1

Introduction

Facial nerve schwannomas (FNS) are rare entities. There is no clear consensus about treatment. Currently, most authors agree that the ultimate goal is to preserve facial nerve function due to the slow-growing and benign nature of the tumors. Total tumor removal and nerve grafting undoubtedly result in Grade III (House–Brackmann grading system ) recovery at best , thus subtotal removal, observation, stereotactic radiosurgery or facial nerve decompression sole is recommended to the patients with good facial nerve function (Grade III or better), since good outcomes of facial nerve could be maintained for a time .

The purpose of the current study was to report long-term outcomes of near-total removal of FNS and discuss about its application.

2

Materials and methods

A consecutive series of 19 FNS patients with good facial nerve function was involved in the study, among which 11 were female and 8 male. The mean age was 36.20 ± 3.22 years (range, 18 to 72 years). We successfully carried out near-total removal of FNS (defined as tumor removal of 95 percentage or greater) on 13 cases under high magnification and intraoperative facial nerve monitoring, and the other 6 cases who were found to have unclear border between nerve shaft and the tumors underwent total tumor removal and nerve grafting. They were divided into the near-total removal group and the total removal group, and followed up for 7.38 ± 1.98 years (range, 5 to 11 years) and 6.66 ± 1.63 years (range, 5 to 9 years), respectively. MRI examination was performed on each patient before surgery, three months after surgery and each year thereafter. Hearing level was measured by audiometer.

During the surgery, intraoperative facial nerve monitoring was used to identify facial nerve from the tumors. A cut was made through the tumors near its junction with facial nerve. The tumor capsule was left, and other tumor tissues were all removed. Nerve sheath was preserved.

The selection of surgical approach was mainly dependent on tumor location. Middle cranial fossa approach was selected when the tumors affected internal auditory canal segment, cerebellar pontine angle segment, labyrinthine segment or geniculate ganglion of facial nerve, and transmastoid approach was considered when tympanic segment or mastoid segment was affected. Middle cranial fossa combined with transmastoid approach was adopted when both the former and latter sites were involved. There were no noticeable complications.

2

Materials and methods

A consecutive series of 19 FNS patients with good facial nerve function was involved in the study, among which 11 were female and 8 male. The mean age was 36.20 ± 3.22 years (range, 18 to 72 years). We successfully carried out near-total removal of FNS (defined as tumor removal of 95 percentage or greater) on 13 cases under high magnification and intraoperative facial nerve monitoring, and the other 6 cases who were found to have unclear border between nerve shaft and the tumors underwent total tumor removal and nerve grafting. They were divided into the near-total removal group and the total removal group, and followed up for 7.38 ± 1.98 years (range, 5 to 11 years) and 6.66 ± 1.63 years (range, 5 to 9 years), respectively. MRI examination was performed on each patient before surgery, three months after surgery and each year thereafter. Hearing level was measured by audiometer.

During the surgery, intraoperative facial nerve monitoring was used to identify facial nerve from the tumors. A cut was made through the tumors near its junction with facial nerve. The tumor capsule was left, and other tumor tissues were all removed. Nerve sheath was preserved.

The selection of surgical approach was mainly dependent on tumor location. Middle cranial fossa approach was selected when the tumors affected internal auditory canal segment, cerebellar pontine angle segment, labyrinthine segment or geniculate ganglion of facial nerve, and transmastoid approach was considered when tympanic segment or mastoid segment was affected. Middle cranial fossa combined with transmastoid approach was adopted when both the former and latter sites were involved. There were no noticeable complications.

3

Results

Summary of the patients in near-total removal group and total removal group is in Tables 1 and 2 . Facial paralysis was firstly presented in 14 of 19 cases (73.7%), followed by hearing loss in 9 of 19 cases (45.0%) and vertigo in 2 of 19 cases (10.5%). Geniculate ganglion and/or labyrinthine segment were most commonly affected (12 cases, 63.2%), followed by tympanic segment (8 cases, 42.1%), mastoid segment (7 cases, 36.8%), internal auditory canal segment (7 cases, 36.8%), and CPA segment (one case, 5.3%). Multi-segment involvement (12 cases, 63.2%) was more common than single-segment involvement.

Table 1

Summary of 13 cases who underwent near-total tumor removal.

No.	Symptoms	Segments affected	PreFNF	PosFNF	Surgical approach	Initial hearing level	Final hearing level	Recurrence	Follow-up (years)
1	SNHL, T	IAC	II	II	MCF	30 dB	30 dB	No	6
2	FP	IAC	II	II	MCF	Normal	Normal	No	8
3	FP, V	GG, LS	II	II	MCF	Normal	Normal	No	6
4	FP, CHL	GG, TS, MS	III	IV	TM, MCF	40 dB	25 dB	No	5
5	T, MHL	LS, TS, MS	I	I	TM, MCF	35 dB	30 dB	No	7
6	T	IAC, GG	I	I	MCF	Normal	Normal	Yes	9
7	FP	CPA	III	II	MCF	Normal	Normal	No	7
8	CHL, T	TS, MS	I	I	TM	30 dB	20 dB	No	5
9	FP	GG, TS	II	II	TM, MCF	Normal	Normal	No	8
10	CHL, T	LS, TS, MS	I	I	TM, MCF	40 dB	25 dB	No	9
11	FP, CHL	GG, TS, MS	III	II	TM, MCF	55 dB	30 dB	No	10
12	FP	IAC	III	III	MCF	Normal	Normal	No	11
13	PF	GG	II	I	MCF	Normal	Normal	No	5

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