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CC BY-NC-ND 4.0 · J Neurol Surg Rep 2024; 85(03): e112-e117
DOI: 10.1055/s-0044-1788071
Case Report

Hearing Improvement after Radiation Therapy for a Facial Nerve Schwannoma: Report of a Case and Review of Literature

Isabella L. Pecorari 
1   Department of Neurological Surgery, Albert Einstein College of Medicine, Bronx, New York, United States
2   Department of Neurological Surgery, Montefiore Medical Center, Bronx, New York, United States
,
Sayak R. Ghosh
1   Department of Neurological Surgery, Albert Einstein College of Medicine, Bronx, New York, United States
2   Department of Neurological Surgery, Montefiore Medical Center, Bronx, New York, United States
,
Howard S. Moskowitz
3   Department of Otorhinolaryngology, Albert Einstein College of Medicine, Bronx, New York, United States
4   Department of Otorhinolaryngology, Montefiore Medical Center, Bronx, New York, United States
,
Vijay Agarwal
1   Department of Neurological Surgery, Albert Einstein College of Medicine, Bronx, New York, United States
2   Department of Neurological Surgery, Montefiore Medical Center, Bronx, New York, United States
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Abstract

Introduction While facial nerve schwannomas are considered benign, they can impart various significant clinical effects due to pressure on nearby cerebrovascular structures within the cerebellopontine angle (CPA). Although surgical resection and/or radiation therapy often provide definitive treatment of such tumors, posttreatment hearing loss is a common finding. In this report, we present the case of a patient with a facial nerve schwannoma successfully treated with radiotherapy with resultant hearing improvement, an extremely rare clinical finding.

Case Presentation A 63-year-old woman presented with a 1-year history of progressively worsening hearing loss and tinnitus. Brain imaging demonstrated an enhancing lesion of the right CPA measuring 2.7 × 2.1 × 3.1 cm. Pretreatment audiometry evaluation revealed sensorineural hearing loss in the right ear with a pure-tone average (PTA) of 74 dB, speech threshold (ST) of 75 dB, and speech discrimination (SD) of 0%. The patient proceeded with attempted surgical resection, aborted due to significant facial nerve stimulation, and ultimately underwent radiation therapy (50.4 Gy, 28 fractions). At the 1-year follow-up visit, the patient reports subjective hearing loss resolution with PTA of 34 dB, 30 dB ST, and 88% SD on audiological evaluation.

Conclusion Although radiation therapy for schwannomas within the CPA has historically been associated with hearing loss, fractionated stereotactic radiotherapy (FSRT) may provide improved clinical outcomes compared with high-dose radiosurgery. Given the effectiveness of this treatment modality and improved quality of life offered to patients over surgery, FSRT may be considered an initial management option for patients with facial nerve schwannomas.

