• Archives of Craniofacial Surgery
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• v.15 no.1
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• pp.28-31
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• 2014

Intraparotid facial nerve schwannoma is a rare benign neoplasm. Due to its rarity, it is not usually a prioritized diagnosis before surgery and may therefore lead to an unintentional treatment error. In this article, we report a single case of intraparotid facial nerve schwannoma. We were able to make a diagnosis with frozen biopsy. A complete resection of the mass while preserving the facial nerve was performed. Herein we present our clinical experience with regards to the treatment process of intraparotid facial nerve schwannoma.

• Journal of Physiology & Pathology in Korean Medicine
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• v.27 no.3
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• pp.327-330
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• 2013

The purpose of this study is to report a clinical progress of treatment of sequelae caused by removal of facial schwannoma through Korean medicine. A patient was diagnosed with facial schwannoma by MRI on 4th June 2012 in local university hospital, he had right facial palsy, auditory hypersensitivity, dizziness after removal of facial schwannoma. Between 25th July 2012 and 26th January 2013, he was treated with acupuncture, cupping, electro-acupuncture every week and observed by House-Brackmann facial nerve grading system(H-B scale) and MoReSS every month. He had 29 times treatments. At the first of treatment, his state was Grade IV (H-B scale), 4/8(facial nerve grading), 10 points during action 7 points during rest(MoReSS) and he had severe facial palsy, ill-acrimation, auditory hypersensitivity. At the middle of treatment, October 2012, symptoms improved. State was Grade III (H-B scale), 5/8(facial nerve grading), 7 points during action 3 points during rest(MoReSS). Severe facial palsy improved ; Forehead creasing and union motor function recovered, he was able to close his eyes so ill-acrimation improved. At the end of treatment, January 2012, state was Grade II (H-B scale), 7.5/8(facial nerve grading), 3 points during action 1 point during rest(MoReSS). He had only occasional tinnitus and auditory hypersensitivity. Acupuncture and electro-acupuncture are estimated to be good for facial palsy after removal of facial schwannoma. More cases are required to develop treatment of facial palsy.

• Journal of Korean Neurosurgical Society
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• v.57 no.4
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• pp.292-294
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• 2015

Vestibular schwannoma (VS) usually present the widening of internal auditory canal (IAC), and these bony changes are typically limited to IAC, not extend to temporal bone. Temporal bone invasion by VS is extremely rare. We report 51-year-old man who revealed temporal bone destruction beyond IAC by unilateral VS. The bony destruction extended anteriorly to the carotid canal and inferiorly to the jugular foramen. On histopathologic examination, the tumor showed typical benign schwannoma and did not show any unusual vascularity or malignant feature. Facial nerve was severely compressed and distorted by tumor, which unevenly eroded temporal bone in surgical field. Vestibular schwannoma with atypical invasion of temporal bone can be successfully treated with combined translabyrinthine and lateral suboccipiral approach without facial nerve dysfunction. Early detection and careful dissection of facial nerve with intraoperative monitoring should be considered during operation due to severe adhesion and distortion of facial nerve by tumor and eroded temporal bone.

• Journal of Korean Neurosurgical Society
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• v.55 no.4
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• pp.208-211
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• 2014

Recently, the increasing rates of facial nerve preservation after vestibular schwannoma (VS) surgery have been achieved. However, the management of a partially or completely damaged facial nerve remains an important issue. The authors report a patient who was had a good recovery after a facial nerve reconstruction using fibrin glue-coated collagen fleece for a totally transected facial nerve during VS surgery. And, we verifed the anatomical preservation and functional outcome of the facial nerve with postoperative diffusion tensor (DT) imaging facial nerve tractography, electroneurography (ENoG) and House-Brackmann (HB) grade. DT imaging tractography at the 3rd postoperative day revealed preservation of facial nerve. And facial nerve degeneration ratio was 94.1% at 7th postoperative day ENoG. At postoperative 3 months and 1 year follow-up examination with DT imaging facial nerve tractography and ENoG, good results for facial nerve function were observed.

• Journal of Korean Neurosurgical Society
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• v.66 no.2
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• pp.183-189
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• 2023

