Atypical Tumors of the Facial Nerve

Case Series and Review of the Literature

Lindsey Ross, M.D; Doniel Drazin, M.D; Paula Eboli, M.D; Gregory P. Lekovic, M.D., Ph.D.

Disclosures

Neurosurg Focus. 2013;34(3):e2 

In This Article

Abstract and Introduction

Abstract

Object The authors present a series of 4 patients with rare facial nerve tumors. The relevant literature is reviewed and is discussed regarding diagnostic features, the role of operative management, and surgical approach.

Methods A retrospective chart review was conducted for patients with tumors of the facial nerve that were treated between 2008 and 2011. Patients undergoing observation with serial MRI and those who were treated with up-front radiosurgery and for whom tissue diagnosis was not available were excluded. In addition, patients with suspected vestibular schwannoma, facial nerve schwannoma, neurofibromatosis Type 2, and metastatic disease were also excluded. The charts of 4 patients (2 men and 2 women) with "atypical" tumors were reviewed and analyzed.

Results A total of 12 patients with tumors of the facial nerve were identified during the study period. Patient characteristics, preoperative imaging, operative approach, tumor histology, and outcomes are described.

Conclusions Atypical facial nerve tumors must be distinguished from the more common facial nerve schwannoma. How the authors of this study treat rare facial nerve tumors is based on their experience with the more common facial nerve schwannomas, characterized by a slow progression of symptoms and growth. Less is known about the rare lesions, and thus a conservative approach may be warranted. Open questions include the role of radiosurgery, facial nerve decompression, and indications for resection of tumor and cable grafting for these rare lesions.

Introduction

Primary tumors of the facial nerve are uncommon lesions. Facial nerve schwannomas of the CPA and/or IAC are the most often encountered facial nerve tumors and may be mistaken for vestibular schwannomas. We present a series of 4 patients with "atypical" tumors of the facial nerve based on 1) location (not involving the CPA or IAC) and/or 2) unusual histological findings. Although individually very rare, these atypical tumors in aggregate contribute significantly to pathology of the facial nerve. The goal of the present study is to highlight the diversity of conditions affecting the facial nerve with a review of the relevant literature and discussion of nuances in diagnostic features. The role of operative management and surgical approach will also be discussed.

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