J Neurol Surg B Skull Base 2019; 80(05): 458-468
DOI: 10.1055/s-0038-1675590
Original Article
Georg Thieme Verlag KG Stuttgart · New York

The Natural History of Facial Schwannomas: A Meta-Analysis of Case Series

Matthew Bartindale
1   Depaent of Otolaryngology–Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois
,
Jeffrey Heiferman
1   Depaent of Otolaryngology–Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois
,
Cara Joyce
2   Clinical Research Office, Division of Biostatistics, Loyola University Medical Center, Maywood, Illinois
,
Neelam Balasubramanian
2   Clinical Research Office, Division of Biostatistics, Loyola University Medical Center, Maywood, Illinois
,
Douglas Anderson
3   Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois
,
John Leonetti
1   Depaent of Otolaryngology–Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois
› Author Affiliations
Further Information

Publication History

10 February 2018

23 September 2018

Publication Date:
21 November 2018 (online)

Abstract

Objective This study is to establish predictors of facial paralysis and auditory morbidity secondary to facial schwannomas by assimilating individualized patient data from the literature.

Design A systematic review of the literature was conducted for studies regarding facial schwannomas. Studies were only included if they presented patient level data, House–Brackmann grades, and tumor location by facial nerve segment. Odds ratios (OR) were estimated using generalized linear mixed models.

Main Outcome Measures Facial weakness and hearing loss.

Results Data from 504 patients were collected from 32 studies. The geniculate ganglion was the most common facial nerve segment involved (39.3%). A greater number of facial nerve segments involved was positively associated with both facial weakness and hearing loss, whereas tumor diameter did not correlate with either morbidity. Intratemporal involvement was associated with higher odds of facial weakness (OR = 4.78, p < 0.001), intradural involvement was negatively associated with facial weakness (OR = 0.56, p = 0.004), and extratemporal involvement was not a predictor of facial weakness (OR = 0.68, p = 0.27). The odds of hearing loss increased with more proximal location of the tumor (intradural: OR = 3.26, p < 0.001; intratemporal: OR = 0.60, p = 0.14; extratemporal: OR = 0.27, p = 0.01).

Conclusion The most important factors associated with facial weakness and hearing loss are tumor location and the number of facial nerve segments involved. An understanding of the factors that contribute most heavily to the natural morbidity can help guide the appropriate timing and type of intervention in future cases of facial schwannoma.

Note

This study was presented as a podium presentation at the North American Skull Base Society 28th Annual Meeting on February 17, 2018 in San Diego, California, U.S.A.


