Surgery versus radiosurgery for facial nerve schwannoma: a systematic review and meta-analysis of facial nerve function, postoperative complications, and progression

View More View Less
  • 1 Departments of Neurosurgery,
  • 2 Otolaryngology–Head and Neck Surgery, and
  • 3 Radiation Oncology, Mayo Clinic, Rochester, Minnesota
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

OBJECTIVE

Intracranial facial nerve schwannomas (FNS) requiring treatment are frequently recommended for surgery or stereotactic radiosurgery (SRS). The objective of this study was to compare facial nerve function outcomes between these two interventions for FNS via a systematic review and meta-analysis.

METHODS

A search of the Ovid EMBASE, PubMed, SCOPUS, and Cochrane databases from inception to July 2019 was conducted following PRISMA guidelines. Articles were screened against prespecified criteria. Facial nerve outcomes were classified as improved, stabilized, or worsened by last follow-up. Incidence was pooled by random-effects meta-analysis of proportions.

RESULTS

Thirty-three articles with a pooled cohort of 519 patients with FNS satisfied all criteria. Twenty-five articles described operative outcomes in 407 (78%) patients; 10 articles reported SRS outcomes in 112 (22%). In the surgical cohort, facial nerve function improved in 23% (95% CI 15%–32%), stabilized in 41% (95% CI 32%–50%), and worsened in 30% (95% CI 21%–40%). In the SRS cohort, facial nerve function was improved in 20% (95% CI 9%–34%), stable in 66% (95% CI 54%–78%), and worsened in 9% (95% CI 3%–16%). Compared with SRS, microsurgery was associated with a significantly lower incidence of stable facial nerve function (p < 0.01) and a significantly higher incidence of worsened facial nerve function (p < 0.01). Tumor progression and complication rates were comparable. Outcome certainty assessments were very low to moderate for all parameters.

CONCLUSIONS

Unfavorable facial nerve function outcomes are associated with surgical treatment of intracranial FNS, whereas stable facial nerve function outcomes are associated with SRS. Therefore, SRS should be recommended to patients with FNS who require treatment, and surgery should be reserved for patients with another indication, such as decompression of the brainstem. Further study is required to definitively optimize and validate management strategies for these rare skull base tumors.

ABBREVIATIONS CN = cranial nerve; ES = effect size; FNS = facial nerve schwannomas; GRADE = Grading of Recommendations, Assessment, Development and Evaluations; HB = House-Brackmann; PICOS = Population, Intervention, Comparator, Outcome, Study type; SRS = stereotactic radiosurgery; VS = vestibular schwannoma.

Supplementary Materials

    • Supplemental Tables 1 and 2 (PDF 527 KB)

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Correspondence Michael J. Link: Mayo Clinic, Rochester, MN. link.michael@mayo.edu.

INCLUDE WHEN CITING Published online October 30, 2020; DOI: 10.3171/2020.6.JNS201548.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Carlson ML, Deep NL, Patel NS, Facial nerve schwannomas: review of 80 cases over 25 years at Mayo Clinic. Mayo Clin Proc. 2016;91(11):15631576.

    • Search Google Scholar
    • Export Citation
  • 2

    Eshraghi AA, Oker N, Ocak E, Management of facial nerve schwannoma: a multicenter study of 50 cases. J Neurol Surg B Skull Base. 2019;80(4):352356.

    • Search Google Scholar
    • Export Citation
  • 3

    McRackan TR, Rivas A, Wanna GB, Facial nerve outcomes in facial nerve schwannomas. Otol Neurotol. 2012;33(1):7882. Published correction in Otol Neurotol. 2012;33(3):472.

    • Search Google Scholar
    • Export Citation
  • 4

    Perez R, Chen JM, Nedzelski JM. Intratemporal facial nerve schwannoma: a management dilemma. Otol Neurotol. 2005;26(1):121126.

  • 5

    Moon JH, Chang WS, Jung HH, Gamma Knife surgery for facial nerve schwannomas. J Neurosurg. 2014;121(suppl):116122.

  • 6

    Litre CF, Gourg GP, Tamura M, Gamma knife surgery for facial nerve schwannomas. Neurosurgery. 2007;60(5):853859.

