Facial Nerve Schwannomas: Review of 80 Cases Over 25 Years at Mayo Clinic

Matthew L. Carlson, Nicholas L. Deep, Neil S. Patel, Larry B. Lundy, Nicole M. Tombers, Christine M. Lohse, Michael J. Link, Colin L. Driscoll

Research output: Contribution to journalArticlepeer-review

24 Scopus citations

Abstract

Objective To elucidate the long-term clinical behavior, treatment, and outcomes of sporadic facial nerve schwannoma (FNS) in a large cohort of patients managed in the post–magnetic resonance imaging era. Patients and Methods Retrospective review at a single tertiary health care system (January 1, 1990, through December 31, 2015), evaluating 80 consecutive patients with sporadic FNS. Results Ninety-eight patients with FNS were identified; 10 with incomplete data and 8 with neurofibromatosis type 2 were excluded. The remaining 80 patients (median age, 47 years; 58% women) were analyzed. Forty-three (54%) patients presented with asymmetrical hearing loss, 33 (41%) reported facial paresis, and 21 (26%) reported facial spasm. Seventeen (21%) exhibited radiologic features mimicking vestibular schwannoma, 14 (18%) presented as a parotid mass, and 5 (6%) were discovered incidentally. Factors predictive of facial nerve paresis or spasm before treatment were female sex and tumor involvement of the labyrinthine/geniculate and tympanic facial nerve segments. The median growth rate among growing FNS was 2.0 mm/y. Details regarding clinical outcome according to treatment modality are described. Conclusion In patients with FNS, female sex and involvement of the labyrinthine/geniculate and tympanic segments of the facial nerve predict a higher probability of facial paresis or spasm. When isolated to the posterior fossa or parotid gland, establishing a preoperative diagnosis of FNS is challenging. Treatment should be tailored according to tumor location and size, existing facial nerve function, patient priorities, and age. A management algorithm is presented, prioritizing long-term facial nerve function.

Original languageEnglish (US)
Pages (from-to)1563-1576
Number of pages14
JournalMayo Clinic proceedings
Volume91
Issue number11
DOIs
StatePublished - Nov 1 2016

ASJC Scopus subject areas

  • Medicine(all)

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