Surgical management of facial nerve schwannomas: a contemporary series of 67 surgeries.

Authors

Ken Matsushima, Michihiro Kohno, Nobuyuki Nakajima, Norio Ichimasu, Masanori Yoshino, Taro Inagaki, Kiyoaki Tsukahara

Published in

Journal of neurosurgery. Pages 1-11. Aug 07, 2026. Epub Aug 07, 2026.

Abstract

Facial nerve schwannomas (FNSs) are rare benign tumors that can involve any segment of the facial nerve. Comprehensive understanding of these tumors remains limited, largely due to the paucity of reports on large surgical series in the literature, and their clinical management is particularly challenging. To balance tumor control with favorable facial nerve function, the authors have adopted nerve-preserving surgery (nonradical tumor removal and bony decompression) for moderate facial nerve palsy and conventional nerve reconstruction surgery (total tumor removal and facial nerve reconstruction) for severe or complete palsy cases. In this study, the authors evaluate the utility of a function-centered surgical strategy and a five-category, location-based classification system, based on a relatively large contemporary series.
A total of 67 consecutive FNS surgeries performed in 61 patients between 2004 and 2022 were retrospectively reviewed. The surgical strategy was selected according to the patient's preoperative facial nerve function and intraoperative electromyography (EMG) responses.
Nerve-preserving surgery was performed in 47 cases (70.1%) and was associated with improved or stable facial nerve function in 87.2%. The mean House-Brackmann grade improved from 3.5 to 3.0 in the nerve preservation group and from 4.6 to 4.0 in the nerve reconstruction group. Overall, facial nerve function improved in 50.7% and worsened in 13.4% of cases. In the nerve preservation group, tumors confined within the temporal bone (intrameatal, tympanic, and mastoid types), younger age, and favorable EMG responses were associated with better postoperative facial nerve function. During long-term follow-up (mean 87.2 months), 27.7% of this group required additional treatment.
A function-centered strategy, supported by intraoperative EMG monitoring and a tumor-centered classification, enables selective nerve preservation and was associated with favorable outcomes in FNS surgery. This strategy may serve as a practical framework for individualized surgical treatment of FNSs.

PMID:
42566790
Bibliographic data and abstract were imported from PubMed on 08 Aug 2026.

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