Question from Gem:
My husband was recently diagnosed with a facial nerve schwannoma (per the radiologist’s MRI report) with a “size of 1.2 x 1.2 x 0.6 cm lobulated, enhancing mass eroding the anterior aspect of the right petrous apex in the region of the genu of the facial nerve.” We have seen one neurosurgeon who recommends conventional therapy with surgical removal of the tumor. He said my husband’s 3 options are: do nothing, Gamma Knife or surgery to remove the tumor. He recommends surgery and advised us about the risks of GM (he mentioned swelling of the facial nerve which can cause permanent damage, scarring which may make surgery difficult if needed at a later time, the chance of the tumor turning malignant although he said the rate of this occurring is low and because of my husband’s age as well – he is 47 and the doc feels he is still young to have GM due to the risks he mentioned). We want to explore all our options and be better educated before making such a big decision. What are your feelings about what he has told us about GM? Would my husband be a good candidate for it based on his age and the type of tumor that he has? We were told that facial nerve neuromas are not common like acoustic neuromas. Have you encountered and treated facial nerve neuromas using GM with great success? Incidentally, my husband’s symptoms are Bell’s Palsy-type that has been slowly getting worse over the course of maybe 2-3 years (his hearing test shows it’s normal and he has no other sypmtoms like pain, numbness). Thank you for any information you can share with us.
Facial nerve schwannomas are rare and make up less than 1% of all intracranial tumors. You are quite correct in that vestibular and trigeminal schwannomas are more common schwannomas. Gamma Knife surgery or surgical resection are the mainstays of treatment. At our center, we have observed similar tumor control rates and preservation of neurological function in patients with either facial nerve schwannomas or the more common vestibular schwannomas.
The upfront risks of surgical resection are substantially greater than with Gamma Knife surgery. In a series by Isaacson from the University of Michigan, the authors noted an 8.3% risk of facial weakness after resection. Other risks include infection, cerebrospinal fluid leak, stroke, seizures, and hearing decline or loss.
Although the Gamma Knife usually affords tumor control (i.e. no growth or tumor shrinkage), I have operated on some patients with tumors who have failed Gamma Knife surgery. On the whole, I have not observed a greater degree of difficulty with resection of a tumor following Gamma Knife surgery. Occasionally, the Gamma Knife helps make a tumor easier to resect by devascularizing a portion of the tumor. Of course, facial schwannomas are inherently difficult tumors to resect in the first place given their location and intimate involvement with cranial nerves.
Your husband may be a candidate for Gamma Knife surgery. I would be happy to review his specific neuro-imaging studies and clinical records to determine that with more certainty. If you wish, you may forward these records to me. Information for this is listed under the “Make An Appointment” option of our Gamma Knife web page or you may contact my office staff at 434-924-8129.