Facial Schwannoma Research Articles

Facial nerve schwannoma presenting as conductive hearing loss

Facial nerve schwannoma presenting as conductive hearing loss

Greater superficial petrosal nerve schwannoma

Greater superficial petrosal nerve (GSPN) schwannoma is a very rare type of facial nerve schwannoma. Including our case, only 6 schwannomas have been reported to originate from the GSPN. Clinical features, imaging, diagnosis, differential diagnosis and treatment are discussed reviewing other cases in the pertinent literature.

Intratemporal Facial Nerve Schwannoma: A Management Dilemma

To report the findings in patients with facial nerve schwannoma in whom surgery was elected at onset versus patients treated expectantly. Retrospective case review. Tertiary referral center. Twenty-four patients with a mean age of 44 years (range, 18-65 yr) were followed for an average of 6 years (range, 1-19 yr). Eleven patients underwent complete tumor excision and 13 patients were enrolled in ongoing monitoring only. Facial nerve function and hearing acuity were noted at the time of initial and last visits. Magnetic resonance imaging was used to determine tumor growth in those individuals treated expectantly and as a means of excluding tumor recurrence/persistence in those treated surgically. Of the 11 patients who underwent tumor removal, the facial nerve was spared in 7. Eight had varying degrees of facial nerve dysfunction initially. In this group (mean follow-up, 8 yr), six patients had unchanged nerve function, four had improved nerve function, and one had worsened. No long-term recurrence was noted. Of the 13 patients followed expectantly, three had facial weakness initially. During the follow-up interval (mean, 5 yr), facial function remained unchanged for eight and worsened in five. During this interval, 4 of the 13 patients demonstrated tumor growth and 3 have recently undergone tumor removal. Facial nerve schwannomas are extremely slow growing and frequently present without facial dysfunction. It is possible to surgically remove these tumors while sparing the nerve; as a result, postoperative function is correspondingly better. Finally, the decision on how to treat these patients should be individualized and based on initial facial function, growth rate, surgical experience, and informed patient consent.

Intra Parotid Facial Nerve Schwannoma: A Case Report

Schwannoma in the head and neck region is very rare. The tumour occurring in the intraparotid facial nerve is even rarer. A patient presenting with a parotid swelling with facial nerve paralysis is not pathognomonic of a facial nerve schwannoma. However it may occur because enlargement of the parotid, by any kind of tumour especially a malignant one can cause facial nerve paralysis. We report a case of an intraparotid facial nerve schwannoma, in a patient who presented with parotid enlargement and facial nerve paralysis.

Malignant schwanomma of parotid gland

Malignant neoplasms of facial nerve presenting as parotid mass are rare. The incidence of Malignant Schwannoma (MS) in general population is 0.001 % while its incidence in patients with Von Reclinghausen's neurofibromatosis (NF-1) is 4%. A case is presented of a 40-year-old male patient presenting with swelling in right parotid region increasing in size since last 10 years. Computed topography scan examination showed presence of parotid tumour with erosion of temporal bone and intracranial extension. Pre-operative tru-cut biopsy showed histology of pleomorphic adenoma. Patient was subjected to craniofacial resection and final histology turned out to be malignant schwannoma of facial nerve in the parotid gland. Since it's a rare intraparotid tumour, role of histopathology and immonohistochemistry in diagnosing the tumour and review of literature is presented.

