Conservative facial nerve management in jugular foramen schwannomas

Objective: Although transposition of the facial nerve is crucial in infiltr ative vascular lesions involving the jugular foramen, the objective was to show that a conservative approach to management of the facial nerve is suff icient with jugular foramen neuromas because of their noninfiltrative, less vascular nature and medial location in the jugular foramen. Study Design: Retrospective case review. Setting: Tertiary, private, multiphysician, otologic practice. Patients: Sixteen patients with jugular foramen schwannoma (18 procedures) treated between January 1975 and October 1995. The 8 male and 8 female pati ents ranged in age from 13 to 66 years (mean age 47.7 years). Intervention: One-stage, total jugular foramen neuroma removal without tran sposition of the facial nerve. using a variety of surgical approaches. Main Outcome Measures: Facial nerve transposition (yes or no), House-Brackm ann facial nerve grade, lower cranial nerve status, complications. Results: One-stage total tumor removal was accomplished in all the cases. I n 13 (72%) of the neuromas, removal was accomplished without facial nerve t ransposition. Transposition was performed in 2 revision cases in which scar tissue from a previous operation prevented complete control of the carotid artery and safe removal, 2 cases with large tumor extension anteriorly to the petrous apex, and 1 case with extensive involvement of the middle ear. A House-Brackmann facial nerve Grade I or II was obtained in 16 of the 18 p rocedures, with 1 Grade III and 1 case that remained Grade V, as it was pre operatively. Conclusions: One-stage, total tumor removal can be achieved with excellent control of the important vascular structures and without transposition of t he facial nerve in a majority of jugular foramen schwannomas.