Intradural Facial Nerve Schwannoma: Diagnostic and Therapeutic Problems

ABSTRACT

Objectives: To define characteristics of intradural facial schwannoma (FS) and discuss management strategies. Method: Retrospective review of clinical charts. Results: Six patients were diagnosed, based on surgical findings, as having intradural FS. None of the patients complained initially of facial weakness, but all showed severe disturbance of hearing function assessed on admission. FS was suspected in four of our six patients because of imaging findings or facial palsy caused by a small tumor. Total removal was performed in five cases followed by facial nerve reconstruction, and nearly total removal was performed in one case. Most patients recovered to Grade II or III palsy during the follow-up, and long-lasting palsy before surgery showed poor recovery. Conclusion: Imaging findings such as tumor extension to the middle fossa and clinical findings such as facial palsy caused by a small tumor strongly suggest a diagnosis of FS. Facial function can be restored satisfactorily for most patients after appropriate surgery.

KEYWORDS

Cerebellopontine angle - facial nerve - schwannoma - surgery

REFERENCES

• 1 Sherman J D, Dagnew E, Pensak M L, van Loveren H R, Tew Jr J M. Facial nerve neuromas: report of 10 cases and review of the literature.  Neurosurgery. 2002;  50 450-456
• 2 House J W, Brackmann D E. Facial nerve grading system.  Otolaryngol Head Neck Surg. 1985;  93 146-147
• 3 Kubota Y, Kawamata T, Kubo O, Kasuya H, Muragaki Y, Hori T. Large facial nerve schwannomas without facial palsy: case reports and review of the literature.  Neurosurg Rev. 2005;  28 234-238
• 4 Lipkin A F, Coker N J, Jenkins H A, Alford B R. Intracranial and intratemporal facial neuroma.  Otolaryngol Head Neck Surg. 1987;  96 71-79
• 5 Liu R, Fagan P. Facial nerve schwannoma: surgical excision versus conservative management.  Ann Otol Rhinol Laryngol. 2001;  110 1025-1029
• 6 Hasegawa T, Kobayashi T, Kida Y, Tanaka T, Yoshida K, Osuka K. Two cases of facial neurinoma successfully treated with gamma knife radiosurgery [in Japanese].  No Shinkei Geka. 1999;  27 171-175
• 7 Chung J W, Ahn J H, Kim J H, Nam S U, Kim C-J, Lee K-S. Facial nerve schwannomas: different manifestations and outcomes.  Surg Neurol. 2004;  62 245-252