Mohammad Hassan A Noureldine1, R Tushar Jha2, Ivo Peto3, Patrick J Malafronte4, Kyle Allen5, Siviero Agazzi6. 1. Department of Neurosurgery, Institute for Brain Protection Sciences, Johns Hopkins University School of Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA. 2. Department of Neurosurgery, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA. 3. Department of Neurosurgery, University of South Florida Morsani College of Medicine, Tampa General Hospital, Tampa, Florida, USA. 4. Ruffolo, Hooper & Associates, M.D., P.A., Tampa, Florida, USA. 5. Department of Neurosurgery, University of South Florida Morsani College of Medicine, Tampa General Hospital, Tampa, Florida, USA; Tampa Bay Hearing and Balance Center, Tampa, Florida, USA. 6. Department of Neurosurgery, University of South Florida Morsani College of Medicine, Tampa General Hospital, Tampa, Florida, USA. Electronic address: sagazzi@health.usf.edu.
Abstract
BACKGROUND: Facial nerve schwannomas (FNSs) are rare benign tumors that arise from Schwann cells of the facial nerve. FNSs are similar to vestibular schwannomas in many aspects, yet their infiltrative nature into the facial nerve fascicles warrants a more conservative management approach. In the last decade, stereotactic radiosurgery (SRS) has shown promise in stabilizing or shrinking FNSs. CASE DESCRIPTION: A 71-year-old woman presented with mild facial paresis. Tumor growth after a period of watchful waiting warranted treatment with SRS, which was complicated by an acute posterior fossa hemorrhage and brainstem compression, necessitating microsurgical hematoma evacuation, tumor resection, and facial nerve substitution. CONCLUSIONS: SRS has led to better facial nerve function and outcomes and is currently considered a reasonable alternative to microsurgical resection in patients with FNSs. This is the first report to our knowledge of an acute, life-threatening hemorrhage after SRS in a patient with FNS.
BACKGROUND:Facial nerve schwannomas (FNSs) are rare benign tumors that arise from Schwann cells of the facial nerve. FNSs are similar to vestibular schwannomas in many aspects, yet their infiltrative nature into the facial nerve fascicles warrants a more conservative management approach. In the last decade, stereotactic radiosurgery (SRS) has shown promise in stabilizing or shrinking FNSs. CASE DESCRIPTION: A 71-year-old woman presented with mild facial paresis. Tumor growth after a period of watchful waiting warranted treatment with SRS, which was complicated by an acute posterior fossa hemorrhage and brainstem compression, necessitating microsurgical hematoma evacuation, tumor resection, and facial nerve substitution. CONCLUSIONS:SRS has led to better facial nerve function and outcomes and is currently considered a reasonable alternative to microsurgical resection in patients with FNSs. This is the first report to our knowledge of an acute, life-threatening hemorrhage after SRS in a patient with FNS.