Objectives:

Facial nerve schwannomas (FNS) are rare benign tumors originating from Schwann cells of the seventh cranial nerve. Managing FNS is complex, involving a balance between surgical resection and observation, with the primary goal of preserving facial nerve function. Stereotactic radiosurgery (SRS) is emerging as an alternative. This study aims to evaluate the efficacy and safety of SRS in managing FNS compared to surgical resection and observation.

Methods:

We performed a retrospective analysis of patients diagnosed with FNS at our institution between 1992 and 2024. Demographic, clinicopathologic, radiologic and treatment data were collected. Statistical analyses included Fisher’s Exact test and ANOVA where appropriate.

Results:

We analyzed 85 patients with 90 tumors. Nineteen tumors were treated with SRS (21.1 %), thirty-six with surgical resection (40 %), and thirty-five were monitored without intervention (38.9 %). Statistically significant differences were observed in tumor size (P < 0.001) across treatment groups, as well as in House-Brackman scale grading (P < 0.001), CNVII deficit on presentation (P < 0.001), other neurologic symptoms on presentation (other than cranial nerves 3,4,5,6,7,8 symptoms) (P < 0.001), in tumors‘ extension as intracranial, extracranial, or both (P < 0.001), and in existing comorbidities (P = 0.005). SRS achieved 100% local control rate over 19.3 years of follow-up, compared to surgical outcomes showing local tumor control rates of 100%, 97.22%, 88.88%, and 86.11% at 1, 2, 12, and 26 years, respectively, while no significant difference was observed. There was a statistically significant difference in CN VII deficit at last follow up (P =0.047), and in initial symptoms resolution (P=0.009). Multivariate analysis did not reveal any predictive role of treatment type in local control. Only presence of comorbidities predicted lack of recovery from cranial nerve palsy.

Conclusion(s):

SRS offers outstanding long-term control of facial nerve schwannomas with better outcomes in facial nerve (CN VII) deficits at the final follow-up. These results support SRS as a viable treatment option for FNS, providing effective tumor control with no demonstrated inferiority to surgery as a treatment option.