 
  • References

  • 1 Park SH, Kim J, Moon IS, Lee WS. The best candidates for nerve-sparing stripping surgery for facial nerve schwannoma. Laryngoscope 2014; 124 (11) 2610-2615
  • 2 McRackan TR, Wilkinson EP, Rivas A. Primary tumors of the facial nerve. Otolaryngol Clin North Am 2015; 48 (03) 491-500
  • 3 Shi W, Jain V, Kim H. , et al. Fractionated stereotactic radiotherapy for facial nerve schwannomas. J Neurol Surg B Skull Base 2016; 77 (01) 75-80
  • 4 McRackan TR, Rivas A, Wanna GB. , et al. Facial nerve outcomes in facial nerve schwannomas. Otol Neurotol 2012; 33 (01) 78-82
  • 5 Yang W, Zhao J, Han Y. , et al. Long-term outcomes of facial nerve schwannomas with favorable facial nerve function: tumor growth rate is correlated with initial tumor size. Am J Otolaryngol 2015; 36 (02) 163-165
  • 6 Perez R, Chen JM, Nedzelski JM. Intratemporal facial nerve schwannoma: a management dilemma. Otol Neurotol 2005; 26 (01) 121-126
  • 7 Carlson ML, Deep NL, Patel NS. , et al. Facial nerve schwannomas: Review of 80 cases over 25 years at Mayo Clinic. Mayo Clin Proc 2016; 91 (11) 1563-1576
  • 8 Sun Y, Xing B, Han S. , et al. Stripping surgery in facial nerve schwannomas with favorable facial nerve function. Am J Otolaryngol 2015; 36 (04) 513-516
  • 9 Lu R, Li S, Zhang L, Li Y, Sun Q. Stripping surgery in intratemporal facial nerve schwannomas with poor facial nerve function. Am J Otolaryngol 2015; 36 (03) 338-341
  • 10 Nadeau DP, Sataloff RT. Fascicle preservation surgery for facial nerve neuromas involving the posterior cranial fossa. Otol Neurotol 2003; 24 (02) 317-325
  • 11 Fezeu F, Lee CC, Dodson BK. , et al. Stereotactic radiosurgery for facial nerve schwannomas: a preliminary assessment and review of the literature. Br J Neurosurg 2015; 29 (02) 213-218
  • 12 Moon JH, Chang WS, Jung HH, Lee KS, Park YG, Chang JH. Gamma knife surgery for facial nerve schwannomas. J Neurosurg 2014; 121 (Suppl): 116-122
  • 13 Madhok R, Kondziolka D, Flickinger JC, Lunsford LD. Gamma knife radiosurgery for facial schwannomas. Neurosurgery 2009; 64 (06) 1102-1105 , discussion 1105
  • 14 Moher D, Liberati A, Tetzlaff J, Altman DG. ; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 2009; 62 (10) 1006-1012
  • 15 House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg 1985; 93 (02) 146-147
  • 16 Centre for evidence-based medicine. Available from: https://www.cebm.net/ ; accessed on June 8, 2017
  • 17 American Academy of Otolaryngology–Head and Neck Surgery Foundation, Inc. Committee on Hearing and Equilibrium guidelines for the evaluation of hearing preservation in acoustic neuroma (vestibular schwannoma). American Academy of Otolaryngology–Head and Neck Surgery Foundation, INC. Otolaryngol Head Neck Surg 1995; 113 (03) 179-180
  • 18 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 (02) 377-381
  • 19 Study quality assessment tools: quality assessment tool for case series studies. National Institutes of Health. https://www.nhlbi.nih.gov/health-pro/guidelines/in-develop/cardiovascular-risk-reduction/tools/case_series . Accessed on June 8, 2017
  • 20 Zheng Z, Li J, Shen Y, Xu L, Sun J. Radical intracapsular microenucleation technique for exclusively intraparotid facial nerve schwannoma: Long-term follow-up review. J Craniomaxillofac Surg 2016; 44 (12) 1963-1969
  • 21 Xiang D, Liu L, Li Y, Qiao J. Near-total removal of facial nerve schwannomas: long-term outcomes. Am J Otolaryngol 2015; 36 (03) 390-392
  • 22 Doshi J, Heyes R, Freeman SR. , et al. Clinical and radiological guidance in managing facial nerve schwannomas. Otol Neurotol 2015; 36 (05) 892-895
  • 23 Bacciu A, Medina M, Ben Ammar M. , et al. Intraoperatively diagnosed cerebellopontine angle facial nerve schwannoma: how to deal with it. Ann Otol Rhinol Laryngol 2014; 123 (09) 647-653
  • 24 Li Y, Liu H, Cheng Y. Subtotal resection of facial nerve schwannoma is not safe in the long run. Acta Otolaryngol 2014; 134 (04) 433-436
  • 25 Lee DW, Byeon HK, Chung HP, Choi EC, Kim S-H, Park YM. Diagnosis and surgical outcomes of intraparotid facial nerve schwannoma showing normal facial nerve function. Int J Oral Max. 2013; 42 (07) 874-879