Facial nerve schwannomas: A report of four cases and a review of the literature

Objective To evaluate both the surgical approaches and results of the facial nerve schwannoma cases as diagnosed in our clinic in line with the literature. Material and methods The files of 4 cases diagnosed in our clinic as facial nerve schwannoma between1996 to 2002 were reviewed retrospectively. All the cases were evaluated with detailed history; ear, nose, and throat examination; computed tomography; and/or magnetic resonance imaging. If required, electromyography and audiometric evaluations were made. Fine-needle aspiration cytology was also performed in appropriate cases. The surgical approach used was determined depending on the tumor location and its extent. Facial nerve reconstruction was accomplished if the integrity of the nerve could not be protected. Cases were followed up for facial nerve function, complications, and recurrence. Results The tumors occurred in the vertical (n = 2), internal auditory canal (n = 1), and the peripheric segment (n = 1) of the nerve. As symptoms, facial paralysis (n = 2), hearing loss (n = 3), tinnitus (n = 1), otorrhea (n = 2), parotid mass (n = 2), and external auditory canal mass (n = 1) were observed. Radiologic investigations provided important informations. However, fine-needle aspiration cytology did not contribute to a correct preoperative diagnosis. The superficial parotidectomy approach (n = 1), retrosigmoid approach (n = 1), and transmastoid-superficial parotidectomy combined approach (n = 2) were used. The integrity of the nerve could not be protected in 3 of the cases. After the reconstruction surgery, the facial nerve function was evaluated as House-Brackmann grade 3 for all 3 cases at the mean 38.6 months follow-up time. No tumors have recurred during follow-up. Conclusion Facial nerve schwannoma is a rare tumor. Through improved surgical and reconstruction techniques, postoperative morbidity is at acceptable levels. The rate of recurrence is low. It should be kept in mind for differential diagnosis of facial nerve paralysis. (Am J Otolaryngol 2004;25:426-431.)

Long-term functional outcome in facial nerve graft by fibrin glue in the temporal bone and cerebellopontine angle.

The aim of this study was to evaluate the functional outcome of facial nerve repair with fibrin glue in end-to-end anastomosis and intermediate nerve graft. Thirty-six patients undergoing facial nerve repair by end-to-end anastomosis or facial nerve grafting using exclusively fibrin glue between 1986 and 1999 were included in this retrospective study. The population comprised ten vestibular schwannomas (28%), nine temporal bone fractures (25%), seven facial nerve schwannomas (19%), four facial nerve hemangiomas (11%), two iatrogenic facial nerve interruptions (6%) and four miscellaneous facial nerve lesions (11%). Data were reviewed concerning etiology, location of the nerve interruption, type of repair and postoperative facial function according to the repaired facial nerve recovery scale (A: normal; B: independent movements of eyelid and mouth; C: strong closure of eyelids and mouth; D: incomplete eyelid closure; E: minimal movement; F: no movement). Eleven patients (31%) underwent end-to-end nerve anastomosis and 25 (69%) underwent intermediate facial nerve grafting. The mean follow-up period was 50 months (range: 3-95). Among patients followed-up more than 18 months (n = 20), a score of B or C was obtained in 16 patients (80%), a score D in 2 cases (10%) and a score E in 2 cases (10%). The type of repair and the site of interruption did not influence the results. Fibrin glue is a simple, rapid and efficient means of facial nerve repair. In case of intraoperative facial nerve interruption, this type of repair can be attempted in any location at the time of the tumor removal.

Vestibular-like facial nerve schwannoma

Objective: To evaluate the prevalence as well as the management of primary facial nerve schwannoma (PFNS) presenting as vestibular schwannoma. Methods: A retrospective review was carried out on 146 patients referred to and operated upon in our institution over a 5-year period for tumors of the internal auditory canal extending or not into the cerebello-pontine angle (TICA). A review of the literature included an extensive MEDLINE search of the literature since 1966 and careful inspection of the bibliography of each article. Articles pertaining to facial nerve schwannomas were reviewed to identify cases of vestibular-like facial (V-LF) nerve schwannoma. Results: Two cases of tumors were finally diagnosed as PFNS. Clinical and radiological evaluations were typical of a vestibular schwannoma. Facial function was normal in each case. Unsuspected facial nerve schwannomas were found during surgery. Tumor removal was not performed. Postoperatively House and Brackmann (HB) facial function was normal in one case and grade II in the other case. These two cases represented a 1.4% prevalence, which is within the limits reported in the literature. Among V-LF nerve schwannomas reported in the literature, the postoperative functional facial outcome usually worsened when the tumor was resected. Conclusion: The prevalence of V-LF nerve schwannoma has been reported in the two last decades owing to the development of modern imaging. The conservative management of early staged tumors presenting as vestibular schwannoma is recommended in order to counsel the patient regarding the possibility of V-LF nerve schwannoma and to prolong normal facial function.

