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J Neurol Surg B Skull Base
DOI: 10.1055/a-2724-4037
Original Article

The Price of Paralysis: Analyzing the Direct Cost of Facial Rehabilitation after Vestibular Schwannoma Resection

Authors

  • Robert J. Macielak

    1   Department of Otolaryngology–Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States

  • Micah K. Harris

    2   Department of Otolaryngology–Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States

  • Vivian F. Kaul

    3   Department of Otorhinolaryngology–Head and Neck Surgery, The University of Texas Health Science Center at Houston, Houston, Texas, United States

  • Leslie R. Kim

    1   Department of Otolaryngology–Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States

  • Shana McGrath

    4   Outpatient Rehabilitation, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States

  • Desi P. Schoo

    1   Department of Otolaryngology–Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States

  • Kyle C. Wu

    5   Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States

  • Edward E. Dodson

    1   Department of Otolaryngology–Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States

  • Daniel M. Prevedello

    5   Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States

  • Oliver F. Adunka

    1   Department of Otolaryngology–Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States

  • Yin Ren

    1   Department of Otolaryngology–Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States

Funding Information This study was performed without commercial sponsorship or support.
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Abstract

Objective

To estimate the direct costs associated with facial nerve rehabilitation for patients with facial paralysis after vestibular schwannoma (VS) resection.

Study Design

Retrospective cohort study.

Setting

Academic tertiary referral center.

Participants

Patients treated sequentially between September 2016 and May 2021 who experienced any degree of facial nerve dysfunction after VS resection and received rehabilitative interventions.

Main Outcome Measure

Estimated costs calculated based on institutional billing data.

Results

A total of 15 patients (67% female, median age at surgery of 56 years) were identified. Of the patients 14 (93%) had tumors with cerebellopontine angle extension, with a median size of 20.7 mm (interquartile range [IQR] 13.8–23.5). The median House-Brackmann (HB) grade immediately after surgery was 6 (IQR 3–6), and the median HB grade at most recent evaluation was 5 (IQR 4–6) with a median follow-up of 29 months (IQR 17–44). A total of 11 patients (73%) underwent periocular procedures; 4 (27%) underwent extensive rehabilitative surgeries, including nerve transfer and static sling procedures; 5 (33%) underwent chemodenervation therapy; and 9 (60%) performed facial retraining therapy with treatment being initiated at a median of 6.2 months (IQR 3.2–9.3) after surgery. The median cost for all patients was $3,125 (IQR $1,120–14,843), with the median cost of extensive rehabilitative surgery being $15,970 (IQR $14,907–29,289).

Conclusion

The median cost associated with facial rehabilitation is relatively low at $3,125; however, this amount varies based on the type of procedures pursued and individual need. Ultimately, a dedicated team of specialists is required to appropriately manage postoperative facial dysfunction in a cost-effective manner.

Keywords

vestibular schwannoma - microsurgery - facial rehabilitation - cost

Ethical Approval

The Ohio State University IRB Protocol #2019H0363.


Note

This study was presented as a poster at the American Academy of Otolaryngology–Head and Neck Surgery 2024 Annual Meeting and Oto Expo on September 30, 2024 in Miami, FL.


Supplementary Material



Publication History

Received: 28 July 2025

Accepted: 13 October 2025

Accepted Manuscript online:
17 October 2025

Article published online:
31 October 2025

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