  • 7

    Fezeu F, Lee CC, Dodson BK, Stereotactic radiosurgery for facial nerve schwannomas: a preliminary assessment and review of the literature. Br J Neurosurg. 2015;29(2):213218.

    • Search Google Scholar
    • Export Citation
  • 8

    Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.

    • Search Google Scholar
    • Export Citation
  • 9

    Freeman MF, Tukey JW. Transformations related to the angular and the square root. Ann Math Stat. 1950;21(4):607611.

  • 10

    DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7(3):177188.

  • 11

    Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557560.

  • 12

    Atkins D, Best D, Briss PA, Grading quality of evidence and strength of recommendations. BMJ. 2004;328(7454):1490.

  • 13

    Wells G, Shea B, O’Connell D, The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta-Analyses. Ottawa Hospital Research Institute; 2016.

    • Search Google Scholar
    • Export Citation
  • 14

    Murad MH, Sultan S, Haffar S, Bazerbachi F. Methodological quality and synthesis of case series and case reports. BMJ Evid Based Med. 2018;23(2):6063.

    • Search Google Scholar
    • Export Citation
  • 15

    Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50(4):10881101.

  • 16

    Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629634.

    • Search Google Scholar
    • Export Citation
  • 17

    Bacciu A, Medina M, Ben Ammar M, Intraoperatively diagnosed cerebellopontine angle facial nerve schwannoma: how to deal with it. Ann Otol Rhinol Laryngol. 2014;123(9):647653.

    • Search Google Scholar
    • Export Citation
  • 18

    Chung JW, Ahn JH, Kim JH, Facial nerve schwannomas: different manifestations and outcomes. Surg Neurol. 2004;62(3):245252, 452.

  • 19

    Doshi J, Heyes R, Freeman SR, Clinical and radiological guidance in managing facial nerve schwannomas. Otol Neurotol. 2015;36(5):892895.

    • Search Google Scholar
    • Export Citation
  • 20

    Günther M, Danckwardt-Lillieström N, Gudjonsson O, Surgical treatment of patients with facial neuromas—a report of 26 consecutive operations. Otol Neurotol. 2010;31(9):14931497.

    • Search Google Scholar
    • Export Citation
  • 21

    Kim CS, Suh MW. Skull base surgery for removal of temporal bone tumors. Acta Otolaryngol Suppl. 2007;(558):414.

  • 22

    Kohmura E, Aihara H, Miyake S, Fujita A. Intradural facial nerve schwannoma: diagnostic and therapeutic problems. Skull Base. 2007;17(3):215222.

    • Search Google Scholar
    • Export Citation
  • 23

    Lahlou G, Nguyen Y, Russo FY, Intratemporal facial nerve schwannoma: clinical presentation and management. Eur Arch Otorhinolaryngol. 2016;273(11):34973504.

    • Search Google Scholar
    • Export Citation
  • 24

    Lee JD, Kim SH, Song MH, Management of facial nerve schwannoma in patients with favorable facial function. Laryngoscope. 2007;117(6):10631068.

    • Search Google Scholar
    • Export Citation
  • 25

    Li Y, Dai C. A retrospective study on facial nerve schwannomas: a disease with a high risk of misdiagnosis and hearing loss. Eur Arch Otorhinolaryngol. 2017;274(9):33593366.

    • Search Google Scholar
    • Export Citation
  • 26

    Liu R, Fagan P. Facial nerve schwannoma: surgical excision versus conservative management. Ann Otol Rhinol Laryngol. 2001;110(11):10251029.

    • Search Google Scholar
    • Export Citation
  • 27

    Lu R, Li S, Zhang L, Stripping surgery in intratemporal facial nerve schwannomas with poor facial nerve function. Am J Otolaryngol. 2015;36(3):338341.

    • Search Google Scholar
    • Export Citation
  • 28

    McMonagle B, Al-Sanosi A, Croxson G, Fagan P. Facial schwannoma: results of a large case series and review. J Laryngol Otol. 2008;122(11):11391150.

    • Search Google Scholar
    • Export Citation
  • 29

    Minovi A, Vosschulte R, Hofmann E, Facial nerve neuroma: surgical concept and functional results. Skull Base. 2004;14(4):195201.

  • 30

    Mowry S, Hansen M, Gantz B. Surgical management of internal auditory canal and cerebellopontine angle facial nerve schwannoma. Otol Neurotol. 2012;33(6):10711076.

