• Gautam U Mehta, Gregory P Lekovic, William H Slattery, Derald E Brackmann, Hao Long, Hideyuki Kano, Douglas Kondziolka, Monica Mureb, Kenneth Bernstein, Anne-Marie Langlois, David Mathieu, Ahmed M Nabeel, Wael A Reda, Sameh R Tawadros, Khaled Abdelkarim, El-Shehaby Amr M N AMN Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt. Neurosurgery D, Reem M Emad, Nasser Mohammed, Dusan Urgosik, Roman Liscak, Cheng-Chia Lee, Huai-Che Yang, Amanallah Montazeripouragha, Anthony M Kaufmann, Krishna C Joshi, Gene H Barnett, Daniel M Trifiletti, L Dade Lunsford, and Jason P Sheehan.
• Division of Neurosurgery, House Ear Institute, Los Angeles, California.
• Neurosurgery. 2020 Dec 15; 88 (1): E91-E98.

BackgroundFacial nerve schwannomas are rare, challenging tumors to manage due to their nerve of origin. Functional outcomes after stereotactic radiosurgery (SRS) are incompletely defined.ObjectiveTo analyze the effect of facial nerve segment involvement on functional outcome for these tumors.MethodsPatients who underwent single-session SRS for facial nerve schwannomas with at least 3 mo follow-up at 11 participating centers were included. Preoperative and treatment variables were recorded. Outcome measures included radiological tumor response and neurological function.ResultsA total of 63 patients (34 females) were included in the present study. In total, 75% had preoperative facial weakness. Mean tumor volume and margin dose were 2.0 ± 2.4 cm3 and 12.2 ± 0.54 Gy, respectively. Mean radiological follow-up was 45.5 ± 38.9 mo. Progression-free survival at 2, 5, and 10 yr was 98.1%, 87.2%, and 87.2%, respectively. The cumulative proportion of patients with regressing tumors at 2, 5, and 10 yr was 43.1%, 63.6%, and 63.6%, respectively. The number of involved facial nerve segments significantly predicted tumor progression (P = .04). Facial nerve function was stable or improved in 57 patients (90%). Patients with involvement of the labyrinthine segment of the facial nerve were significantly more likely to have an improvement in facial nerve function after SRS (P = .03). Hearing worsened in at least 6% of patients. Otherwise, adverse radiation effects included facial twitching (3 patients), facial numbness (2 patients), and dizziness (2 patients).ConclusionSRS for facial nerve schwannomas is effective and spares facial nerve function in most patients. Some patients may have functional improvement after treatment, particularly if the labyrinthine segment is involved.Copyright © 2020 by the Congress of Neurological Surgeons.

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