Keywords

facial nerve schwannoma - hearing improvement - radiation therapy - CPA mass


Publication History

Received: 30 January 2024

Accepted: 26 April 2024

Article published online:
08 July 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Samii M, Gerganov VM. Chapter 41 - Tumors of the cerebellopontine angle. In: Grisold W, Soffietti R. eds. Handbook of Clinical Neurology. Elsevier; 2012: 633-639
    Google Scholar
  • 2 Rhoton Jr AL. The cerebellopontine angle and posterior fossa cranial nerves by the retrosigmoid approach. Neurosurgery 2000; 47 (3, Suppl): S93-S129
    CrossrefPubMedGoogle Scholar
  • 3 Granick MS, Martuza RL, Parker SW, Ojemann RG, Montgomery WW. Cerebellopontine angle meningiomas: clinical manifestations and diagnosis. Ann Otol Rhinol Laryngol 1985; 94 (1 Pt 1): 34-38
    CrossrefPubMedGoogle Scholar
  • 4 Springborg JB, Poulsgaard L, Thomsen J. Nonvestibular schwannoma tumors in the cerebellopontine angle: a structured approach and management guidelines. Skull Base 2008; 18 (04) 217-227
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Verkhratsky A, Butt AM. Chapter 14 - Pathology of the peripheral nervous system. In: Verkhratsky A, Butt AM. eds. Neuroglia. Academic Press; 2023: 673-690
    Google Scholar
  • 6 Rutherford SA, King AT. Vestibular schwannoma management: what is the ‘best’ option?. Br J Neurosurg 2005; 19 (04) 309-316
    CrossrefPubMedGoogle Scholar
  • 7 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
    CrossrefPubMedGoogle Scholar
  • 8 Huang MY, Vermeulen S. Clinical perspectives regarding patients with internal auditory canal or cerebellopontine angle lesions: surgical and radiation oncology perspectives. Semin Ultrasound CT MR 2003; 24 (03) 124-132
    CrossrefPubMedGoogle Scholar
  • 9 Coughlin AR, Willman TJ, Gubbels SP. Systematic review of hearing preservation after radiotherapy for vestibular schwannoma. Otol Neurotol 2018; 39 (03) 273-283
    CrossrefPubMedGoogle Scholar
  • 10 Ansari SF, Terry C, Cohen-Gadol AA. Surgery for vestibular schwannomas: a systematic review of complications by approach. Neurosurg Focus 2012; 33 (03) E14
    CrossrefPubMedGoogle Scholar
  • 11 Colombo F, Maye H, Rutherford S. et al. Surgery versus radiosurgery for vestibular schwannoma: shared decision making in a multidisciplinary clinic. Neurooncol Adv 2023; 5 (01) vdad089
    PubMedGoogle Scholar
  • 12 Goldbrunner R, Weller M, Regis J. et al. EANO guideline on the diagnosis and treatment of vestibular schwannoma. Neuro-oncol 2020; 22 (01) 31-45
    CrossrefPubMedGoogle Scholar
  • 13 Santa Maria PL, Shi Y, Gurgel RK. et al. Long-term hearing outcomes following stereotactic radiosurgery in vestibular schwannoma patients-a retrospective cohort study. Neurosurgery 2019; 85 (04) 550-559
    CrossrefPubMedGoogle Scholar
  • 14 Libell JL, Balar AB, Libell DP. et al. Facial nerve schwannoma: case report and brief review of the literature. Radiol Case Rep 2023; 18 (10) 3442-3447
    CrossrefPubMedGoogle Scholar
  • 15 Pilavaki M, Chourmouzi D, Kiziridou A, Skordalaki A, Zarampoukas T, Drevelengas A. Imaging of peripheral nerve sheath tumors with pathologic correlation: pictorial review. Eur J Radiol 2004; 52 (03) 229-239
    CrossrefPubMedGoogle Scholar
  • 16 Liu R, Fagan P. Facial nerve schwannoma: surgical excision versus conservative management. Ann Otol Rhinol Laryngol 2001; 110 (11) 1025-1029
    CrossrefPubMedGoogle Scholar
  • 17 Eshraghi AA, Oker N, Ocak E. et al. Management of facial nerve schwannoma: a multicenter study of 50 cases. J Neurol Surg B Skull Base 2019; 80 (04) 352-356
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Xu F, Pan S, Alonso F, Dekker SE, Bambakidis NC. intracranial facial nerve schwannomas: current management and review of literature. World Neurosurg 2017; 100: 444-449
    CrossrefPubMedGoogle Scholar
  • 19 Rotter J, Lu VM, Graffeo CS. et al. Surgery versus radiosurgery for facial nerve schwannoma: a systematic review and meta-analysis of facial nerve function, postoperative complications, and progression. J Neurosurg 2020; 135 (02) 542-553
    CrossrefPubMedGoogle Scholar
  • 20 Silk PS, Lane JI, Driscoll CL. Surgical approaches to vestibular schwannomas: what the radiologist needs to know. Radiographics 2009; 29 (07) 1955-1970
    CrossrefPubMedGoogle Scholar
  • 21 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
    PubMedGoogle Scholar
  • 22 Sheehan JP, Kano H, Xu Z. et al. Gamma Knife radiosurgery for facial nerve schwannomas: a multicenter study. J Neurosurg 2015; 123 (02) 387-394
    CrossrefPubMedGoogle Scholar
  • 23 Winn HR. Youmans and Winn Neurological Surgery E-Book: 4-Volume Set. Elsevier Health Sciences; 2022
    Google Scholar
  • 24 Nishioka K, Abo D, Aoyama H. et al. Stereotactic radiotherapy for intracranial nonacoustic schwannomas including facial nerve schwannoma. Int J Radiat Oncol Biol Phys 2009; 75 (05) 1415-1419
    CrossrefPubMedGoogle Scholar
  • 25 Madhok R, Kondziolka D, Flickinger JC, Lunsford LD. Gamma knife radiosurgery for facial schwannomas. Neurosurgery 2009; 64 (06) 1102-1105 , discussion 1105
    CrossrefPubMedGoogle Scholar
  • 26 Kida Y, Yoshimoto M, Hasegawa T. Radiosurgery for facial schwannoma. J Neurosurg 2007; 106 (01) 24-29
    CrossrefPubMedGoogle Scholar
  • 27 Fezeu F, Lee C-C, 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
    CrossrefPubMedGoogle Scholar
  • 28 Andrews DW, Suarez O, Goldman HW. et al. Stereotactic radiosurgery and fractionated stereotactic radiotherapy for the treatment of acoustic schwannomas: comparative observations of 125 patients treated at one institution. Int J Radiat Oncol Biol Phys 2001; 50 (05) 1265-1278
    CrossrefPubMedGoogle Scholar
  • 29 Persson O, Bartek Jr J, Shalom NB, Wangerid T, Jakola AS, Förander P. Stereotactic radiosurgery vs. fractionated radiotherapy for tumor control in vestibular schwannoma patients: a systematic review. Acta Neurochir (Wien) 2017; 159 (06) 1013-1021
    CrossrefPubMedGoogle Scholar
  • 30 Carlson ML, Jacob JT, Pollock BE. et al. Long-term hearing outcomes following stereotactic radiosurgery for vestibular schwannoma: patterns of hearing loss and variables influencing audiometric decline. J Neurosurg 2013; 118 (03) 579-587
    CrossrefPubMedGoogle Scholar
  • 31 Andrews DW, Werner-Wasik M, Den RB. et al. Toward dose optimization for fractionated stereotactic radiotherapy for acoustic neuromas: comparison of two dose cohorts. Int J Radiat Oncol Biol Phys 2009; 74 (02) 419-426
    CrossrefPubMedGoogle Scholar
  • 32 Franzin A, Spatola G, Serra C. et al. Evaluation of hearing function after gamma knife surgery of vestibular schwannomas. Neurosurg Focus 2009; 27 (06) E3
    CrossrefPubMedGoogle Scholar
  • 33 Udawatta M, Kwan I, Preet K. et al. Hearing preservation for vestibular schwannomas treated with stereotactic radiosurgery or fractionated stereotactic radiotherapy. World Neurosurg 2019; 129: e303-e310
    CrossrefPubMedGoogle Scholar
  • 34 Combs SE, Engelhard C, Kopp C. et al. Long-term outcome after highly advanced single-dose or fractionated radiotherapy in patients with vestibular schwannomas - pooled results from 3 large German centers. Radiother Oncol 2015; 114 (03) 378-383
    CrossrefPubMedGoogle Scholar