Intraoperatively diagnosed cerebellopontine angle facial nerve schwannoma: how to deal with it.
OBJECTIVE
This study aimed to report our experience in the management of patients with intraoperatively diagnosed intracranial facial nerve schwannomas (FNSs) and propose a decision-making strategy.


METHODS
Twenty-three patients with FNS of the internal auditory canal and/or cerebellopontine angle operated on between 1992 and 2012 were identified.


RESULTS
Preoperatively, all cases have been radiographically diagnosed as vestibular schwannomas. Operative procedures consisted of total tumor resection with grafting in 43.4% of patients, near-total resection leaving behind the tumor capsule overlying the facial nerve in 21.7%, total tumor resection with preservation of anatomic continuity of the facial nerve in 13%, and subtotal resection in 4.3%. Four patients (17.4%) underwent bony decompression with no tumor removal.


CONCLUSIONS
Management of FNS diagnosed at surgery represents a significant clinical challenge. We considered total tumor resection with grafting when patients presented with preoperative facial nerve palsy (≥ grade III). Both subtotal and near-total tumor removal can be performed in patients with preoperative good facial function and/or large tumors with brainstem compression. Patients with small tumors who were selected for hearing preservation surgery can be considered for bony decompression. Fascicle preservation surgery may be an option when a clear cleavage plane between the tumor and the facial nerve is found.
Department of Clinical and Experimental Medicine, Otolaryngology Unit, University-Hospital of Parma, Parma, Italy andreabacciu@yahoo.it.
Andrea
A
Bacciu
Gruppo Otologico Piacenza, Rome, Italy University of Chieti, Chieti, Italy.
Marimar
M
Medina
Department of Neurosurgery, Military Hospital of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Mehdi
M
Ben Ammar
Gruppo Otologico Piacenza, Rome, Italy University of Chieti, Chieti, Italy.
Flavia
F
D'Orazio
Gruppo Otologico Piacenza, Rome, Italy University of Chieti, Chieti, Italy.
Filippo
F
Di Lella
Gruppo Otologico Piacenza, Rome, Italy University of Chieti, Chieti, Italy.
Alessandra
A
Russo
Department of Otolaryngology, Hôpital Universitaire Nord, Marseille, France.
Jacques
J
Magnan
Gruppo Otologico Piacenza, Rome, Italy University of Chieti, Chieti, Italy.
Mario
M
Sanna
D000293:Adolescent; D000328:Adult; D000368:Aged; D002528:Cerebellar Neoplasms / Q000175:diagnosis* / Q000601:surgery; D002530:Cerebellopontine Angle / Q000473:pathology* / Q000601:surgery; D003390:Cranial Nerve Neoplasms / Q000175:diagnosis* / Q000601:surgery; D003937:Diagnosis, Differential; D007758:Ear, Inner / Q000473:pathology* / Q000601:surgery; D005155:Facial Nerve Diseases / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D009442:Neurilemmoma / Q000175:diagnosis* / Q000601:surgery; D019635:Neurosurgical Procedures / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome
cerebellopontine angle; facial nerve; facial schwannoma; internal auditory canal; management