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.

Vestibularlike facial nerve schwannoma

Objectives: Apparent vestibular schwannoma (VS) may be in fact primary facial nerve schwannoma (PFNS). The purpose of the present study was to evaluate the prevalence as well as the management of PFNS presenting as VS. Methods: Based on an inception cohort of 146 patients operated over a 5-year period for tumors of the internal auditory canal extending or not into the cerebello-pontine angle (TICA), the prevalence and management of tumors originating from the facial nerve were retrospectively reviewed. A review of the literature included an extensive MEDLINE search of the literature. Articles pertaining to facial nerve schwannomas were reviewed to identify cases of vestibular-like facial (V-LF) nerve schwannoma. Results: Two cases of tumors were finally diagnosed as PFNS. Clinical and radiological evaluations were typical of a vestibular schwannoma. Auditory and facial functions were normal in each case. Both patients had stage II tumor and were operated through retrosigmoid approach. Unsuspected facial nerve schwannomas were found during surgery. Tumor removal was not performed. Postoperatively facial function was normal in 1 case and House and Brackman grade II in the other case. These 2 cases represented 1.4% prevalence, which is within the ranges reported in the literature. The review of the literature of V-LF nerve schwannoma demonstrated that the postoperative functional facial outcome usually worsened when the tumor was resected. Conclusion: Although low, the prevalence of V-LF nerve schwannoma might argue for the conservative management of early staged tumors especially when the auditory and facial functions are normal.

Vestibular-like facial nerve schwannoma

Problem: Apparent vestibular schwannoma (VS) may be in fact primary facial nerve schwannoma (PFNS). The purpose of the present study was to evaluate the prevalence as well as the management of PFNS presenting as VS. Methods: Based on an inception cohort of 146 patients operated in our institution over a 5-year period for tumors of the internal auditory canal (extending into the cerebello-pontine angle [TICA] or not), the prevalence and management of tumors originating from the facial nerve were retrospectively reviewed. A review of the literature included an extensive MEDLINE search of the literature and careful inspection of the bibliography of each article. Articles pertaining to facial nerve schwannomas were reviewed to identify cases of vestibular-like facial (V-LF) nerve schwannoma. Results: Two cases of tumors were finally diagnosed as PFNS. Clinical and radiological evaluations were typical of a vestibular schwannoma. Auditory and facial functions were normal in each case. Both patients had stage II tumor and were operated through the retrosigmoid approach. Unsuspected facial nerve schwannomas were found during surgery. Tumor removal was not performed. Postoperatively facial function was normal in one case and House-Brackmann grade II in the other case. These 2 cases represented 1.4% prevalence, which is within the ranges reported in the literature. The review of the literature of V-LF nerve schwannoma demonstrated that the postoperative functional facial outcome usually worsened when the tumor was resected. Conclusion: Although low, the prevalence of V-LF nerve schwannoma might argue for the conservative management of early-stage tumors, especially when the auditory and facial functions are normal. Significance: The conservative management of early-stage tumors presenting as vestibular schwannoma is recommended in order to counsel the patient regarding the possibility of V-LF nerve schwannoma and to prolong normal facial function. Support: No support

