Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, MN; Department of Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, MN.
Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Scottsdale, AZ.
Mayo Clin Proc. 2016 Nov;91(11):1563-1576. doi: 10.1016/j.mayocp.2016.07.007. Epub 2016 Oct 5.
To elucidate the long-term clinical behavior, treatment, and outcomes of sporadic facial nerve schwannoma (FNS) in a large cohort of patients managed in the post-magnetic resonance imaging era.
Retrospective review at a single tertiary health care system (January 1, 1990, through December 31, 2015), evaluating 80 consecutive patients with sporadic FNS.
Ninety-eight patients with FNS were identified; 10 with incomplete data and 8 with neurofibromatosis type 2 were excluded. The remaining 80 patients (median age, 47 years; 58% women) were analyzed. Forty-three (54%) patients presented with asymmetrical hearing loss, 33 (41%) reported facial paresis, and 21 (26%) reported facial spasm. Seventeen (21%) exhibited radiologic features mimicking vestibular schwannoma, 14 (18%) presented as a parotid mass, and 5 (6%) were discovered incidentally. Factors predictive of facial nerve paresis or spasm before treatment were female sex and tumor involvement of the labyrinthine/geniculate and tympanic facial nerve segments. The median growth rate among growing FNS was 2.0 mm/y. Details regarding clinical outcome according to treatment modality are described.
In patients with FNS, female sex and involvement of the labyrinthine/geniculate and tympanic segments of the facial nerve predict a higher probability of facial paresis or spasm. When isolated to the posterior fossa or parotid gland, establishing a preoperative diagnosis of FNS is challenging. Treatment should be tailored according to tumor location and size, existing facial nerve function, patient priorities, and age. A management algorithm is presented, prioritizing long-term facial nerve function.
阐明在后磁共振成像时代，大量患者中散发面神经神经鞘瘤（FNS）的长期临床行为、治疗和结局。
在单一三级医疗保健系统（1990 年 1 月 1 日至 2015 年 12 月 31 日）进行回顾性研究，评估了 80 例连续的散发 FNS 患者。
共发现 98 例 FNS 患者，其中 10 例数据不完整，8 例患有神经纤维瘤病 2 型，排除在外。分析了剩余的 80 例患者（中位年龄 47 岁，58%为女性）。43 例（54%）患者表现为不对称性听力损失，33 例（41%）报告有面瘫，21 例（26%）报告有面肌痉挛。17 例（21%）表现出类似于前庭神经鞘瘤的影像学特征，14 例（18%）表现为腮腺肿块，5 例（6%）为偶然发现。治疗前面神经瘫痪或痉挛的预测因素是女性和肿瘤累及迷路/膝状神经节和鼓室面神经段。生长性 FNS 的中位生长速度为 2.0mm/y。描述了根据治疗方式的临床结果的详细信息。
在 FNS 患者中，女性和面神经迷路/膝状神经节和鼓室段受累预测面瘫或痉挛的可能性更高。当局限于后颅窝或腮腺时，术前诊断 FNS 具有挑战性。治疗应根据肿瘤位置和大小、现有面神经功能、患者的优先事项和年龄来调整。提出了一种管理算法，优先考虑长期面神经功能。
