Facial Nerve Schwannoma Complicated by Acute Hemorrhage After Treatment with Stereotactic Radiosurgery.

BACKGROUND: Facial nerve schwannomas (FNSs) are rare benign tumors that arise from Schwann cells of the facial nerve. FNSs are similar to vestibular schwannomas in many aspects, yet their infiltrative nature into the facial nerve fascicles warrants a more conservative management approach. In the last decade, stereotactic radiosurgery (SRS) has shown promise in stabilizing or shrinking FNSs. CASE DESCRIPTION: A 71-year-old woman presented with mild facial paresis. Tumor growth after a period of watchful waiting warranted treatment with SRS, which was complicated by an acute posterior fossa hemorrhage and brainstem compression, necessitating microsurgical hematoma evacuation, tumor resection, and facial nerve substitution. CONCLUSIONS: SRS has led to better facial nerve function and outcomes and is currently considered a reasonable alternative to microsurgical resection in patients with FNSs. This is the first report to our knowledge of an acute, life-threatening hemorrhage after SRS in a patient with FNS.

Comprehensive craniospinal radiation for controlling central nervous system leukemia.

PURPOSE: To determine the benefit of radiation therapy (RT) in resolution of neurologic symptoms and deficits and whether the type of RT fields influences central nervous system (CNS) control in adults with CNS leukemia. METHODS AND MATERIALS: A total of 163 adults from 1996 to 2012 were retrospectively analyzed. Potential associations between use of radiation and outcome were investigated by univariate and multivariate analysis. RESULTS: The median survival time was 3.8 months after RT. Common presenting symptoms were headache in 79 patients (49%), cranial nerve VII deficit in 46 (28%), and cranial nerve II deficit in 44 (27%). RT was delivered to the base of skull in 48 patients (29%), to the whole brain (WB) in 67 (41%), and to the craniospinal axis (CS) in 48 (29%). Among 149 patients with a total of 233 deficits, resolution was observed in 34 deficits (15%), improvement in 126 deficits (54%), stability in 34 deficits (15%), and progression in 39 deficits (17%). The 12-month CNS progression-free survival was 77% among those receiving CS/WB and 51% among those receiving base of skull RT (P=.02). On multivariate analysis, patients who did not undergo stem cell transplantation after RT and base of skull RT were associated with worse CNS progression-free survival. CONCLUSIONS: Improvement or resolution of symptoms occurred in two thirds of deficits after RT. Comprehensive radiation to the WB or CS seems to offer a better outcome, especially in isolated CNS involvement.

Schwannoma of the facial nerve: indications for surgical treatment.

There is no preoperative diagnostic modality that can identify facial nerve schwannoma with certainty. Difficulty in locating the facial nerve intraoperatively raises suspicion of a neurogenous tumor of the facial nerve, and this may prevent unnecessary damage to the nerve. Not every facial nerve schwannoma should be resected.

Intra-parotid facial nerve schwannoma with intra-temporal extension; a case report. Is there a role for stereotactic radiotherapy?

Facial nerve schwannoma (FNS) is an extremely rare benign tumour that may arise anywhere along the course of the facial nerve; the standard treatment is total removal via microsurgery. Stereotactic radiotherapy has been shown to be effective in the treatment of skull base tumours, in particular for acoustic neuromas; it is interesting to notice that also the few data existing in literature about the use of radiotherapy for non acoustic schwannomas show an excellent local control rate and few adverse effects. Here we report a case of facial nerve neuroma, involving the nerve sheath from the geniculate ganglion to the parotid gland, treated with fractionated stereotactic radiotherapy after debulking surgery.

Facial nerve schwannoma.

PURPOSE OF REVIEW: The purpose of this review is to summarize the current literature on facial nerve schwannoma and make practical recommendations based on best practices for the management of this difficult but benign neoplasm. RECENT FINDINGS: Facial nerve schwannoma can be asymptomatic or can present with progressive or acute facial nerve palsy. Associated otological symptoms such as conductive and/or sensorineural hearing loss can occur. The tumor is usually slow-growing and can involve multiple segments of the nerve. Radiographic imaging and facial nerve electrical testing can be helpful in treatment planning. Options for management can include observation, decompression, stripping, resection with grafting, and possibly radiotherapy. Future adjunctive therapies to improve facial nerve function may include electrical stimulation, steroid hormones, and possibly stem cell therapy. SUMMARY: Treatment of facial schwannoma is individualized based on patient symptoms, history, and clinicoradiographic evaluation. Not all patients require surgery. As the tumor can involve multiple segments of the nerve, the surgeon attempting removal should be familiar with modern neurotological surgical techniques. Ongoing translational research will hopefully allow us to decrease facial nerve morbidity in these patients.

Stereotactic radiotherapy for intracranial nonacoustic schwannomas including facial nerve schwannoma.

PURPOSE: Although the effectiveness of stereotactic radiosurgery for nonacoustic schwannomas is currently being assessed, there have been few studies on the efficacy of stereotactic radiotherapy (SRT) for these tumors. We investigated the long-term outcome of SRT for nonacoustic intracranial nerve schwannomas. METHODS AND MATERIALS: Seventeen patients were treated between July 1994 and December 2006. Of these patients, 7 had schwannomas located in the jugular foramen, 5 in the trigeminal nerve, 4 in the facial nerve, and 1 in the oculomotor nerve. Radiotherapy was used as an initial treatment without surgery in 10 patients (59%) and after initial subtotal resection in the remaining patients. The tumor volume ranged from 0.3 to 31.3 mL (mean, 8.2 mL). The treatment dose was 40 to 54 Gy in 20 to 26 fractions. The median follow-up period was 59.5 months (range, 7.4-122.6 months). Local control was defined as stable or decreased tumor size on follow-up magnetic resonance imaging. RESULTS: Tumor size was decreased in 3 patients, stable in 13, and increased in 1 after SRT. Regarding neurologic symptoms, 8 patients (47%) had improvement and 9 patients were unchanged. One patient had an increase in tumor size and received microsurgical resection at 32 months after irradiation. No patient had worsening of pre-existing neurologic symptoms or development of new cranial nerve deficits at the last follow-up. CONCLUSIONS: SRT is an effective alternative to surgical resection for patients with nonacoustic intracranial nerve schwannomas with respect to not only long-term local tumor control but also neuro-functional preservation.

