title: Clinical and radiological guidance in managing facial nerve schwannomas.
abstract: OBJECTIVE
  To present a review of all patients diagnosed with a facial nerve schwannoma (FNS) managed in our center over almost two decades, and suggest guidelines for their classification and management.
  
  
  METHODS
  Retrospective case review
  
  
  METHODS
  Tertiary referral center
  
  
  METHODS
  Twenty-eight patients with a facial nerve schwannoma
  
  
  METHODS
  Conservative or surgical management depending on clinical and radiological features
  
  
  METHODS
  Patient demographics, site of tumor, and clinical symptoms, including facial nerve function (House-Brackmann score) at baseline and follow-up. In those managed surgically, operative approach and surgical outcomes were also recorded.
  
  
  RESULTS
  Of 28 patients, 16 were male. Mean age at presentation was 46 years. The majority presented with either facial weakness or hearing loss. The internal auditory canal segment of the facial nerve was the most commonly affected (19/28, 68%). Multi-segmental lesions were found in almost half (46%) of patients. Facial weakness was most commonly associated with involvement of the labyrinthine segment (89%). Overall, 16 (57%) patients were managed surgically.
  
  
  CONCLUSIONS
  FNS may be difficult to distinguish on both clinical and imaging grounds from other cerebellopontine pathologies on the basis of audiovestibular symptoms alone. The presence of facial weakness in combination with imaging findings suggestive of FNS is highly suggestive for FNS. In patients with brainstem compression, rapid tumor growth, or House-Brackmann greater than 4, we suggest a surgical approach based on preoperative audiovestibular status, helping optimize long-term facial function and minimize morbidity. Facial nerve reanimation at the time of primary surgery is preferred.
authors.affiliation: *Department of Otolaryngology, Salford Royal Hospital, Manchester; †Manchester Medical School, Manchester; ‡Department of Radiology, Salford Royal Hospital, Manchester; §Department of Neurosurgery, Salford Royal Hospital, Manchester; ∥Institute of Cancer Sciences, University of Manchester, Manchester, U.K.
authors.forename: Jayesh
authors.initials: J
authors.lastname: Doshi
authors.forename: Richard
authors.initials: R
authors.lastname: Heyes
authors.forename: Simon Richard Mackenzie
authors.initials: SR
authors.lastname: Freeman
authors.forename: Gillian M
authors.initials: GM
authors.lastname: Potter
authors.forename: Charlotte Lucy
authors.initials: CL
authors.lastname: Ward
authors.forename: Scott Alexander
authors.initials: SA
authors.lastname: Rutherford
authors.forename: Andrew Thomas
authors.initials: AT
authors.lastname: King
authors.forename: Richard Thomas
authors.initials: RT
authors.lastname: Ramsden
authors.forename: Simon Kingsley Wickham
authors.initials: SK
authors.lastname: Lloyd
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003390:Cranial Nerve Neoplasms / Q000145:classification / Q000175:diagnosis* / Q000628:therapy; D005154:Facial Nerve / Q000473:pathology / Q000601:surgery; D005155:Facial Nerve Diseases / Q000145:classification / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009442:Neurilemmoma / Q000145:classification / Q000175:diagnosis* / Q000628:therapy; D012189:Retrospective Studies; D016896:Treatment Outcome