Facial nerve schwannoma (FNS) as operative findings

Introduction FNS are rare slow-growing tumors, accounting for less than 1 % of all temporal bone tumors. They are typically solitary, unilateral and sporadic.

Case report A 59-year-old patient presented with progressiv hypoacusis, tinnitus aurium left for 2 years, and peripheral facial nerve palsy (PFNP) for ½ year. Clinically, there was a protrusion of the upper quadrant of the eardrum, patient suffered from PFNP The House-Brackmann Scale (HB) IV. MRI of the head and CT of petrous bone presented a soft tissue proliferation in the middle ear area with suspected cholesteatoma. A high grade combined hearing loss was seen in audiogram. Intraoperatively, a tumor of the facial nerve (FN) in the middle ear area without evidence for cholesteatoma was found. Tumor resection was performed in the area of the middle ear up to the ganglion geniculi with decompression of the FN, atticotomy and tympanoplasty type III. Histologically a schwannoma of the FN was confirmed. Outpatient controls showed improvement in hearing, the PFNP was postoperatively HB Level V.

Discussion Facial nerve tumors are predominantly present in the perigeniculate area and the tympanic segment. Typical symptoms include the progression of PFNP, hearing loss, tinnitus and vestibular symptoms. Treatment methods include surgical resection with nerve preservation, complete resection with nerve grafting, decompression and stereotactic radiation. Surgical therapy of an SNF depends on the size, anatomical location of the tumor and on the patient's hearing status.

Conclusion In patients with fluctuating, progressive or recurrent PNFP, hypoacusis and tinnitus aurium, tumors of the FN must be considered. Cholesteatoma and middle ear adenoma may mimic FNS on otoscopy and MRT/CT.

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Publication History

Article published online:
10 June 2020