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Intracranial Facial Schwannomas: Multiple Distinct Entities Necessitating Tailored Management.

Kaith K Almefty¹, Michael A Mooney², Ossama Al-Mefty²

¹Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.

World Neurosurgery

|September 23, 2022

Summary

Facial nerve schwannomas are rare tumors. Preserving facial nerve function is key, with fascicle-sparing surgery offering the best outcomes for these challenging cerebellopontine angle tumors.

Keywords:

Cerebellopontine angle tumor Facial nerve function Facial nerve schwannoma Fascicular-sparing technique Geniculate ganglion Interposition grafting

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Area of Science:

Neurosurgery
Otolaryngology
Oncology

Background:

Facial nerve (FN) schwannomas are rare neurogenic tumors.
Their management is complex, especially when preserving FN function is critical.
Cisternal subtypes can mimic vestibular schwannomas.

Purpose of the Study:

To evaluate management strategies for facial nerve schwannomas.
To identify methods for maintaining facial nerve function post-surgery.
To highlight diagnostic features of the cisternal subtype.

Main Methods:

Retrospective analysis of 13 patients with FN schwannomas.
Review of patient demographics, clinical data, imaging, and surgical outcomes.
Analysis of surgical techniques, including fascicle-sparing and nerve grafting.

Main Results:

Eleven patients underwent surgery for cisternal, ganglion, or combined FN schwannomas.
Fascicle-sparing subtotal resection preserved preoperative FN function in 5 of 7 patients.
Near-total removal led to FN function deterioration in 2 patients.

Conclusions:

FN schwannoma management requires individualized approaches based on tumor subtype and preoperative FN function.
Observation may be suitable for asymptomatic tumors with normal FN function.
Fascicle-sparing subtotal resection is recommended for tumors with preserved FN function to maintain function.