PubMed2003
OBJECTIVE: To evaluate the surgical results in primary facial nerve (FN) tumors. STUDY DESIGN: Retrospective case review. SETTING: Private neuro-otological and skull-base tertiary referral center. PATIENTS: Twenty eight consecutive patients affected by primary FN tumors that underwent surgery between December 1990 and February 2001. INTERVENTIONS: The lesions were removed through a variety of surgical approaches, depending on tumor location and extension, as well as preoperative hearing. In one case, partial removal was performed. MAIN OUTCOME MEASURES: Preoperative and postoperative FN function; preoperative and postoperative hearing level; and postoperative complications. RESULTS: Based on histologic examination, tumors were distributed as follows: 18 schwannomas, six hemangiomas, two meningiomas, and two neurofibromas. Tumor location varied, with lesions distributed along the entire length of the nerve. Facial dysfunction was the most frequently recorded symptom, followed by hearing loss. Only five patients presented a preoperative grade 1 facial function. In the remaining patients of the group, the facial deficit lasted from 2 to 120 months, with a mean of 31.2 months. Anatomic integrity of the nerve was preserved in 4 cases; all others required a nerve interruption followed by reconstruction using a sural nerve graft. The complications recorded were: one cerebrospinal fluid leak, one postoperative retraction pocket, and one external auditory canal wall resorption requiring a surgical revision. Preoperative hearing remained unchanged in 8 out of the 15 patients in whom a hearing preservation procedure was attempted. In 25 cases, a follow-up of equal to or longer than 1 year was available, with the FN functions: two grade 1, eight grade 3, nine grade 4, three grade 5, and three grade 6. Patients with a preoperative deficit lasting more than 1 year demonstrated the worst recovery. CONCLUSIONS: Primary FN tumors are rare lesions that include different histologic types. FN deficit represents the most common symptom, but it is not present in all cases. A conservative strategy is often adopted in presence of a normal preoperative facial function. When surgical management is selected, the decision on surgical approach to use depends on tumor size and location, as well as on preoperative hearing. FN integrity may be spared in rare occasions, but more frequently nerve reconstruction is required. Final facial function recovery is mainly dependent on the preoperative presence of FN deficit and its duration.