Hostname: page-component-77c89778f8-gvh9x Total loading time: 0 Render date: 2024-07-19T05:38:45.007Z Has data issue: false hasContentIssue false

Management of a facial nerve schwannoma with fractionated stereotactic radiotherapy: a case report

Published online by Cambridge University Press:  09 June 2023

Alia Mousli*
Affiliation:
Department of Oncology Radiotherapy, Institute of Salah Azaiez, Tunis, Tunisia University Tunis El Manar, Tunis, Tunisia
Hadhemi Ayadi
Affiliation:
Department of Oncology Radiotherapy, Institute of Salah Azaiez, Tunis, Tunisia
Amani Yousfi
Affiliation:
Department of Oncology Radiotherapy, Institute of Salah Azaiez, Tunis, Tunisia University Tunis El Manar, Tunis, Tunisia
Rim Abidi
Affiliation:
Department of Oncology Radiotherapy, Institute of Salah Azaiez, Tunis, Tunisia University Tunis El Manar, Tunis, Tunisia
Chiraz Nasr
Affiliation:
Department of Oncology Radiotherapy, Institute of Salah Azaiez, Tunis, Tunisia University Tunis El Manar, Tunis, Tunisia
*
Corresponding author: Alia Mousli, Department of Oncology, Radiotherapy, Institute of Salah Azaiez,Tunis, Tunisia; Email: alia_1709@LIVE.fr

Abstract

Introduction:

Neuroma of the facial nerve (NFN) is an extremely rare benign tumour that can involve any segment of the facial nerve. It is revealed by facial weakness with or without hearing loss and has commonly been managed by microsurgery. Our purpose is to systematically review the literature about the role of fractionated stereotactic radiotherapy (FSRT) on the treatment of NFN.

Clinical case:

We report the case of a 70-year-old-woman who presented progressively worsening facial paralysis associated with mild conductive hearing loss and dizziness. The multimodal magnetic resonance imaging (MRI) was very suggestive of an intrapetrous neuroma, centred on the tract of the VII nerve and the left geniculate ganglion. She was treated by FSRT at the dose of 18 Gy in three fractions on the isodose line 80 %. After 18-month follow-up, she reported a facial weakness improvement. The MRI revealed a stable disease.

Conclusion:

The clinical presentation of the schwannoma of the facial nerve depends essentially on its location. It is therefore very variable, ranging from an isolated mild hearing loss to a vestibular syndrome with facial paralysis. Through this observation with literature review, we reported a long-term tumour control with improvement of pre-treatment symptomatology with FSRT.

