title: Evolution in the management of facial nerve schwannoma.
abstract: OBJECTIVE
  To design a treatment algorithm based on experience with facial nerve schwannomas (FNS) over a 30-year period.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Seventy-nine patients with facial nerve schwannomas seen from 1979 through 2009 at a tertiary referral private otologic practice were categorized by treatment modality. Interventions included surgical resection with grafting, bony decompression, observation, or stereotactic radiation. Outcome measures included House-Brackmann facial nerve grade before and after intervention as well as change in facial nerve grade, tumor size, involved segments of nerve, time to intervention.
  
  
  RESULTS
  Thirty-seven patients (46.8%) ultimately underwent surgical excision with grafting or primary anastomosis, 21 (26.6%) underwent bony decompression alone, 15 (19.0%) were managed with observation only, and 6 (7.6%) had stereotactic radiation. Through 1995, 85% of cases had surgical resection and none had observation only. Of the 52 patients seen after 1995, 27% had surgical resection and grafting, 33% had bony decompression, 29% were managed with observation alone, and 11% had radiotherapy. Facial nerve grade was maintained or improved over the follow-up period (mean time = 3.9 years) in 78.9% of the decompression group and 100% of the observation and radiation groups compared to 54.8% of the resection group (P ≤ .012).
  
  
  CONCLUSIONS
  Surgical resection and grafting, once widely accepted and practiced, has in many cases given way to observation, bony decompression, or stereotactic radiation. A wide armamentarium of options is available to the neurotologist treating facial nerve schwannomas with the ability to preserve facial function for a longer period of time.
authors: House Clinic, Los Angeles, California 90057, USA. ewilkinson@hei.org
authors: Eric P
authors: EP
authors: Wilkinson
authors: Michael
authors: M
authors: Hoa
authors: William H
authors: WH
authors: Slattery
authors: Jose N
authors: JN
authors: Fayad
authors: Rick A
authors: RA
authors: Friedman
authors: Marc S
authors: MS
authors: Schwartz
authors: Derald E
authors: DE
authors: Brackmann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003390:Cranial Nerve Neoplasms / Q000473:pathology / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods; D005154:Facial Nerve / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D009367:Neoplasm Staging; D009442:Neurilemmoma / Q000473:pathology / Q000601:surgery*; D016634:Radiosurgery / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D016038:Skin Transplantation / Q000379:methods; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult