Intratemporal facial nerve schwannoma: a management dilemma.

OBJECTIVE: To report the findings in patients with facial nerve schwannoma in whom surgery was elected at onset versus patients treated expectantly. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. PATIENTS: Twenty-four patients with a mean age of 44 years (range, 18-65 yr) were followed for an average of 6 years (range, 1-19 yr). INTERVENTION: Eleven patients underwent complete tumor excision and 13 patients were enrolled in ongoing monitoring only. MAIN OUTCOME MEASURES: Facial nerve function and hearing acuity were noted at the time of initial and last visits. Magnetic resonance imaging was used to determine tumor growth in those individuals treated expectantly and as a means of excluding tumor recurrence/persistence in those treated surgically. RESULTS: Of the 11 patients who underwent tumor removal, the facial nerve was spared in 7. Eight had varying degrees of facial nerve dysfunction initially. In this group (mean follow-up, 8 yr), six patients had unchanged nerve function, four had improved nerve function, and one had worsened. No long-term recurrence was noted. Of the 13 patients followed expectantly, three had facial weakness initially. During the follow-up interval (mean, 5 yr), facial function remained unchanged for eight and worsened in five. During this interval, 4 of the 13 patients demonstrated tumor growth and 3 have recently undergone tumor removal. CONCLUSION: Facial nerve schwannomas are extremely slow growing and frequently present without facial dysfunction. It is possible to surgically remove these tumors while sparing the nerve; as a result, postoperative function is correspondingly better. Finally, the decision on how to treat these patients should be individualized and based on initial facial function, growth rate, surgical experience, and informed patient consent.