Fractionated Stereotactic
Radiotherapy for Facial Nerve Neuroma:
The First Reported Case
Shearwood McClelland III M.D.1,
Kathryn E. Dusenbery M.D.2, Patrick D. Higgins Ph.D.2,
Walter A. Hall M.D., M.B.A.1
Departments of 1Neurosurgery and 2Radiation
Oncology, University of Minnesota Medical School, Minneapolis, MN
Introduction:
Facial
nerve neuromas are extremely rare, and are often mistaken for acoustic neuromas
when located near the vestibular nerve.
Usually presenting with facial weakness and hearing loss, facial nerve
neuromas of the cerebellopontine angle have commonly been managed by
surgery. We present the first
reported case of a facial nerve neuroma treated with fractionated stereotactic
radiotherapy (FSRT).
Methods:
The
patient was a 40-year-old woman who presented with tinnitus, dizziness, and
decreased hearing that was associated with a right intracanalicular mass on
magnetic resonance imaging. She
underwent a middle fossa craniotomy only to reveal a facial nerve tumor rather
than an acoustic neuroma that was not resected due to the high risk of facial
paralysis. Following surgery, her
facial function worsened and was associated with tumor enlargement on MRI. She was referred for FSRT and received 54 Gy in daily 1.8-Gy fractions with a prescription
isodose line of 90%.
Results:
Three
months after treatment she had no worsening of her pre-treatment symptoms, and
at one-year follow-up, she experienced facial weakness improvement accompanied
by an absence of tumor growth on MRI.
These clinical and imaging findings persisted at 48 months of follow-up.
Conclusion:
In
the first report of a facial nerve neuroma treated with fractionated
stereotactic radiotherapy, this treatment resulted in excellent long-term (4
year) tumor control with improvement of pre-treatment symptomatology and
absence of morbidity. This report
demonstrates the potential for using FSRT to treat facial nerve neuromas of the
cerebellopontine angle that could otherwise be associated with significant
operative morbidity.
Keywords:
Fractionated
Stereotactic Radiotherapy, Facial Nerve Neuroma, Cerebellopontine Angle, Tumor
Control