Intraparotid facial nerve schwannoma: diagnosis and management

Objective Facial nerve schwannomas are rare neoplasms that present a challenge in diagnosis and management. We sought to gain insight into the clinical presentation and its implications in management. Study design and setting A group of patients diagnosed with schwannoma was reviewed, with focus on tumor arising in the intraparotid region of the facial nerve. The patient population consisted of 3722 patients evaluated retrospectively over 38 years at the Shadyside Facial Paralysis Center, a tertiary referral center. From this population, 29 patients (18 women and 11 men) with the diagnosis of schwannoma were selected for review. Results Twenty-nine patients had facial nerve schwannoma. The average age at diagnosis was 44 years (range, 7 to 78 years). Eight patients had intraparotid involvement, with 5 having a palpable mass in the parotid. The duration of symptoms averaged 8.4 years overall, with intraparotid involvement averaging 10.9 years. The 8 intraparotid schwannomas had a mean House-Brackmann grade of 1.5/6 at initial presentation. Postoperative facial nerve function was only 4.4/6 for resected intraparotid schwannomas. Conclusions Intraparotid facial nerve schwannomas are slow growing tumors, which are usually asymptomatic but can be painful. Schwannoma should be suspected if the facial nerve cannot be found intraoperatively or if the tumor is intimately associated with the facial nerve. In cases where schwannoma is suspected, biopsy is recommended, while complete resection is postponed to obtain imaging studies to evaluate the extent of disease and to discuss possible outcomes with the patient. Significance This article provides guidance for the appropriate management of intraparotid facial nerve schwannoma.

Coexisting Facial Nerve Schwannoma and Monomorphic Adenoma of the Parotid Gland

We describe the case of a patient with a parotid mass that was found to consist of both a facial nerve schwannoma and a monomorphic adenoma. To our knowledge, this is the first report of these two lesions presenting as a single tumor. We also discuss the incidence, diagnosis, and treatment of parotid facial nerve schwannomas.

Diagnóstico del schwannoma intracraneal del nervio facial. factores clínicos, radiológicos y valor de la inmunohistoquímica

ObjectiveTo analyze the clinical, radiological, and pathological features which may be useful to differentiate intracranial schwannomas of the facial nerve from vestibular schwannomas Material and MethodsA retrospective study of 91 patients undergoing surgery with a clinical suspicion of vestibular schwannoma is presented. Clinical and radiological features are analyzed. Immunohistochemistry for neurofilaments was performed in selected cases of unilateral vestibular schwannomas, bilateral vestibular schwannomas, and facial nerve schwannomas ResultsFacial function was normal in 83% of patients with vestibular schwannoma. Both patients with facial schwannomas had preoperative House-Brackmann grade II facial function. MRI showed no main differences between facial and vestibular schwannomas. A positive immunostaining was found in unilateral vestibular schwannomas, bilateral vestibular schwannomas, and facial nerve schwannomas ConclusionThere are no specific clinical, radiological, or pathological factors to accurately differentiate schwannomas of the facial nerve from vestibular schwannomas

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.

Nonvestibular Schwannomas of the Brain: A 7-Year Experience

OBJECTIVE Nonvestibular schwannomas are uncommon tumors of the brain. Trigeminal nerve schwannomas are the most common of this group, followed by glossopharyngeal, vagal, facial, accessory, hypoglossal, oculomotor, trochlear, and abducens nerve schwannomas, in descending order of frequency. We present a series of nonvestibular schwannomas that were surgically treated during a 7-year period. METHODS Forty-six patients with schwannomas of Cranial Nerves V (26 cases), VII (7 cases), IX, X, and XI (9 cases), XII (3 cases), and III (1 case) were microsurgically treated by the senior author (LNS) during a 7-year period, from 1993 to 2000. The clinical presentations, operative approaches, complications, and results were studied. RESULTS Forty-five patients underwent gross total tumor resection in the first operation. One patient who had undergone subtotal tumor resection in the initial operation experienced a large recurrence after 4 years, and gross total tumor resection was achieved in the second operation. There were no postoperative deaths. Postoperative morbidity consisted of cerebrospinal fluid leaks for 5 patients (3 patients required a second operation to repair the leak, and 2 patients responded to lumbar drain placement), meningitis for 3 patients (2 cases were aseptic and 1 involved bacterial meningitis, which resolved with antibiotic therapy), vasospasm requiring angioplasty for 1 patient, temporary hemiparesis for 2 patients (who experienced good recoveries), and permanent hemiparesis for 1 patient. New cranial nerve deficits were observed for 24% of patients but were usually partial. The mean follow-up period was 33.3 months (range, 0.2–93 mo). No patient experienced tumor recurrence after complete tumor removal. The patient who experienced regrowth of the tumor did not exhibit recurrence after the second operation. The Karnofsky Performance Scale scores at the latest follow-up examination were 80 or more for 45 patients (98%) and 70 for 1 patient. CONCLUSION Nonvestibular schwannomas can be treated via microsurgical excision, with excellent functional results. Recurrence is rare after total tumor excision, although much longer follow-up monitoring is required.

