Intradural facial nerve schwannoma: Diagnostic and therapeutic problems

Objectives: To define characteristics of intradural facial schwannoma (FS) and discuss management strategies. Method: Retrospective review of clinical charts. Results: Six patients were diagnosed, based on surgical findings, as having intradural FS. None of the patients complained initially of facial weakness, but all showed severe disturbance of hearing function assessed on admission. FS was suspected in four of our six patients because of imaging findings or facial palsy caused by a small tumor. Total removal was performed in five cases followed by facial nerve reconstruction, and nearly total removal was performed in one case. Most patients recovered to Grade II or III palsy during the follow-up, and longlasting palsy before surgery showed poor recovery. Conclusion: Imaging findings such as tumor extension to the middle fossa and clinical findings such as facial palsy caused by a small tumor strongly suggest a diagnosis of FS. Facial function can be restored satisfactorily for most patients after appropriate surgery.