Facial nerve and chorda tympani schwannomas: Case series, and advantages of using non-rigid registration of post-enhanced 3D-T1 Turbo Field Echo and CT images (TURFECT) in their diagnosis and surgical treatment

Features and management of a schwannoma of the chorda tympani and review of the literature

Intrinsic facial nerve tumors are rare lesions. Among the different histology types, schwannomas is the most frequently reported in literature. Other histological types of facial nerve tumors are hemangiomas, meningiomas, and neurofibromas. Chorda tympani schwannomas (CTSs) are extremely rare entities and are considered as an independent subgroup of facial nerve schwannomas because of their clinical characteristics. The aim of this report is to present the clinical and radiological features and the management of a CTS in a 27-year-old male presenting with conductive hearing loss.

Nuances in transcanal endoscopic approach to benign middle ear tumours in adult patients

BACKGROUND AND OBJECTIVE

Minimally invasive surgery of benign middle ear tumours is possible by using the endoscope. The optimal lighting and the broadest vision it offers, allow a transcanal approach to these rare tumours. The objective of this work is to summarise its key points through a case series.

MATERIALS AND METHODS

Retrospective study of benign middle ear tumours that underwent exclusive endoscopic surgery in a third-level adult university hospital between June 2018 and June 2020. Postoperative follow-up was performed by otoendoscopy and audiometry.

RESULTS

Six patients underwent surgery during the study period. Five patients were female and one male, with an average age of 57.8 years (±21.9). Four tumours were in the left ear and 2 in the right ear. These included four tympanic paragangliomas (three type I and one type II), a chorda tympani neuroma, and a congenital cholesteatoma. There were no serious postoperative complications. At present, no tumour recurrence has been found in either case, with a minimum follow-up of 7 months.

CONCLUSIONS

The present study adds evidence on the safety and efficacy of endoscopic transcanal ear surgery, as a minimally invasive technique, for the treatment of benign middle ear tumours confined to the tympanic cavity.

Management of non-vestibular schwannomas in adult patients: a systematic review and consensus statement on behalf of the EANS skull base section Part II: Trigeminal and facial nerve schwannomas (CN V, VII)

BACKGROUND

Non-vestibular schwannomas are relatively rare, with trigeminal and jugular foramen schwannomas being the most common. This is a heterogenous group which requires detailed investigation and careful consideration to management strategy. The optimal management for these tumours remains unclear and there are several controversies. The aim of this paper is to provide insight into the main principles defining management and surgical strategy, in order to formulate a series of recommendations.

METHODS

A task force was created by the EANS skull base section committee along with its members and other renowned experts in the field to generate recommendations for the surgical management of these tumours on a European perspective. To achieve this, the task force performed an extensive systematic review in this field and had discussions within the group. This article is the second of a three-part series describing non-vestibular schwannomas (V, VII).

RESULTS

A summary of literature evidence was proposed after discussion within the EANS skull base section. The constituted task force dealt with the practice patterns that exist with respect to pre-operative radiological investigations, ophthalmological assessments, optimal surgical and radiotherapy strategies, and follow-up management.

CONCLUSION

This article represents the consensually derived opinion of the task force with respect to the treatment of trigeminal and facial schwannoma. The aim of treatment is maximal safe resection with preservation of function. Careful thought is required to select the appropriate surgical approach. Most middle fossa trigeminal schwannoma tumours can be safely accessed by a subtemporal extradural middle fossa approach. The treatment of facial nerve schwannoma remains controversial.

An Incidental Chorda Tympani Schwannoma Identified During Middle Ear Surgery

Chorda tympani schwannomas are rare benign tumors of the middle ear cleft. This is a case of incidental chorda tympani schwannoma identified intraoperatively. The patient was a 50-year-old male with chronic active otitis media complicated by left-sided facial paralysis. During closed mastoidectomy and tympanoplasty approach, a well-demarcated swelling on the left chorda tympani nerve was identified and sectioned for pathologic evaluation. The histopathologic evaluation established the diagnosis of schwannoma. Although the tumor was unlikely the cause of the disease process in this patient, his facial paralysis and middle ear disease were resolved after surgery.

Nuances in transcanal endoscopic approach to benign middle ear tumours in adult patients

BACKGROUND AND OBJECTIVE

Minimally invasive surgery of benign middle ear tumours is possible by using the endoscope. The optimal lighting and the broadest vision it offers, allow a transcanal approach to these rare tumours. The objective of this work is to summarize its key points through a case series.

MATERIALS AND METHODS

Retrospective study of benign middle ear tumours that underwent exclusive endoscopic surgery in a third-level adult university hospital between June 2018 and June 2020. Postoperative follow-up was performed by otoendoscopy and audiometry.

RESULTS

Six patients underwent surgery during the study period. Five patients were female and one male, with an average age of 57.8 years (± 21.9). Four tumours were in the left ear and 2 in the right ear. These included 4tympanic paragangliomas (3 type I and one type II), a chorda tympani neuroma, and a congenital cholesteatoma. There were no serious postoperative complications. At present, no tumour recurrence has been found in either case, with a minimum follow-up of 7 months.

CONCLUSIONS

The present study adds evidence on the safety and efficacy of endoscopic transcanal ear surgery, as a minimally invasive technique, for the treatment of benign middle ear tumours confined to the tympanic cavity.

A New Case of Endoscopic Resection of a Chorda Tympani Schwannoma

Chorda tympani schwannoma is a very rare tumor, with only 12 reported cases in the English literature. There are few reports on the diagnosis of chorda tympani schwannoma, and it is easily misdiagnosed. At present, surgery is recognized as a treatment for chorda tympani schwannoma. We describe the clinical course of a patient presenting with a chorda tympani schwannoma treated with surgical resection using a transcanal endoscopic approach, and the results after this treatment were satisfactory. Therefore, we accordingly advocate the minimally invasive method of transcanal endoscopic resection to maximize intraoperative visualization and reduce postoperative morbidity for middle ear tumors.