Delayed Facial Nerve Paralysis after Vestibular Schwannoma Resection

Abstract

Objective To describe the incidence and clinical course of patients who develop delayed facial nerve paralysis (DFNP) after surgical resection of vestibular schwannoma.

Setting Tertiary skull base center.

Methods Retrospective chart review.

Results Two hundred and forty six consecutive patients, who underwent surgical resection for vestibular schwannoma at a single center between 2010 and 2015, were analyzed. Of these patients, 22 (8.9%) developed DFNP, defined here as deterioration of function by at least 2 House–Brackmann (HB) grades within 30 days in patients with immediate postoperative HB ≤ 3. The mean age of DFNP patients was 47.2 years (range: 17–67) and 16 (73%) were female. The mean tumor size in greatest dimension was 2.1 cm (range: 0.7–3.5 cm). At the conclusion of each case, the facial nerve stimulated at the brainstem. Mean immediate postoperative facial nerve function was HB 1.8 (range: 1–3). Average facial nerve function at the 3-week-postoperative visit was 4.4 (range: 2–6). In 1-year, 8 patients (36%) recovered HB 1 function, 10 patients (46%) recovered to HB 2, and 2 patients (9%) were HB 3. The remaining 2 patients did not recover function and were HB 6 at last follow-up. Initial postoperative facial nerve function (HB 1 or HB 2) was associated with improved recovery to normal (HB 1) function (p = 0.018).

Conclusion A majority of patients that develop delayed paralysis will recover excellent facial nerve function. Patients should be counseled; however, a small percentage of patients will not recover function long-term, despite having a previously functioning and anatomically intact nerve.

Keywords

vestibular schwannoma - acoustic neuroma - facial paralysis - skull base surgery - translabyrinthine - suboccipital - retrosigmoid - delayed facial paralysis

Institutional Review Board Approval

Vanderbilt University IRB 32 approval 171083.

Financial Material and Support

No funding to disclose.

• References

• 1 Prasad SC, Balasubramanian K, Piccirillo E. , et al. Surgical technique and results of cable graft interpositioning of the facial nerve in lateral skull base surgeries: experience with 213 consecutive cases. J Neurosurg 2018; 128 (02) 631-638
• 2 Yawn RJ, Wright HV, Francis DO, Stephan S, Bennett ML. Facial nerve repair after operative injury: Impact of timing on hypoglossal-facial nerve graft outcomes. Am J Otolaryngol 2016; 37 (06) 493-496
• 3 Li Q, Jia Y, Feng Q. , et al. Clinical features and outcomes of delayed facial palsy after head trauma. Auris Nasus Larynx 2016; 43 (05) 514-517
• 4 Tripathi PB, Floriolli D, Caughlin BP. Delayed facial nerve paralysis following blast trauma. Facial Plast Surg 2017; 33 (01) 116-118
• 5 Gaudin RA, Remenschneider AK, Phillips K. , et al. Facial palsy after dental procedures - Is viral reactivation responsible?. J Craniomaxillofac Surg 2017; 45 (01) 71-75
• 6 Manosalva RE, Dyckman D, Melzer JM. Delayed facial nerve palsy after open reduction of an isolated zygomaticomaxillary complex fracture. J Craniofac Surg 2016; 27 (04) e392-e394
• 7 Xu P, Liu W, Zuo W, Wang D, Wang H. Delayed facial palsy after tympanomastoid surgery: A report of 15 cases. Am J Otolaryngol 2015; 36 (06) 805-807
• 8 Magliulo G, D'Amico R, Di Cello P. Delayed facial palsy after vestibular schwannoma resection: clinical data and prognosis. J Otolaryngol 2003; 32 (06) 400-404
• 9 Franco-Vidal V, Nguyen DQ, Guerin J, Darrouzet V. Delayed facial paralysis after vestibular schwannoma surgery: role of herpes viruses reactivation--our experience in eight cases. Otol Neurotol 2004; 25 (05) 805-810
• 10 Scheller C, Strauss C, Fahlbusch R, Romstöck J. Delayed facial nerve paresis following acoustic neuroma resection and postoperative vasoactive treatment. Zentralbl Neurochir 2004; 65 (03) 103-107
• 11 Carlstrom LP, Copeland III WR, Neff BA, Castner ML, Driscoll CL, Link MJ. Incidence and risk factors of delayed facial palsy after vestibular schwannoma resection. Neurosurgery 2016; 78 (02) 251-255
• 12 Morton RP, Ackerman PD, Pisansky MT. , et al. Prognostic factors for the incidence and recovery of delayed facial nerve palsy after vestibular schwannoma resection. J Neurosurg 2011; 114 (02) 375-380
• 13 House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg 1985; 93 (02) 146-147
• 14 Sargent EW, Kartush JM, Graham MD. Meatal facial nerve decompression in acoustic neuroma resection. Am J Otol 1995; 16 (04) 457-464
• 15 Holliday MJ, Sampath P. Decompression of the labyrinthine segment of the facial nerve in acoustic neuroma surgery: a consideration for minimizing postoperative delayed facial nerve dysfunction. Neurosurg Focus 1998; 5 (03) e7
• 16 Scheller C, Richter HP, Engelhardt M, Köenig R, Antoniadis G. The influence of prophylactic vasoactive treatment on cochlear and facial nerve functions after vestibular schwannoma surgery: a prospective and open-label randomized pilot study. Neurosurgery 2007; 61 (01) 92-97 , discussion 97–98
• 17 Scheller C, Wienke A, Tatagiba M. , et al. Interobserver variability of the House-Brackmann facial nerve grading system for the analysis of a randomized multi-center phase III trial. Acta Neurochir (Wien) 2017; 159 (04) 733-738