Treatment of Facial Nerve Neuroma (schwannoma) in Israel

Facial nerve neuroma (schwannoma) is a rare tumor that grows slowly, but can reach large sizes. It leads to hearing loss and facial paresis. The treatment involves the conventional surgery and radiosurgical techniques. Facial nerve neuroma is much less common than the acoustic neuroma. Nonetheless, one can find doctors with successful experience in treating this disease in Israel.

Where can schwannoma develop?

Facial nerve neuroma is a benign tumor of neuroectodermal origin. It grows from the nerve sheaths. Initially, this is a small node in the capsule, but over the years it can reach impressive sizes.

According to the localization of the facial nerve neuroma, it can be:

• Extratemporal
• Intratemporal
• Intracranial

Two thirds of cases of the disease occur in the intratemporal localization, i.e. a tumor is located inside the petrous part of the temporal bone. In turn, the neoplasms with such a localization can develop in the labyrinthine, tympanic and mastoid segments of the facial nerve, geniculate body and greater superficial petrosal nerve. Depending on the location, the symptoms may be different. In 70-80% of cases, these are tumors of the geniculate body. However, in the future they can spread to other parts of the nerve, as they gradually increase in size.

Facial nerve neuroma can have intracranial and extracranial spread. This means that it can grow either inside the skull or outside it.

Diagnostics

The neoplasm most often develops in women aged 35-40 years. When visiting a doctor, 60% of patients complain of hearing loss, while every third patient has a stuffy feeling in the ear. In a third of patients, the diagnostic examination reveals a neoplasm in the tympanic cavity.

The leading set of symptoms is facial neuropathy. It is observed in 70% of those seeking medical help for schwannoma. The facial nerve contains many motor fibers and provides facial expressions. According to House-Brackmann, there are 6 degrees of neuropathy:

• 1 – mild muscle weakness
• 2 – obvious, but not mutilating difference between the two sides of the face
• 3 – forehead is almost motionless, the eye can be completely closed with some effort
• 4 – mutilating asymmetry of the face, the forehead is completely motionless, the eye cannot be completely closed, the forehead is asymmetric
• 5 – only slight movements of the muscles of the face on the affected side
• 6 – complete paralysis of the facial muscles on the affected side

The disease can mimic exudative otitis media (ear inflammation with suppuration). The pathology is also differentiated with tumors of a different origin. In addition to schwannoma, hemangioma and cholesteatoma can have a similar localization.

The diagnostics of facial nerve schwannoma involves the use of the following diagnostic methods:

• Otomicroscopy
• Audiological tests to determine the degree of hearing loss
• Electromyography
• Electroneurography
• High-resolution CT scan of the temporal bones
• MRI of the brain

What is the process of treatment?

When deciding whether to treat or monitor the patient, several factors are considered:

• Peculiarities of the patient: his age, the presence of concomitant diseases, fear of surgery and complications, tolerance of facial nerve schwannoma symptoms and motivation to get rid of the clinical manifestations of the disease, expectations regarding the treatment results
• Features of the tumor: the size of the tumor, its growth inside the skull or an external type of growth, manifestation of severe symptoms, the speed of tumor growth
• Available treatment methods: if the hospital contacted by the patient has an experienced doctor, who has already removed facial nerve schwannomas, if the hospital uses radiosurgical methods, if the patient can pay for a more effective and safe treatment

As a rule, the patient can be supervised for some time, while he preserves working ability and social activity, has minimal symptoms, the size of the tumor is small and the schwannoma does not compress the brain, does not threaten with serious complications. During the follow-up period, the MRI scan is performed at least once a year.

Surgical treatment

The main treatment is a surgical removal of the tumor. A surgeon performs a microsurgical operation with preservation of the facial nerve fibers.

There are different opinions regarding the optimal timing of the surgery. The facial nerve schwannoma is a rare tumor. Therefore, there are still not enough medical observations to make it possible to assert with confidence the superiority of a particular treatment strategy.

Some doctors recommend supervising patients first, but not performing surgery until more than 50% of nerve fibers are affected according to EMG findings. Other authors note the best treatment results with an early surgical intervention, even before the manifestation of the signs of the facial nerve degeneration. The restoration of its function is observed in 8-24 months after the surgery.

