• Kaith K Almefty, Michael A Mooney, Ossama Al-Mefty, Walid Ibn Essayed, Wenya Linda Bi, Li Cai, and KadriPaulo A SPASDepartment of Neurosurgery, Brigham and Women`s Hospital, Harvard Medical School, Boston, Massachusetts, USA; Medical School, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil..
• Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
• World Neurosurg. 2022 Dec 1; 168: e187e195e187-e195.

ObjectiveFacial nerve (FN) schwannomas are extremely rare. According to their origin and involved segment(s), they constitute distinct subtypes. Intact FN function presents a management challenge, particularly in the cerebellopontine angle cisternal subtype that masquerades as a vestibular schwannoma. Fascicular-sparing technique with subtotal resection can maintain a good FN function. This study focuses on management to maintain good FN function.MethodsA retrospective analysis of a cohort of 13 patients harboring FN schwannoma. Patient demographics, clinical findings, imaging, surgical intervention, and outcomes were analyzed.ResultsFive women and 8 men, with an average age of 55.3 years (39-75 years), harbored 6 cisternal, 2 ganglion, and 5 combined tumors. Average tumor size was 28.3 mm (16-50 mm). Eleven patients underwent surgery. Seven patients had fascicle-sparing technique, 5 of whom maintained their preoperative FN function, whereas 2 patients with near-total removal had a deterioration in FN function. Two patients with preoperative complete facial paralysis had gross total removal with interposition nerve graft.ConclusionsFN schwannomas management is individualized according to the subtype and the FN function at presentation. When FN function is normal, observation can be applied for prolonged period of time. At the early sign of deterioration, sub- or near-total resection with fascicle sparing technique can be performed. The cisternal subtype masquerade as vestibular schwannoma and should be recognized at the initial exposure by the appearance of finely splayed nerve fascicles at the perimetry of the tumor which elicits a motor response at low threshold stimulation.Copyright © 2022 Elsevier Inc. All rights reserved.

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