Objective : The facial nerve trace on the ipsilateral side of the vestibular schwannoma was reconstructed by diffusion tensor imaging tractography to identify the adjacent relationship between the facial nerve and the tumor, and to improve the level of intraoperative facial nerve protection. Methods : The clinical data of 30 cases of unilateral vestibular schwannoma who underwent tumor resection via retrosigmoid approach were collected between January 2019 and December 2020. All cases underwent magnetic resonance imaging examination before operation. Diffusion tensor imaging and anatomical images were used to reconstruct the facial nerve track of the affected side, so as to predict the course of the nerve and its adjacent relationship with the tumor, to compare the actual trace of the facial nerve during operation, verify the degree of coincidence, and evaluate the nerve function (House-Brackmann grade) after surgery. Results : The facial nerve of 27 out of 30 cases could be displayed by diffusion tensor imaging tractography, and the tracking rate was 90% (27/30). The intraoperative locations of facial nerve shown in 25 cases were consistent with the preoperative reconstruction results. The coincidence rate was 92.6% (25/27). The facial nerves were located on the anterior middle part of the tumor in 14 cases, anterior upper part in eight cases, anterior lower part in seven cases, and superior polar in one case. Intraoperative facial nerve anatomy was preserved in 30 cases. Among the 30 patients, total resection was performed in 28 cases and subtotal resection in two cases. The facial nerve function was evaluated 2 weeks after operation, and the results showed grade I in 12 cases, grade II in 16 cases and grade III in two cases. Conclusion : Preoperative diffusion tensor imaging tractography can clearly show the trajectory and adjacent position of the facial nerve on the side of vestibular schwannoma, which is beneficial to accurately identify and effectively protect the facial nerve during the operation, and is worthy of clinical application and promotion.

• Archives of Craniofacial Surgery
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• v.20 no.1
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• pp.71-74
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• 2019

Schwannoma is a benign tumor rarely found in the head and neck and much less commonly found in the intraparotid facial nerve. It is a slow-growing encapsulated tumor originating from the Schwann cells or axonal nerve sheath. It can occur anywhere along the course of the facial nerve. Patients may present with symptoms of facial palsy, but the most common presenting symptom is an asymptomatic swelling. Diagnosis is usually difficult before surgical removal and histopathological examination. We report a rare case of intraparotid facial nerve schwannoma in a 57-year-old female who had sustained a mass of the right preauricular area for 3 years. She reported no pain or facial muscle weakness. Enhanced computed tomography findings revealed the impression of pleomorphic adenoma. However, intraoperative gross findings were not characteristic of pleomorphic adenoma, and a frozen biopsy was performed resulting in the impression of a nerve sheath tumor. We performed an extracapsular surgical excision without parotidectomy. Permanent histopathology and immunohistochemistry reports diagnosed the mass as schwannoma. There were no complications including facial palsy after surgery. No recurrence was found at 6 months after surgery.

• Journal of Korean Neurosurgical Society
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• v.43 no.1
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• pp.57-60
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• 2008

The authors herein propose the staged excision as a novel strategy to preserve facial nerve and minimize complication during microsurgery of large vestibular schwannoma (VS). At the first stage, for reducing mass effect on the brain stem and cerebellum, subtotal tumor resection was performed via a retrosigmoid craniotomy without intervention of meatal portion of tumor. With total resection of the remaining tumor, the facial nerve was decompressed and delineated during the second stage translabyrinthine approach at a later date. A 38-year-old female who underwent the staging operation for resection of her huge VS is illustrated.

• Journal of Korean Neurosurgical Society
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• v.40 no.2
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• pp.125-127
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• 2006

Facial nerve schwannomas are uncommon tumors. A 40-year-old female presented with left-side facial weakness. Computed tomography[CT] imaging showed a $3\;{\times}\;2cm$ lesion on the posterior portion of the left middle cranial fossa. The mass abutted the anterior aspect of the left petrous bone with a wide erosive change involving the area of the left facial nerve ganglion [geniculate ganglion]. A well-circumscribed extra-axial mass was seen on magnetic resonance imaging[MRI]. The tumor was completely removed through subtemporal approach and the patient was discharged without additional neurological deficit. This rare case is discussed and a review of the relevant literature is presented.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.32 no.1
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• pp.68-71
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• 2010

Facial nerve schwannomas (FNSs) are usually painless, slow-growing, and without specific symptoms, so that early diagnosis may be difficult. They are particularly liable to being misdiagnosed as parotid gland origin benign tumor before surgery, which can lead to unnecessary parotidectomy or unexpected facial nerve injury. To prevent these complications, it is important that the correct diagnosis is performed at least in intraoperative time. When an adhesion between the mass and the facial nerve is exist or when electrical stimulation of the mass triggers facial movement, FNS is highly suggested diagnosis. In such cases, frozen section analysis should always be performed. In this case, the pre-operative diagnosis from clinical examination and MRI was pleomorphic adenoma. However, intraoperative features led us to suspect that the mass originated from facial nerves, and intraoperative frozen section analysis yielded results consistent with a schwannoma. Based on this intraoperative diagnosis, we carried out a successful conservative treatment with preservation of facial nerve.

• Korean Journal of Head & Neck Oncology
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• v.29 no.2
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• pp.87-92
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• 2013

Complete facial nerve palsy is emotionally and physiologically devastating condition. Management of patients with the facial nerve palsy poses significant challenges to achieve the goal of returning patients to their premorbid state. We experienced a case of iatrogenic facial nerve palsy in a 66 year-old patient, who was diagnosed as facial nerve schwannoma with previous incisional biopsy. The author describes the management of this patient and reviews the literature.