Type
Case Study
Copyright
© The Author(s), 2023. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Cornelius, J F, Sauvaget, E, Tran Ba Huy, P, George, B. Surgical treatment of facial nerve schwannomas. Prog Neurol Surg 2008; 21: 119130.CrossRefGoogle Scholar
Pulec, J L. Facial nerve neuroma. Ear Nose Throat J 1994; 73: 721722; 725739; 743752.CrossRefGoogle Scholar
Pathapati, D, Barla, K, Dayal, M, Gati, R, Lakota, P K. Facial nerve schwannoma: the rare/great mimicker of vestibular schwannoma/neuroma. Indian J Radiol Imaging 2021; 31: 510513.CrossRefGoogle Scholar
Chen, M-C, Tseng, T-M, Hung, S-H, Chen, P-Y. Facial nerve schwannoma: a case report and review of the literature. Oncol Lett 2014; 8: 27872789.CrossRefGoogle ScholarPubMed
Lee, J D, Lee, W-S. Surgical findings to differentiate between facial nerve schwannoma and vestibular schwannoma. Clin Exp Otorhinolaryngol 2014; 7: 157159.CrossRefGoogle ScholarPubMed
Xu, F, Pan, S, Alonso, F, Dekker, S E, Bambakidis, N C. Intracranial facial nerve schwannomas: current management and review of literature. World Neurosurg 2017; 100: 444449.CrossRefGoogle ScholarPubMed
McRackan, T R, Wilkinson, E P, Brackmann, D E, Slattery, W H. Stereotactic radiosurgery for facial nerve schwannomas: meta-analysis and clinical review. Otol Neurotol 2015; 36: 393398.CrossRefGoogle ScholarPubMed
Quesnel, A M, Santos, F. Evaluation and management of facial nerve schwannoma. Otolaryngologic Clinics of North America 2018; 51: 11791192.CrossRefGoogle ScholarPubMed
McClelland, S, Dusenbery, K E, Higgins, P D, Hall, W A. Treatment of a facial nerve neuroma with fractionated stereotactic radiotherapy. Stereotact Funct Neurosurg 2007; 85: 299302.CrossRefGoogle Scholar
McRackan, T R, Wilkinson, E P, Rivas, A. Primary tumors of the facial nerve. Otolaryngol Clin N Am 2015; 48: 491500.CrossRefGoogle Scholar
Chung, J W, Ahn, J H, Kim, J H, Nam, S Y, Kim, C-J, Lee, K-S. Facial nerve schwannomas: different manifestations and outcomes. Surg Neurol 2004; 62: 245252.CrossRefGoogle Scholar
Abada, R, Belamkaddem, A, Moujahid, S et al. Neurinome du nerf facial - a propos d’un cas et revue de la littérature. Journal Tunisien d’ORL et de Chirurgie Cervico-Faciale 2011; 26: 45–48.Google Scholar
Wilkinson, E P, Hoa, M, Slattery, W H et al. Evolution in the management of facial nerve schwannoma. Laryngoscope 2011; 121: 20652074.CrossRefGoogle Scholar
Cho, Y S, Choi, J E, Lim, J H, Cho, Y-S. Management of facial nerve schwannoma: when is the timing for surgery. Eur Arch Otorhinolaryngol 2022; 279: 12431249.CrossRefGoogle Scholar
Shi, W, Jain, V, Kim, H et al. Fractionated stereotactic radiotherapy for facial nerve schwannomas. J Neurol Surg B Skull Base. Georg Thieme Verlag KG 2016; 77: 7580.Google Scholar
Söderlund Diaz, L, Hallqvist, A. LINAC-based stereotactic radiosurgery versus hypofractionated stereotactic radiotherapy delivered in 3 or 5 fractions for vestibular schwannomas: comparative assessment from a single institution. J Neurooncol 2020; 147: 351359.CrossRefGoogle Scholar
Hillman, T A, Chen, D A, Fuhrer, R. An alternative treatment for facial nerve tumors: short-term results of radiotherapy. Ear Nose Throat J 2008; 87: 574577.CrossRefGoogle Scholar
Nishioka, K, Abo, D, Aoyama, H et al. Stereotactic radiotherapy for intracranial nonacoustic schwannomas including facial nerve schwannoma. Int J Radiat Oncol Biol Phys 2009; 75: 14151419.CrossRefGoogle Scholar
Showalter, T N, Werner-Wasik, M, Curran, W J, Friedman, D P, Xu, X, Andrews, D W. Stereotactic radiosurgery and fractionated stereotactic radiotherapy for the treatment of nonacoustic cranial nerve schwannomas. Neurosurgery 2008; 63: 734740; discussion 740.CrossRefGoogle Scholar
Choi, C Y H, Soltys, S G, Gibbs, I C et al. Stereotactic radiosurgery of cranial nonvestibular schwannomas: results of single- and multisession radiosurgery. Neurosurgery 2011; 68: 12001208; discussion 1208.CrossRefGoogle Scholar
Hong, S, Kagawa, K, Sato, K, Nomura, Ichi S.. The long-term outcome of cyberknife-based stereotactic radiotherapy for intra/ extracranial non-vestibular schwannomas: a single-center experience. 2021; 21: e21–e21. doi: 10.1016/j.wneu.2022.05.132.CrossRefGoogle Scholar
McRackan, T, Wilkinson, E, Brackmann, D, Slattery, W. Stereotactic radiosurgery for facial nerve schwannomas: metaanalysis and clinical review. Otol Neurotol 2015; 36: 393398.CrossRefGoogle ScholarPubMed