Modern Management of Skull Base Facial Nerve Schwannomas (2023 AMW)
2023 AAO-HNSF Annual Meeting & OTO Experience
Facial nerve schwannomas are rare benign tumors arising from the sheath of the facial nerve. They may affect any part of the facial nerve from the cerebellopontine angle (CPA) to the most peripheral branches of the nerve. In the CPA and skull base their management offers particular challenges because 1) they often resemble vestibular schwannomas 2) they are in close proximity to other neurological structures particularly the vestibular system and cochlea 3) resection results in significant facial weakness. Clinical features are similar to vestibular schwannomas and are generally unhelpful in differentiating them. In contrast, radiological assessment with magnetic resonance imaging and, in some cases computed tomography, is critical for accurate diagnosis and may, with appropriate sequences, clearly differentiate from vestibular schwannomas. This is not, however, universally the case. Treatment is most frequently with serial imaging with most tumors never requiring treatment. Those that require treatment, may be removed surgically or stabilized with radiosurgery. Decision making is very different from vestibular schwannoma management because of the risk of facial weakness with treatment and because of the higher proportion of patients that have serviceable hearing. This session will focus on the controversies around management of facial nerve schwannomas, propose means by which the likelihood of correct diagnosis can be optimized and discuss how long term outcomes can be optimized.
Credits
CME:1.0, MOC:1.0