An alternative treatment for facial nerve tumors: short-term results of radiotherapy.

A review of medical records of patients undergoing radiotherapy for facial nerve tumors was undertaken to determine subsequent facial nerve results, hearing results, and tumor control. Two patients with facial nerve tumors received this treatment. Facial nerve function remains excellent in one patient and significantly improved in the other. Neither tumor demonstrated growth. Current philosophies of facial nerve schwannoma management attempt to balance tumor control with facial nerve function. Radiotherapy for these tumors appears to preserve short-term facial function and may be a viable alternative to surgical management.

Malignant epithelioid cranial nerve sheath tumor: case report of a radiation response.

Malignant epithelioid nerve sheath tumors (MESs) especially those involving intracranial cranial nerves are rare and thought to be radioresistant. We report a case of a MES involving the Vth and VIIth cranial nerves responsive to radiotherapy. A 41-year-old man with progressive left facial weakness underwent an MRI that disclosed an enhancing lesion involving both V3 cranial nerve and the distal VIIth nerve. Biopsy confirmed a malignant epithelioid schwannoma. The tumor was resected but residual tumor was present at the cut end of the infraorbital nerve, within the oral cavity and at the brainstem. Positive excision margins were irradiated to 60 Gy/30 fractions by a wedge pair technique extending from the inferior orbit to C2. Tumor was controlled for 38 months and then radiographic recurrence was resected from the infratemporal fossa outside the irradiated field.A new primary MES tumor developed at 69 months at the C1/C2 root levels at the lower edge of the previously irradiated field. It was subtotally resected but by 77 months residual tumor had grown inferiorly down to C5 so this area was re-irradiated with a complicated 7-field approach to spare spinal cord. Initially the tumor responded but ultimately progressed posteriorly where radiation dose was limited by spinal cord tolerance. New involvement of the Xth cranial nerve was noted. The patient expired from brainstem compression 7 years after initial radiotherapy. The long-term control of the original tumor despite positive margins argues for the use of radiotherapy in the treatment of these tumors.

[Laser therapy and cryomassage in rehabilitation of patients with facial nerve neuropathy]. / Lazeroterapiia i kriomassazh v vosstanovitel'nom lechenii bol'nykh s nevropatiei litsevogo nerva.

Cryomassage and its combination with low-intensity infra-red laser radiation have been introduced as a novel treatment of facial nerve neuropathy (FNN) in 32 patients. Electrophysiological investigations (facial thermography, classical electrodiagnosis, electromyography of the mimic muscles) and clinical data including those of long-term follow-up show that neither cryomassage nor infra-red laser radiation studied promote transformation of facial tissues in FNN patients. Use of the above factors is effective in a preclinical stage of forming contracture of the mimic muscles. Special techniques of application of local hypothermia and laser radiation can be used in multimodality treatment of both the established contracture and sluggish paresis of the facial muscles.

Bell's palsy as an early manifestation of acute lymphoblastic leukemia.

A 20-year-old man with the complaints of malaise, fever, and tooth gum bleeding presented at a hospital. He was found to have generalized lymphadenopathy, thrombocytopenia, and leukocytosis. Ensuing bone marrow biopsy led to a diagnosis of acute lymphoblastic leukemia (ALL). He also had a sense of "facial stretching" and difficulty during eating. After clinical examination, he was diagnosed with right-sided peripheral type facial nerve paralysis (Bell's palsy). The magnetic resonance imaging studies demonstrated bilateral facial nerve involvement, predominantly on the right side. The patient received steroid treatment and local facial radiotherapy for Bell's palsy. A concurrent facial exercise program was ordered. Seemingly a less significant diagnosis in a leukemia patient, we considered our case notable since an ALL patient presenting with Bell's palsy, especially at the very beginning of the disease, is not that common. The cases of relapsing ALL reported in the literature initially presenting with the same scenario further strengthen the significance.

Superior oblique palsy in a patient with a history of perineural spread from a periorbital squamous cell carcinoma.

A 74-year-old man experienced vertical diplopia. Two years earlier, he was diagnosed with a squamous cell carcinoma of the periorbital frontal skin, with perineural spread involving the ophthalmic division of the right trigeminal nerve and the right facial nerve. The clinical findings were consistent with a right fourth cranial nerve palsy. Computerized tomography and magnetic resonance imaging demonstrated a discrete mass involving the belly of the right superior oblique muscle. An anterior orbitotomy and biopsy demonstrated a mass extending into the belly of the superior oblique muscle. Histology revealed an infiltrating squamous cell carcinoma. The possibility of perineural, direct, or metastatic spread to the superior oblique muscle should be considered in a patient with a history of squamous cell carcinoma of the head and neck. The authors believe this case to be the first report of superior oblique underaction due to involvement of the muscle by squamous cell carcinoma, presumably because of perineural spread. Diagnosis was made possible by neuroimaging and histopathology. There was good short-term resolution of the patient's diplopia after radiotherapy.