss, and involvement in the facial nerve canal and the anterior epitympanic recess. Precise analyses of neuro-otological and neuroradiological studies are crucial to obtain an accurate preoperative diagnosis.

顔面神経鞘腫の４症例

Reports on facial nerve schwannoma have been gradually increasing, and it is no longer a rare disease. We have had 4 cases of facial nerve schwannoma in our clinic since October, 1978, when our clinic opened. The first case (a 34 year-old, female), a small schwannoma was found in the tympanic portion of the facial nerve when she underwent a tympanoplasty for cholesteatoma. The second case (a 45 year-old, female), suffered from slowly progressive facial nerve palsy and later from severe vertigo. The third case (a 73 year-old, male), experienced severe vertigo with long-term facial palsy, while the fourth case (a 60 year-old, male), suffered from sudden onset of slight facial palsy with a subauricular tumor. The patients with facial nerve schwannoma complained of various symptoms such as facial nerve palsy, hearing disturbance, vertigo or dizziness, tinnitus, otalgia or headache, depending on the site of occurrence and tumor size. A multitumor type of schwannoma originating from a single facial nerve such as case 4 is rare. We reviewed the literature covering 11 cases of the multitumor type of facial nerve schwannoma. When we encounter a facial palsy patient with fluctuating degrees of palsy, in addition to the variety of symptoms mentioned above, and who does not response to extensive treatment, a diagnosis of schwannoma is considered. Accordingly, the pathway of the facial nerve, from the CP-angle to the parotid gland is carefully examined. MRI is a suitable method for examination.

Outgrowing schwannomas arising from tympanic segments of the facial nerve

Purpose: Although there have been numerous reports of clinical cases of facial nerve schwannoma, histopathologic studies of its early stages of development are rare. The purpose of this study was to describe the incidence, origin, and pathology of small, asymptomatic Schwannomas of the facial nerve. Materials and Methods: Fifteen hundred twenty-six ears from the human temporal bone collection of the Otitis Media Research Center Otopathology Laboratory at the University of Minnesota were studied under light microscopy. Results: Twelve bones with morphologic indications of type A Antoni tissue that mimics facial schwannoma in the tympanic cavity were selected. The 12 ears were from nine individuals with asymptomatic histories. The twelve Schwannomas developed from perineurium at dehiscences in the facial canal near the oval window, forming defects in the epineurium by growth of Schwann cells downward and outward toward the stapes. No obvious compressions or lesions within fibers in the facial nerve were observed. Conclusion: Because these tumors grow slowly without hearing loss or facial nerve symptoms, they may be mistaken for granulation tissue during surgery for chronic otitis media.

顔面神経鞘腫の2例

We experienced two cases of facial nerve schwannoma. Case 1 was a 55-year-old female who complained of right facial palsy and right otalgia. She was diagnosed as having intratemporal facial nerve schwannoma. Case 2 was a 44 year-old female with mass in the left parotid gland. She was initially diagnosed as having a mixed tumor, but the pathological diagnosis was schwannoma.Patients with intratemporal facial nerve schwannoma usually exhibit gradually developing facial palsy and sometimes recurrent facial palsy; these symptoms are similar to those in Bell's palsy, thus, these patients may be initially misdiagnose as having Bell's palsy.