Modern Management of Skull Base Facial Nerve Schwannomas

PROGRAM DESCRIPTION: Facial nerve schwannomas are rare benign tumors arising from the sheath of the facial nerve. They may affect any part of the facial nerve from the cerebellopontine angle (CPA) to the most peripheral branches of the nerve. In the CPA and skull base their management offers particular challenges because 1) they often resemble vestibular schwannomas 2) they are in close proximity to other neurological structures particularly the vestibular system and cochlea 3) resection results in significant facial weakness. Clinical features are similar to vestibular schwannomas and are generally unhelpful in differentiating them. In contrast, radiological assessment with magnetic resonance imaging and, in some cases computed tomography, is critical for accurate diagnosis and may, with appropriate sequences, clearly differentiate from vestibular schwannomas. This is not, however, universally the case. Treatment is most frequently with serial imaging with most tumors never requiring treatment. Those that require treatment, may be removed surgically or stabilised with radiosurgery. Decision making is very different from vestibular schwannoma management because of the risk of facial weakness with treatment and because of the higher proportion of patients that have serviceable hearing.

This session will focus on the controversies around management of facial nerve schwannomas, propose means by which the likelihood of correct diagnosis can be optimised and discuss how long term outcomes can be optimised.

OUTCOME OBJECTIVE 1: Discuss optimal means by which facial nerve schwannomas can be diagnosed correctly

OUTCOME OBJECTIVE 2: Discuss how imaging and clinical findings can help determine the optimal management plan

OUTCOME OBJECTIVE 3: Discuss how outcomes can be optimised in order to maximise long term quality of life

BACKGROUND STATEMENT: It is important to be aware of the pitfalls in managing FNS. The panel has very extensive experience in management and have widely published on the subject. They will be able to undertake a wide ranging discussion to ensure that the audience leave with a better understanding of their management.