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.


Neurosurg Focus. 2013;34(3):e2 

In This Article


A total of 12 patients with tumors of the facial nerve were identified during the study period. Preoperatively identified facial nerve schwannomas treated with up-front radiosurgery (n = 2) or with resection and cable grafting (n = 2) were excluded from analysis. In addition, a facial nerve schwannoma diagnosed intraoperatively during surgery as a presumed vestibular schwannoma (n = 1) and a metastatic tumor to the CPA (n = 1) causing facial weakness were excluded from analysis. Finally, tumors that were believed to be facial nerve schwannomas based on imaging and that had been managed with a "wait and scan" approach were similarly excluded (n = 2). One tumor that was isolated to the mastoid segment of the facial nerve and that exhibited radiographic features believed to be unusual for schwannoma was found at surgery to be a schwannoma; this case was included because the tumor was not identified preoperatively as a facial nerve schwannoma (see Case 2 below). The charts of the 4 patients with "atypical" tumors of the facial nerve were reviewed and analyzed.

Patient Characteristics

There were 2 men and 2 women. The mean age was 53 years old. All 4 patients presented with some degree of facial paresis, except the patient in Case 3; the length of time from onset of facial weakness to diagnosis was 21 months. Three of the 4 patients had a history of remote Bell palsy, after which a complete recovery was made.

Surgical interventions included facial nerve decompression (n = 3), partial tumor resection and/or biopsy (n = 3), and tumor resection with interposition cable graft (n = 1). The approach was via a middle fossa craniotomy (n = 2) or a transpetrosal one (n = 2). Tumor histology was consistent with a hemangioma of the facial nerve (n = 1), meningioma (n = 1), schwannoma (n = 1), and a glomus facialis tumor (n = 1).

The mean preoperative House-Brackmann facial nerve grade was III. The mean House-Brackmann facial nerve grade at last follow-up was II. There was no major perioperative morbidity or death.