Surgical management of facial neuromas: lessons learned.
OBJECTIVE
Primary tumors of the facial nerve are rare, representing 1% of all intrapetrous lesions. We analyzed the management and surgical outcomes of 16 patients with multisegment facial neuromas treated at our institution during a 16-year period.


METHODS
A retrospective chart review.


METHODS
Tertiary referral center.


METHODS
All patients included in the study had surgical management of their facial neuroma. There were 9 women and 7 men. The mean age was 46 years, with a mean follow-up period of 3 years.


METHODS
Surgical excision (n = 15) or decompression (n = 1) of facial neuroma.


METHODS
Tumor location, presenting symptoms, hearing outcomes, and facial function.


RESULTS
Thirteen (81%) patients had facial paresis as their presenting symptom. Unilateral hearing loss was present in 9 (56%) patients. Most tumors (n = 15) involved multiple segments of the facial nerve and ranged in size from 1.5 to 7 cm. Fifteen (94%) patients had the tumor completely excised, and 1 (6%) patient underwent needle decompression of the cystic component of the tumor. The geniculate ganglion was the most commonly involved (11 patients, 69%) segment of the nerve, followed by the labyrinthine and tympanic segments. Despite multiple types of reconstructive options used, the best recovery of facial function was a House-Brackmann Grade III in 12 patients.


CONCLUSIONS
Treatment of facial neuromas depends on the extent of tumor, degree of facial paresis, and hearing function. We advocate complete resection of tumor when facial palsy exists. Patients with normal facial function and hearing may be advised on a more conservative treatment option such as radiologic observation, drainage of any cystic component of the tumor for histologic diagnosis, and/or bony decompression of the tumor.
Shirazi
Mobeen A
MA
Department of Otolaryngology-Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois, USA.
Leonetti
John P
JP
Marzo
Sam J
SJ
Anderson
Douglas E
DE
D000328:Adult; D003390:Cranial Nerve Neoplasms / Q000601:surgery*; D019299:Decompression, Surgical; D005154:Facial Nerve / Q000503:physiopathology; D005155:Facial Nerve Diseases / Q000601:surgery*; D005158:Facial Paralysis / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D034381:Hearing Loss / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D009463:Neuroma / Q000601:surgery*; D013506:Otologic Surgical Procedures; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D012189:Retrospective Studies; D016896:Treatment Outcome