  • 26 Bacciu A, Nusier A, Lauda L, Falcioni M, Russo A, Sanna M. Are the current treatment strategies for facial nerve schwannoma appropriate also for complex cases?. Audiol Neurootol 2013; 18 (03) 184-191
  • 27 Li Y, Jiang H, Chen X. , et al. Management options for intraparotid facial nerve schwannoma. Acta Otolaryngol 2012; 132 (11) 1232-1238
  • 28 Gross BC, Carlson ML, Moore EJ, Driscoll CL, Olsen KD. The intraparotid facial nerve schwannoma: a diagnostic and management conundrum. Am J Otolaryngol 2012; 33 (05) 497-504
  • 29 Mowry S, Hansen M, Gantz B. Surgical management of internal auditory canal and cerebellopontine angle facial nerve schwannoma. Otol Neurotol 2012; 33 (06) 1071-1076
  • 30 Lee WS, Kim J. Revised surgical strategy to preserve facial function after resection of facial nerve schwannoma. Otol Neurotol 2011; 32 (09) 1548-1553
  • 31 Günther M, Danckwardt-Lillieström N, Gudjonsson O. , et al. Surgical treatment of patients with facial neuromas--a report of 26 consecutive operations. Otol Neurotol 2010; 31 (09) 1493-1497
  • 32 Bäck L, Heikkilä T, Passador-Santos F, Saat R, Leivo I, Mäkitie AA. Management of facial nerve schwannoma: A single institution experience. Acta Otolaryngol 2010; 130 (10) 1193-1198
  • 33 Guzzo M, Ferraro L, Ibba T. , et al. Schwannoma in the parotid gland. Experience at our institute and review of the literature. Tumori 2009; 95 (06) 846-851
  • 34 McMonagle B, Al-Sanosi A, Croxson G, Fagan P. Facial schwannoma: results of a large case series and review. J Laryngol Otol 2008; 122 (11) 1139-1150
  • 35 Kohmura E, Aihara H, Miyake S, Fujita A. Intradural facial nerve schwannoma: diagnostic and therapeutic problems. Skull Base 2007; 17 (03) 215-222
  • 36 Lee JD, Kim SH, Song MH, Lee HK, Lee WS. Management of facial nerve schwannoma in patients with favorable facial function. Laryngoscope 2007; 117 (06) 1063-1068
  • 37 Kida Y, Yoshimoto M, Hasegawa T. Radiosurgery for facial schwannoma. J Neurosurg 2007; 106 (01) 24-29
  • 38 Litre CF, Gourg GP, Tamura M. , et al. Gamma knife surgery for facial nerve schwannomas. Neurosurgery 2007; 60 (05) 853-859 , discussion 853–859
  • 39 Minovi A, Vosschulte R, Hofmann E, Draf W, Bockmühl U. Facial nerve neuroma: surgical concept and functional results. Skull Base 2004; 14 (04) 195-200 , discussion 200–201
  • 40 Chung JW, Ahn JH, Kim JH, Nam SY, Kim CJ, Lee KS. Facial nerve schwannomas: different manifestations and outcomes. Surg Neurol 2004; 62 (03) 245-252 , discussion 452
  • 41 Kim CS, Chang SO, Oh SH, Ahn SH, Hwang CH, Lee HJ. Management of intratemporal facial nerve schwannoma. Otol Neurotol 2003; 24 (02) 312-316
  • 42 Liu R, Fagan P. Facial nerve schwannoma: surgical excision versus conservative management. Ann Otol Rhinol Laryngol 2001; 110 (11) 1025-1029
  • 43 Chong KW, Chung YFA, Khoo MLC, Lim DTH, Hong GS, Soo KC. Management of intraparotid facial nerve schwannomas. Aust N Z J Surg 2000; 70 (10) 732-734
  • 44 Jackler RK. Atlas of Skull Base Surgery and Neurotology. 2nd ed. Stuttgart, Germany; Thieme: 2008
  • 45 Wilkinson EP, Hoa M, Slattery III WH. , et al. Evolution in the management of facial nerve schwannoma. Laryngoscope 2011; 121 (10) 2065-2074
  • 46 Umredkar A, Singla N, Gupta SK, Radotra B. Greater superficial petrosal nerve schwannoma: report of two cases and literature review. Neurol India 2011; 59 (05) 786-788
  • 47 Lipkin AF, Coker NJ, Jenkins HA, Alford BR. Intracranial and intratemporal facial neuroma. Otolaryngol Head Neck Surg 1987; 96 (01) 71-79
  • 48 Huoh KC, Cheung SW. Chorda tympani neuroma. Otol Neurotol 2010; 31 (07) 1172-1173
  • 49 McNulty BN, Wise S, Cohen DS. , et al. Facial nerve schwannomas mimicking as vestibular schwannomas. J Neurol Surg B Skull Base 2017; 78 (04) 283-287
  • 50 Jethanamest D, Rivera AM, Ji H, Chokkalingam V, Telischi FF, Angeli SI. Conservative management of vestibular schwannoma: Predictors of growth and hearing. Laryngoscope 2015; 125 (09) 2163-2168
  • 51 Vianna M, Adams M, Schachern P, Lazarini PR, Paparella MM, Cureoglu S. Differences in the diameter of facial nerve and facial canal in bell's palsy--a 3-dimensional temporal bone study. Otol Neurotol 2014; 35 (03) 514-518
  • 52 Sughrue ME, Kane AJ, Kaur R. , et al. A prospective study of hearing preservation in untreated vestibular schwannomas. J Neurosurg 2011; 114 (02) 381-385