Objective: There is no consensus for the management of facial nerve schwannomas (FNS). We aim
to provide a structured approach to their management based on a large series over
a 19-year period. Study Design: Retrospective review. Patients/material and Methods: Overall 28 FNS patients were included in the study. Mean age at diagnosis was 46.4
years (range, 22-73). Mean duration of follow-up was 48 months (range, 3-144). Results: Facial weakness was the presenting symptom in 16 patients (57%). Most patients had
multisegment involvement; the internal acoustic canal (IAC) was most commonly affected
(68%). Fourteen patients were initially managed conservatively; 14 patients received
primary surgical intervention. Two patients failed conservative management due to
deterioration in facial nerve function and underwent surgery. No patients opted for
stereotactic radiotherapy. Ten patients had primary nerve grafting (HB score outcome
III/IV in 7/10 patients after mean follow-up of 34 months) and five patients had a
staged VII/XII transposition (HB outcome IV in 2/4 patients and HB outcome V in the
other two patients [mean follow-up of 25 months, one patient missing data]). Conclusions: The philosophy of our unit in managing FNS is to preserve facial function wherever
possible. There is strong evidence from this study that such an approach is valid
given the high proportion of patients who had preservation of facial function over
the follow-up period and the small number of tumors that showed significant growth.
