Outgrowing schwannomas arising from tympanic segments of the facial nerve

Large middle ear schwannoma of the Jacobson's nerve with intracranial extension

The patient is a 64-year-old woman who developed a sensation of right ear fullness and hearing loss in early November 2010. Physical examination revealed a painless reddish granular lesion filling in the right external auditory canal. Her right ear was deaf, and no facial palsy was noted. Computed tomography, magnetic resonance imaging and positron emission tomography revealed a middle ear mass extending to the external auditory canal with intracranial invasion causing temporal lobe retraction and inferiorly extending just anterior to the jugular bulb as well. A combination of transmastoid and middle cranial fossa approach along with anterior rerouting of the facial nerve was employed for a near-total removal of the tumor. Based upon the operative findings, it was deemed that the tumor could have arisen from the Jacobson's nerve.

The presenting features of middle ear facial nerve sheath tumors: a clinical review

Facial nerve sheath tumors are the most common middle ear benign neoplasms. Four facial nerve sheath tumors in the middle ear were diagnosed in our department over a 12-year period, and we described our experience in the management of these tumors. A thorough review of the English literature on middle ear peripheral nerve sheath tumors has been conducted, and the findings of this review are presented and discussed. We have paid particular attention to the presenting features of these tumors with the aim of enhancing diagnostic ability.

[Intracranial facial nerve schwannomas. Seven cases reviewed]

BACKGROUND AND PURPOSE

Intracranial facial nerve schwannomas are rare neoplasms. Preoperative diagnosis is difficult because of non-specific clinical presentations (deafness, facial paralysis sudden or progressive) and radiological differential diagnosis (petrous bone tumor, vestibular schwannoma). Treatment depends on localization and has to be discussed for each case.

METHODS

Seven cases (four men and three women) of intracranial facial nerve schwannomas were retrospectively studied.

RESULTS

Before treatment, we found deafness in six cases (two sudden and four progressive), a facial palsy in five cases (three sudden and two progressive). Five patients had deafness and facial palsy. One patient had only headache. Three schwannomas were supra and intra-petrous, two in the cerebello-pontine angle, and two were plurifocal (petrous bone, internal auditive canal and cerebellopontine angle). Six patients were operated on with an oto-neurosurgical procedure. After treatment, facial palsy always worsened (requesting secondary hypoglosso-facial anastomosis in cinq cases). Only one case of transmission deafness improved after ossiculoplasty. One patient is still under clinical and radiological observation.

CONCLUSION

Diagnosis is difficult and made operatively in half of patients. A large tumor requires surgery, but surveillance can be a good option for a small one, considering the risk of postoperative facial palsy.

[Intrapretosal schwannomas of facial nerve]

The aim of this study was to determine the factors that are important to the diagnosis and treatment of facial neuroma. The most common tumors of the peripheral nerves are the neurinomas; about 50% of them are found in the head and neck region. Among them, the most frequent is the VIII nerve tumor, while the facial neuroma is extremely rare. Neuromas can be intracraneal, intratemporal and extratemporal. The last one has a higher frequency. We present our experience in the intrapetrosal facial neuromas; usually showing different presentation symptoms wich is a characteristic of them. Retrospective study that was carried out at a private tertiary referral center. 3 patients were referred from other centers for otological surgery. One of them had symptoms of chronic otitis media, the second one was diagnosed of a glomus tumor and the last one showed a facial palsy. All the patients were operated on and then the facial nerve was repaired. Two patients had an end to end anastomosis, and in the other one we managed to keep the integrity of the facial nerve. The Hous -Brackmann facial grading scale was used. Two patients had grade II and the other grade III in this scale in the long-term follow up.

Fascicle preservation surgery for facial nerve neuromas involving the posterior cranial fossa

OBJECTIVE

To assess facial nerve function after fascicle preservation surgery in cases of facial nerve neuroma involving the cerebellopontine angle.

STUDY DESIGN

Retrospective case series and literature review.

SETTING

Tertiary referral center.

PATIENTS

Seven patients with facial nerve neuroma involving the posterior cranial fossa were reviewed from a single neurotologist's practice and combined with a review of 648 cases reported in the literature.

INTERVENTIONS

Translabyrinthine resection was used in all patients for complete tumor removal. Nerve reconstruction was accomplished with fascicle preservation (three cases), cable nerve interposition grafting (three cases, one of which involved using cranial nerve VIII as the graft), or direct anastomosis (one case).

MAIN OUTCOME MEASURE

Facial nerve function as measured by the House-Brackmann grading system. RESULTS A postoperative facial nerve (House-Brackmann) grade of II/VI was obtained in two of our three patients who underwent fascicle preservation reconstruction and in two of eight cases reported by other authors. One case reported elsewhere resulted in grade I/VI, and four other cases reported elsewhere achieved grade III/VI; only two cases were grade V/VI. There were no tumor recurrences at 5 to 19 years of follow-up.

CONCLUSION

Most cases of facial nerve neuroma require facial nerve resection. In rare cases, these tumors can be dissected away from the nerve fascicles, allowing the surgeon to preserve the facial nerve. This method resulted in better long-term postoperative facial nerve function (House-Brackmann grade II/VI vs. grade III/VI) compared with other techniques for patients in this small series, and no tumor recurrence.