1

Introduction

Facial nerve schwannomas (FNS) are mostly slow-growing tumors that may involve any segments of facial nerve, but have a predilection for labyrinthine segment/geniculate ganglion .

Complete tumor removal and nerve grafting invariably lead to House–Brackmann Grade III recovery at best . Apparently, it is a source of great distress to patients, especially those whose initial facial nerve function is normal or mildly abnormal. Thus, delayed surgical removal may be considered in those patients with favorable facial nerve function (not worse than Grade III). Observation with serial radiologic examinations may maintain facial nerve at a favorable level for a long period.

In the study, we reviewed a consecutive series of 21 patients with FNS who had favorable facial nerve function and were managed by observation. The long-term follow-up results of them were reported, and the affecting factors of tumor growth were discussed.

2

Materials and methods

The study covered a consecutive series of 21 patients with FNS who had favorable facial nerve function and accepted observation as the management. They visited a tertiary referral center between 1998 and 2009. There were 12 females and 9 males. Mean age was 37.30 ± 3.52 years (range, 22–70 years). Three-dimensional MRI examination and high-resolution CT of temporal bone were performed at the time of diagnosis. Then the patients underwent three-dimensional MRI examination once per year during the follow-up. Hearing level was measured by clinical audiometer.

Initial tumor size was defined as average of the tumor size on three dimensions of initial MRI image. Tumor growth was defined as an increase in the average tumor size (≥ 1 mm). The patients were divided into larger size group (≥ 10 mm) and smaller size group (< 10 mm) according to initial average size of the tumors. Moreover, they were also divided into normal facial nerve group and facial palsy group based on initial facial nerve function. Growth rate of the tumors in the groups was compared by Fisher’s exact test, and SPSS 18.0 software was used in statistical analysis.

2

Materials and methods

The study covered a consecutive series of 21 patients with FNS who had favorable facial nerve function and accepted observation as the management. They visited a tertiary referral center between 1998 and 2009. There were 12 females and 9 males. Mean age was 37.30 ± 3.52 years (range, 22–70 years). Three-dimensional MRI examination and high-resolution CT of temporal bone were performed at the time of diagnosis. Then the patients underwent three-dimensional MRI examination once per year during the follow-up. Hearing level was measured by clinical audiometer.

Initial tumor size was defined as average of the tumor size on three dimensions of initial MRI image. Tumor growth was defined as an increase in the average tumor size (≥ 1 mm). The patients were divided into larger size group (≥ 10 mm) and smaller size group (< 10 mm) according to initial average size of the tumors. Moreover, they were also divided into normal facial nerve group and facial palsy group based on initial facial nerve function. Growth rate of the tumors in the groups was compared by Fisher’s exact test, and SPSS 18.0 software was used in statistical analysis.

3

Results

Table 1 listed summary of the cases. They were followed up for 6.4 ± 1.7 years (range, 4–9 years). 7 cases had normal facial nerve function, and 14 patients were Grade II or Grade III at the first visit. 10 patients had mild or moderate hearing loss, and hearing level was obviously worsened (defined as rise of final hearing threshold by more than 5 dB) in 3 of 21 cases (14.3%).

Table 1

Summary of 21 cases with facial nerve schwannomas.

No.	Symptoms	Tumor location	Initial FNF	Final FNF	Initial TS (mm)	Tumor growth	IHL (dB)	FHL (dB)	FU (y)
1	T	GG, LS	I	I	13	No	10	10	9
2	FP	GG	II	II	7	No	5	5	8
3	CHL, T	GG, TS	I	I	11	No	35	35	6
4	RFP	GG, TS	II	III	5	No	5	5	5
5	V, SNHL	CPA, IAC	III	VI	15	Yes	35	40	7
6	V, SNHL	IAC, GG	I	II	14	Yes	40	70	4
7	SNHL	IAC	I	I	15	No	30	35	7
8	FP, SNHL	IAC,GG	III	III	7	No	50	45	6
9	FP, T	TS, MS	II	II	5	No	15	15	4
10	SNHL, V	IAC, GG	I	III	14	Yes	55	55	6
11	SNHL, FP	CPA, IAC	III	III	4	No	40	40	5
12	FP	TS	II	III	16	Yes	15	15	4
13	FPLS, GG	III	III	5	No	10	10	6
14	FP, V	GG, MS	III	III	5	No	15	15	5
15	SNHL	IAC	I	II	13	Yes	50	50	5
16	SNHL, FP	IAC,GG	III	III	8	Yes	45	55	8
17	FP	TS,MS	II	IV	12	Yes	15	40	7
18	FP, T	TS, MS	IIq	II	3	No	15	15	9
19	SNHL, V	CPA	I	III	15	Yes	50	50	9
20	FP	GG	II	II	4	No	10	10	8
21	FP	GG,TS,MS	II	IV	15	Yes	10	40	7

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