The facial nerve neuroma usually grows very slowly. The manifestations of facial neuropathy are minimal, and this is especially true for neoplasms with external growth. Therefore, doctors often remove a part of the nerve with the preservation and decompression (elimination of pressure) of the trunk. In many cases, although not always, the preservation of the trunk allows maintaining the facial nerve function.

Radiosurgery

The radiosurgical treatment is performed in leading centers in Israel. It aims to destroy the tumor with radiation.

A patient does not need a large number of radiation sessions, as with the conventional radiation therapy. Instead, a high, precise and repeating contour of the tumor dose of radiation is directed at the target region from different points. As a result, the neoplasm is destroyed in just one or several (usually up to five) sessions.

This approach to treatment has obvious benefits:

• No incisions are required
• No pain
• No fear of surgery
• No recovery period
• No postoperative scars

In comparison with surgical intervention, the radiosurgical method contributes to the preservation of the facial nerve function. Accordingly, it allows maintaining a high quality of human life and improving both working and social capacity.

Here are the main situations when doctors opt for radiosurgical treatment:

• Elderly age
• Somatic diseases that increase the risk of surgery for the patient’s health
• Refusal of surgical intervention
• Relapse of schwannoma of the facial nerve after surgery

The results of radiosurgical treatment are comparable with the results of surgical resection of the tumor. The procedure is effective in 90% of patients. It can not only stabilize the tumor, but even decrease its size. However, the failures can also happen. In 30% of cases, the size of the tumor does not decrease, while in 10% of patients, the neoplasm continues to grow, although the rate of progression of the disease slows down.

Both radiosurgery and radiotherapy can be used as an addition to surgery. The non-radical surgery may result in relapses. To reduce the risk of the repeated growth of schwannoma, the surgery is followed by irradiation.

Why is it better to undergo treatment in Israel?

Israel offers a high level of medicine and reasonable prices. Patients from all over the world often come here to receive medical services in the field of oncology, cardiovascular surgery, plastic surgery. The hospitals in Israel admit people with rare diseases, which include facial nerve neuroma.

Here are the benefits of treatment in the hospitals of Israel:

• Safe and effective microsurgical operations
• Removal of the tumor with a minimal risk of relapse, while maintaining the facial nerve function
• Possibility of restoration of hearing in case of its loss
• Availability of radiosurgical treatment methods that are safer and better tolerated than surgical procedures, although they have a higher cost
• Specialists with experience in the treatment of such a rare disease as facial nerve schwannoma
• Low cost of medical services
• Well-equipped hospitals specializing in neurology
• Adequate care, full recovery of patients after surgery

Where to seek help from?

You can contact one of the Centers of Neurology and Neurosurgery in Israel to undergo treatment of facial nerve neuroma at an affordable price. To choose a suitable hospital, please, use the international service Booking Health. On our portal you can find information about doctors, neurosurgery clinics in different countries, sort them by a number of parameters:

• Available treatment methods (surgery, radiosurgery)
• Cost of surgery or other services
• Rating
• Patient reviews
• The nearest available dates for the surgical procedure

Booking Health specialists can take care of the arrangement of your trip abroad. We have extensive international experience in medical tourism. We will provide the necessary information, make arrangements with the hospital, solve all the issues instead of you and support you during your stay in another country. We offer the following services and benefits:

• Selection of the Neurosurgery Hospital in Israel, doctors in which have sufficient and successful experience in the treatment of facial nerve neuroma
• Making an appointment for surgery on the most suitable dates for you
• Reduced cost of treatment – the prices for medical services will be reduced due to exclusion of additional coefficients for foreign patients
• Direct communication with the doctor
• Information about the prices, costs of medical procedures, return of unspent funds after the completion of the program
• Preparation of a medical program without the need to repeat previously performed diagnostic tests
• Buying and forwarding medicines
• Communication with the hospital after treatment completion
• Organization of additional diagnostics, treatment or rehabilitation

Booking Health specialists provide high-quality services. We will take care about booking a hotel and airline tickets for you, as well as about meeting you at the airport and taking you to the hospital by car.