Intratemporal facial nerve schwannoma: a management dilemma.
OBJECTIVE
To report the findings in patients with facial nerve schwannoma in whom surgery was elected at onset versus patients treated expectantly.


METHODS
Retrospective case review.


METHODS
Tertiary referral center.


METHODS
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).


METHODS
Eleven patients underwent complete tumor excision and 13 patients were enrolled in ongoing monitoring only.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Perez
Ronen
R
Department of Otolaryngology, Sunnybrook and Women's College Health Science Center, and the University of Toronto, Toronto, Ontario, Canada.
Chen
Joseph M
JM
Nedzelski
Julian M
JM
D000293:Adolescent; D000328:Adult; D000368:Aged; D003390:Cranial Nerve Neoplasms / Q000175:diagnosis / Q000601:surgery*; D018450:Disease Progression; D005155:Facial Nerve Diseases / Q000175:diagnosis / Q000601:surgery*; D005158:Facial Paralysis / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000601:surgery; D009442:Neurilemmoma / Q000175:diagnosis / Q000601:surgery*; D009460:Neurologic Examination; D019370:Observation; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D012888:Skull Neoplasms / Q000175:diagnosis / Q000601:surgery*; D013701:Temporal Bone / Q000601:surgery*; D047368:Tumor Burden / Q000502:physiology