    • Search Google Scholar
    • Export Citation
  • 31

    Nadeau DP, Sataloff RT. Fascicle preservation surgery for facial nerve neuromas involving the posterior cranial fossa. Otol Neurotol. 2003;24(2):317325.

    • Search Google Scholar
    • Export Citation
  • 32

    Park SH, Kim J, Moon IS, Lee WS. The best candidates for nerve-sparing stripping surgery for facial nerve schwannoma. Laryngoscope. 2014;124(11):26102615.

    • Search Google Scholar
    • Export Citation
  • 33

    Sherman JD, Dagnew E, Pensak ML, Facial nerve neuromas: report of 10 cases and review of the literature. Neurosurgery. 2002;50(3):450456.

    • Search Google Scholar
    • Export Citation
  • 34

    Shirazi MA, Leonetti JP, Marzo SJ, Anderson DE. Surgical management of facial neuromas: lessons learned. Otol Neurotol. 2007;28(7):958963.

    • Search Google Scholar
    • Export Citation
  • 35

    Sun Y, Xing B, Han S, Stripping surgery in facial nerve schwannomas with favorable facial nerve function. Am J Otolaryngol. 2015;36(4):513516.

    • Search Google Scholar
    • Export Citation
  • 36

    West N, Sass H, Møller MN, Cayé-Thomasen P. Facial nerve schwannomas presenting with vestibular dysfunction: a case series. Acta Neurochir (Wien). 2018;160(12):23152319.

    • Search Google Scholar
    • Export Citation
  • 37

    Xiang D, Liu L, Li Y, Qiao J. Near-total removal of facial nerve schwannomas: long-term outcomes. Am J Otolaryngol. 2015;36(3):390392.

    • Search Google Scholar
    • Export Citation
  • 38

    Comps JN, Tuleasca C, Goncalves-Matoso B, Upfront Gamma Knife surgery for facial nerve schwannomas: retrospective case series analysis and systematic review. Acta Neurochir (Wien). 2018;160(5):987996.

    • Search Google Scholar
    • Export Citation
  • 39

    Hasegawa T. Stereotactic radiosurgery for nonvestibular schwannomas. Neurosurg Clin N Am. 2013;24(4):531542.

  • 40

    Madhok R, Kondziolka D, Flickinger JC, Lunsford LD. Gamma knife radiosurgery for facial schwannomas. Neurosurgery. 2009;64(6):11021105.

    • Search Google Scholar
    • Export Citation
  • 41

    McRackan TR, Wilkinson EP, Brackmann DE, Slattery WH. Stereotactic radiosurgery for facial nerve schwannomas: meta-analysis and clinical review. Otol Neurotol. 2015;36(3):393398.

    • Search Google Scholar
    • Export Citation
  • 42

    Shi W, Jain V, Kim H, Fractionated stereotactic radiotherapy for facial nerve schwannomas. J Neurol Surg B Skull Base. 2016;77(1):7580.

    • Search Google Scholar
    • Export Citation
  • 43

    Li Y, Liu H, Cheng Y. Subtotal resection of facial nerve schwannoma is not safe in the long run. Acta Otolaryngol. 2014;134(4):433436.

    • Search Google Scholar
    • Export Citation
  • 44

    Chong KW, Chung YF, Khoo ML, Management of intraparotid facial nerve schwannomas. Aust N Z J Surg. 2000;70(10):732734.

  • 45

    Carlson ML, Tveiten OV, Driscoll CL, Long-term quality of life in patients with vestibular schwannoma: an international multicenter cross-sectional study comparing microsurgery, stereotactic radiosurgery, observation, and nontumor controls. J Neurosurg. 2015;122(4):833842.

    • Search Google Scholar
    • Export Citation
  • 46

    Carlson ML, Tveiten OV, Lund-Johansen M, Patient motivation and long-term satisfaction with treatment choice in vestibular schwannoma. World Neurosurg. 2018;114:e1245e1252.

    • Search Google Scholar
    • Export Citation
  • 47

    Carlson ML, Vivas EX, McCracken DJ, Congress of Neurological Surgeons systematic review and evidence-based guidelines on hearing preservation outcomes in patients with sporadic vestibular schwannomas. Neurosurgery. 2018;82(2):E35E39.

