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J Neurol Surg B Skull Base
DOI: 10.1055/a-2587-6401
Original Article

Incidence and Prognosis of Delayed Facial Nerve Palsy After Vestibular Schwannoma Resection: Systematic Review and Meta-analysis

Authors

  • Ashton Huppert Steed

    1   University of Arizona College of Medicine–Phoenix, Phoenix, Arizona, United States

  • Katherine Riordan

    2   University of Arizona College of Medicine–Tucson, Tucson, Arizona, United States

  • Melissa Papuc

    1   University of Arizona College of Medicine–Phoenix, Phoenix, Arizona, United States

  • Alma Jukic

    1   University of Arizona College of Medicine–Phoenix, Phoenix, Arizona, United States

  • Kory A. Johnson

    3   Translational Research Office Biostatistics and Study Design Services, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, United States

  • Annie Pico

    1   University of Arizona College of Medicine–Phoenix, Phoenix, Arizona, United States

  • Mazen Zaher

    4   Department of Neurosurgery, Banner University Medical Center, Phoenix, Arizona, United States

  • Pedro Aguilar-Salinas

    5   Department of Neurosurgery, Banner University Medical Center, Tucson, Arizona, United States

  • Peter Nakaji

    4   Department of Neurosurgery, Banner University Medical Center, Phoenix, Arizona, United States
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Abstract

Objective

Delayed facial nerve palsy (DFNP) is a complication of microsurgical resection of vestibular schwannoma (VS). This study aims to clarify the definition and incidence of DFNP, as well as evaluate long-term CNVII prognosis in affected patients.

Databases Reviewed

PubMed, Embase, and Scopus databases.

Methods

A systematic literature search was conducted according to Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Full-text publications were included if they reported DFNP incidence, CNVII prognosis, demographic data, and how they defined DFNP.

Results

Ten studies with 2,122 patients who underwent surgical resection for VS were included. Meta-analysis demonstrated a mean incidence of DFNP of 13%, with a mean recovery to House–Brackmann (HB) I/II of 85%. Definitions of DFNP varied widely. Four studies utilized a broad definition of DFNP, without requiring any specific level of change in HB grade in the postoperative period. Two studies defined DFNP as deterioration of CNVII function by at least one HB grade, and an additional four studies defined DFNP as deterioration of CNVII function by at least two HB grades.

Conclusion

The prognosis of CNVII function after DFNP was favorable with 85% of patients regaining function to HB grade I/II within 12 months. Given the heterogeneity in definitions of DFNP, it remains challenging to determine the true incidence of DFNP after VS resection. Grading DFNP by degree of severity would improve studies of this entity. We propose utilizing a novel DFNP Severity Scale to more accurately track prognosis in patients with DFNP based on pre- and postoperative HB scores.

Level of Evidence

Level III—systematic review of nonrandomized cohort studies and retrospective reviews

Keywords

vestibular schwannoma - acoustic neuroma - facial nerve - lateral skull base - DFNP

Previous Presentation

The abstract of the study was presented as a poster at the Triological Society Combined Sections Meeting, January 25 to 27, 2024; West Palm Beach, Florida, United States.


Supplementary Material



Publication History

Received: 06 January 2025

Accepted: 13 April 2025

Article published online:
05 May 2025

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