• Andrea Bacciu, Marimar Medina, Mehdi Ben Ammar, Flavia D'Orazio, Filippo Di Lella, Alessandra Russo, Jacques Magnan, and Mario Sanna.
• Department of Clinical and Experimental Medicine, Otolaryngology Unit, University-Hospital of Parma, Parma, Italy andreabacciu@yahoo.it.
• Ann Oto Rhinol Laryn. 2014 Sep 1; 123 (9): 647-53.

ObjectiveThis study aimed to report our experience in the management of patients with intraoperatively diagnosed intracranial facial nerve schwannomas (FNSs) and propose a decision-making strategy.MethodsTwenty-three patients with FNS of the internal auditory canal and/or cerebellopontine angle operated on between 1992 and 2012 were identified.ResultsPreoperatively, all cases have been radiographically diagnosed as vestibular schwannomas. Operative procedures consisted of total tumor resection with grafting in 43.4% of patients, near-total resection leaving behind the tumor capsule overlying the facial nerve in 21.7%, total tumor resection with preservation of anatomic continuity of the facial nerve in 13%, and subtotal resection in 4.3%. Four patients (17.4%) underwent bony decompression with no tumor removal.ConclusionManagement of FNS diagnosed at surgery represents a significant clinical challenge. We considered total tumor resection with grafting when patients presented with preoperative facial nerve palsy (≥ grade III). Both subtotal and near-total tumor removal can be performed in patients with preoperative good facial function and/or large tumors with brainstem compression. Patients with small tumors who were selected for hearing preservation surgery can be considered for bony decompression. Fascicle preservation surgery may be an option when a clear cleavage plane between the tumor and the facial nerve is found.© The Author(s) 2014.

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