Management Outcomes of Facial Nerve Schwannomas: A Comprehensive Single- Institution Analysis

Abstract

Abstract BACKGROUND And OBJECTIVES Facial nerve schwannomas (FNS) are rare benign tumors requiring a balance between tumor control and facial nerve preservation. Treatment options include open surgical resection (OSR), stereotactic radiosurgery (SRS), and observation. This study evaluates the efficacy and safety of SRS versus OSR and observation. METHODS We retrospectively analyzed patients with FNS treated at our institution from 1992 to 2025. Analyses included chi-square, ANOVA, and logistic regression, with survival assessed using Kaplan–Meier and Cox regression. RESULTS We analyzed 85 patients with FNS; 58.8% were female, with a mean age of 47 years. Sixteen tumors (18.8%) were treated with SRS, 35 (41.2%) with OSR, and 34 (40.0%) were observed. The observation group was older (vs. OSR, p = 0.022), had smaller tumors (vs. OSR and SRS, p = 0.001), and had fewer facial nerve deficits at presentation (vs. SRS, p = 0.001). On multivariate analysis, tumors involving both intracranial and extracranial compartments independently predicted CN VII deficits at last follow-up (p = 0.038). Patients treated with SRS were more likely to experience resolution of presenting symptoms compared to other modalities (p = 0.015). LTC at 15 years was 100% with SRS, compared with 80% with OSR and 75% with observation; differences were not significant (p = 0.39), and treatment type did not predict LTC on multivariate analysis. CONCLUSION SRS provides durable tumor control for FNS, with superior symptom resolution and favorable preservation of facial nerve function. LTC and OS were comparable across treatment groups. To our knowledge, this is the largest cohort evaluating SRS outcomes in FNS to date.