MRI shows an enhancing geniculate-ganglion facial-nerve tumour extending into the labyrinthine segment. Facial function is House–Brackmann II and serial scans show no growth. Hearing is serviceable. What is the preferred strategy?
Stable small facial-nerve schwannoma with good function is usually observed because resection commonly sacrifices facial function; growth, progressive weakness, brainstem effect or hearing change prompts reconsideration.
A. Clinical and MRI surveillance with eye-care advice and intervention triggers: Stable small facial-nerve schwannoma with good function is usually observed because resection commonly sacrifices facial function; growth, progressive weakness, brainstem effect or hearing change prompts reconsideration.
B. Immediate complete excision with cable graft: This trades mild weakness for predictable denervation and is not justified without progression.
C. Empirical facial nerve decompression: Decompression does not remove a stable schwannoma and exposes hearing and facial function to risk.
D. Stereotactic radiotherapy solely because enhancement is present: Enhancement establishes the lesion but is not itself an indication for irradiation.
E. Discharge because hearing is serviceable: Longitudinal imaging and functional review remain necessary.
If facial function deteriorated rapidly to House–Brackmann V with documented tumour growth, active treatment including surgery or radiotherapy would require multidisciplinary discussion.
Independent Clinora educational material; not official JCIE content, an accredited programme, clinical advice, or a substitute for local policy and specialist judgement.
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