Facial nerve schwannoma (FNS) as operative findings

Schwannoma of facial Nerve (FNS) are rare, slow-growing tumours, accounting for less than 1 %  of all temporal bone tumours. They are typically solitary, unilateral and sporadic. Two patients presented to us with unilateral progressiv hypoacusis. Pat. A had a progressive peripheral facial paralysis (PFP) House-Brackmann level (HB) IV for 1/2 year. Pat. B had chronic otitis media adhesiva. MRI of the head and CT of petrous bone presented a soft tissue proliferation in the middle ear area for Pat A suspected as cholesteatoma. Unilateral combined hearing loss was seen in audiogram by both patients. Intraoperatively, Pat. A showed a tumour of the facial nerve (NF) in the middle ear area without evidence for cholesteatoma, Pat. B had granulations on the facial nerve canal and scarred ossicles. A tumour 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 in Pat. A and a reduction of granulative tissue, atticotomy and tympanoplasty type I in Pat. B. Histologically a schwannoma of the FN was confirmed in both patients. Postoperatively, there was PFP HB level V in both Pat. Outpatient controls showed an improvement in hearing for Pat. A. An OP management for Pat. B is currently being planned. Facial nerve tumours are predominantly present in the perigeniculate area and the tympanic segment. Typical symptoms include the progress of PFNP, conductive hearing loss, tinnitus and vestibular symptoms. Treatment depends on the underlying findings. In patients with fluctuating, progressive or recurrent PNFP, hearing loss and tinnitus, tumours of the FN must be considered. Cholesteatoma and middle ear adenoma may imitate FNS on otoscopy and MRT/CT.

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Publication History

Article published online:
13 May 2021