    • Search Google Scholar
    • Export Citation
  • 48

    Hadjipanayis CG, Carlson ML, Link MJ, Congress of Neurological Surgeons systematic review and evidence-based guidelines on surgical resection for the treatment of patients with vestibular schwannomas. Neurosurgery. 2018;82(2):E40E43.

    • Search Google Scholar
    • Export Citation
  • 49

    Pollock BE. Management of vestibular schwannomas that enlarge after stereotactic radiosurgery: treatment recommendations based on a 15 year experience. Neurosurgery. 2006;58(2):241248.

    • Search Google Scholar
    • Export Citation
  • 50

    Graffeo CS, Link MJ, Stafford SL, More II it than meets the eye: outcomes after single-fraction stereotactic radiosurgery in a case series of low-grade arteriovenous malformations. Oper Neurosurg (Hagerstown). 2020;18(2):136144.

    • Search Google Scholar
    • Export Citation
  • 51

    Chen L, Chen LH, Ling F, Removal of vestibular schwannoma and facial nerve preservation using small suboccipital retrosigmoid craniotomy. Chin Med J (Engl). 2010;123(3):274280.

    • Search Google Scholar
    • Export Citation
  • 52

    Perry A, Graffeo CS, Carlstrom LP, Predominance of M1 subtype among tumor-associated macrophages in phenotypically aggressive sporadic vestibular schwannoma. J Neurosurg. Published online October 4, 2019. doi:10.3171/2019.7.JNS19879

    • Search Google Scholar
    • Export Citation
  • 53

    Zheng Z, Li J, Shen Y, Radical intracapsular microenucleation technique for exclusively intraparotid facial nerve schwannoma: long-term follow-up review. J Craniomaxillofac Surg. 2016;44(12):19631969.

    • Search Google Scholar
    • Export Citation
  • 54

    Bartindale M, Heiferman J, Joyce C, The natural history of facial schwannomas: a meta-analysis of case series. J Neurol Surg B Skull Base. 2019;80(5):458468.

    • Search Google Scholar
    • Export Citation
  • 55

    Hopewell JW, Millar WT, Lindquist C, Application of the concept of biologically effective dose (BED) to patients with vestibular schwannomas treated by radiosurgery. J Radiosurg SBRT. 2013;2(4):257271.

    • Search Google Scholar
    • Export Citation
  • 56

    Graffeo C, Donegan D, Erickson D, The impact of insulin-like growth factor index and biological effective dose on outcomes after stereotactic radiosurgery for acromegaly. Neurosurgery. 2019;66(suppl 1):310319.

    • Search Google Scholar
    • Export Citation
  • 57

    Reitzen SD, Babb JS, Lalwani AK. Significance and reliability of the House-Brackmann grading system for regional facial nerve function. Otolaryngol Head Neck Surg. 2009;140(2):154158.

    • Search Google Scholar
    • Export Citation
  • 58

    Banks CA, Jowett N, Hadlock TA. Test-retest reliability and agreement between in-person and video assessment of facial mimetic function using the eFACE facial grading system. JAMA Facial Plast Surg. 2017;19(3):206211.

    • Search Google Scholar
    • Export Citation
  • 59

    Fattah AY, Gurusinghe AD, Gavilan J, Facial nerve grading instruments: systematic review of the literature and suggestion for uniformity. Plast Reconstr Surg. 2015;135(2):569579.

    • Search Google Scholar
    • Export Citation
  • 60

    Carlson ML, Tveiten OV, Yost KJ, The minimal clinically important difference in vestibular schwannoma quality-of-life assessment: an important step beyond P <.05. Otolaryngol Head Neck Surg. 2015;153(2):202208.

    • Search Google Scholar
    • Export Citation
  • 61

    Carlson ML, Tombers NM, Kerezoudis P, Quality of life within the first 6 months of vestibular schwannoma diagnosis with implications for patient counseling. Otol Neurotol. 2018;39(10):e1129e1136.

    • Search Google Scholar
    • Export Citation
  • 62

    Peris-Celda M, Graffeo C, Perry A, Beyond the ABCs: hearing loss and quality-of-life in vestibular schwannoma. Mayo Clinic Proc. 2020. In press.

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 691 691 691
Full Text Views 70 70 70
PDF Downloads 69 69 69
EPUB Downloads 0 0 0