Nonvestibular schwannomas of the brain: a 7-year experience.

Nonvestibular schwannomas are uncommon tumors of the brain. Trigeminal nerve schwannomas are the most common of this group, followed by glossopharyngeal, vagal, facial, accessory, hypoglossal, oculomotor, trochlear, and abducens nerve schwannomas, in descending order of frequency. We present a series of nonvestibular schwannomas that were surgically treated during a 7-year period. Forty-six patients with schwannomas of Cranial Nerves V (26 cases), VII (7 cases), IX, X, and XI (9 cases), XII (3 cases), and III (1 case) were microsurgically treated by the senior author (LNS) during a 7-year period, from 1993 to 2000. The clinical presentations, operative approaches, complications, and results were studied. Forty-five patients underwent gross total tumor resection in the first operation. One patient who had undergone subtotal tumor resection in the initial operation experienced a large recurrence after 4 years, and gross total tumor resection was achieved in the second operation. There were no postoperative deaths. Postoperative morbidity consisted of cerebrospinal fluid leaks for 5 patients (3 patients required a second operation to repair the leak, and 2 patients responded to lumbar drain placement), meningitis for 3 patients (2 cases were aseptic and 1 involved bacterial meningitis, which resolved with antibiotic therapy), vasospasm requiring angioplasty for 1 patient, temporary hemiparesis for 2 patients (who experienced good recoveries), and permanent hemiparesis for 1 patient. New cranial nerve deficits were observed for 24% of patients but were usually partial. The mean follow-up period was 33.3 months (range, 0.2-93 mo). No patient experienced tumor recurrence after complete tumor removal. The patient who experienced regrowth of the tumor did not exhibit recurrence after the second operation. The Karnofsky Performance Scale scores at the latest follow-up examination were 80 or more for 45 patients (98%) and 70 for 1 patient. Nonvestibular schwannomas can be treated via microsurgical excision, with excellent functional results. Recurrence is rare after total tumor excision, although much longer follow-up monitoring is required.

Facial Nerve Schwannoma of the Cerebellopontine Angle: A Diagnostic Challenge

Facial nerve schwannomas are rare lesions that may involve any segment of the facial nerve. Because of their rarity and the lack of a consistent clinical and radiological pattern, facial nerve schwannomas located at the cerebellopontine angle (CPA) and internal auditory canal (IAC) represent a diagnostic and therapeutic challenge for clinicians. In this report, a case of a CPA/IAC facial nerve schwannoma is presented. Contemporary diagnosis and management of this rare lesion are analyzed.

Different Manifestations of Facial Nerve Schwannomas

Chung, Jong Woo; Ahn, Jung Ho; Kim, Jae Ho; Nam, Soon Yuhl; Lee, Kwang-Sun Author Information

Facial nerve schwannoma: surgical excision versus conservative management.

Facial nerve schwannomas are slow-growing tumors that may involve any part of the facial nerve. When they present with moderate to total facial palsy, complete resection is clearly indicated. However, in cases with mild or no facial dysfunction, the best course of treatment is less obvious. A series of 22 patients with facial nerve schwannoma is presented, of whom 12 underwent definitive excision and 10 were managed more conservatively. The best postoperative facial function in the group who had tumor removal was a House-Brackmann grade III, while 8 of the conservatively treated group had normal facial function up to 10 years after presentation. As well, no significant tumor growth was noted on serial radiologic imaging of those being observed. Delaying surgical resection of facial nerve schwannomas may allow patients to retain normal facial function indefinitely.