Predictive Factors of Early Postoperative and Long-Term Facial Nerve Function After Large Vestibular Schwannoma Surgery

Objectives This study aimed at evaluating facial nerve outcomes in vestibular schwannoma patients presenting with preoperative facial nerve palsy. Design A retrospective review. Setting Single-institution cohort. Participants Overall, 368 consecutive patients underwent vestibular schwannoma resection. Patients with prior microsurgery or radiosurgery were excluded. Main Outcome Measures Incidence, House–Brackmann grade. Results Of 368 patients, 9 had confirmed preoperative facial nerve dysfunction not caused by prior treatment, for an estimated incidence of 2.4%. Seven of these nine patients had Koos grade 4 tumors. Mean tumor diameter was 3.0 cm (range: 2.1–4.4 cm), and seven of nine tumors were subtotally resected. All nine patients were followed up clinically for ≥ 6 months. Of the six patients with a preoperative House–Brackmann grade of II, two improved to grade I, three were stable, and one patient worsened to grade III. Of the three patients with grade III or worse, all remained stable at last follow-up. Conclusions Preoperative facial nerve palsy is rare in patients with vestibular schwannoma; it tends to occur in patients with relatively large lesions. Detailed long-term outcomes of facial nerve function after microsurgical resection for these patients have not been reported previously. We followed nine patients and found that eight (89%) of the nine patients had either stable or improved facial nerve outcomes after treatment. Management strategies varied for these patients, including rates of subtotal versus gross-total resection and the use of stereotactic radiosurgery in patients with residual tumor. These results can be used to help counsel patients preoperatively on expected outcomes of facial nerve function after treatment.

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Preservation of Facial Nerve Function after Postoperative Vasoactive Treatment in Vestibular Schwannoma Surgery

Neurosurgery ◽

10.1227/01.neu.0000230260.95477.0a ◽

2006 ◽

Vol 59 (3) ◽

pp. 577-584 ◽

Cited By ~ 43

Author(s):

Christian Strauss ◽

Johann Romstöck ◽

Rudolf Fahlbusch ◽

Stefan Rampp ◽

Christian Scheller

Keyword(s):

Facial Nerve ◽

Hydroxyethyl Starch ◽

Vestibular Schwannoma ◽

Complete Recovery ◽

Potential Effect ◽

Long Term Results ◽

Nerve Function ◽

Facial Nerve Function ◽

Before And After

Abstract OBJECTIVE: Facial nerve paresis and hearing loss are common complications after vestibular schwannoma surgery. Experimental and clinical studies point to a beneficial effect of nimodipine and hydroxyethyl starch for preservation of cochlear nerve function. A retrospective analysis was undertaken to evaluate the effect of vasoactive treatment on facial nerve outcome. PATIENTS AND METHODS: Forty-five patients with vestibular schwannoma removal, intraoperative electromyographic monitoring, and postoperative deterioration of facial nerve function were evaluated. Twenty-five patients underwent vasoactive treatment consisting of nimodipine and hydroxyethyl starch for improvement of hearing outcome. Twenty patients did not receive such treatment. Facial nerve function was evaluated before and after surgery, as well as 1 year after the surgical procedure. Patients were comparable regarding age, tumor size, and preoperative facial nerve function. RESULTS: Long-term results of facial nerve function were significantly improved in those patients who experienced severe postoperative deterioration of facial nerve function and received vasoactive treatment as compared with patients who did not receive nimodipine and hydroxyethyl starch after surgery. Treated patients showed a significantly higher rate of complete recovery compared with patients without treatment. CONCLUSION: The study points to a potential effect of vasoactive treatment for facial nerve function after vestibular schwannoma surgery. In particular, patients with postoperative disfiguring facial nerve palsy clearly benefit from intravenous hydroxyethyl starch and nimodipine with respect to a long-term socially acceptable facial nerve function.

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Surgery for sporadic vestibular schwannoma. Part IV. Predictive factors influencing facial nerve function after surgery

Neurologia i Neurochirurgia Polska ◽

10.1016/j.pjnns.2015.11.006 ◽

2016 ◽

Vol 50 (1) ◽

pp. 36-44 ◽

Cited By ~ 5

Author(s):

Przemysław Kunert ◽

Tomasz Dziedzic ◽

Anna Podgórska ◽

Arkadiusz Nowak ◽

Tomasz Czernicki ◽

...

Keyword(s):

Facial Nerve ◽

Vestibular Schwannoma ◽

Predictive Factors ◽

Nerve Function ◽

Facial Nerve Function ◽

Factors Influencing

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Pre-operative and per-operative factors conditioning long-term facial nerve function in vestibular schwannoma surgery through translabyrinthine approach

The Journal of Laryngology & Otology ◽

10.1017/s0022215100140733 ◽

1998 ◽

Vol 112 (5) ◽

pp. 441-445 ◽

Cited By ~ 15

Author(s):

Olivier Deguine ◽

André Maillard ◽

Alain Bonafe ◽

Hassan El Adouli ◽

Michel Tremoulet ◽

...

Keyword(s):

Facial Nerve ◽

Vestibular Schwannoma ◽

Internal Auditory Canal ◽

Stage Iv ◽

Nerve Function ◽

Facial Nerve Function ◽

Stimulation Threshold ◽

Translabyrinthine Approach ◽

Facial Function

AbstractFacial nerve function was evaluated in 103 patients, after vestibular schwannoma removal through the translabyrinthine approach. The mean follow-up was 43 months (minimum six months). Grade I facial function was achieved in 100 per cent of stage I schwannomata compared with 36 per cent of stage IV schwannomata. Grade I or II facial function was found in 78 per cent of homogeneous schwannomata, compared with 48 per cent of heterogeneous schwannomata. Facial function was preserved in 89 per cent of cases, if the angle between the internal auditory canal and the schwannoma was >66°, compared with 54 per cent if the angle was <66°. There was 82 per cent of normal facial function when the nerve appeared normal after tumour removal, compared with 18 per cent when the nerve was traumatized. When the ratio (stimulation threshold at the internal auditory canal/stimulation threshold at brainstem) was <2, postoperative facial function was preserved in 87 per cent of cases, compared with 13 per cent when the ratio was >2.

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Long-term facial nerve function following facial reanimation after translabyrinthine vestibular schwannoma surgery: A comparison between sural grafting and VII–XII anastomosis

Experimental and Therapeutic Medicine ◽

10.3892/etm.2013.1120 ◽

2013 ◽

Vol 6 (1) ◽

pp. 101-104 ◽

Cited By ~ 10

Author(s):

ZHAOYAN WANG ◽

ZHIHUA ZHANG ◽

QI HUANG ◽

JUN YANG ◽

HAO WU

Keyword(s):

Facial Nerve ◽

Vestibular Schwannoma ◽

Nerve Function ◽

Facial Nerve Function ◽

Facial Reanimation

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An Evidence-Based Vestibular Schwannoma Surgical Outcome Grading Scale for Large-to-Giant Vestibular Schwannomas

10.21203/rs.3.rs-1167597/v1 ◽

2021 ◽

Author(s):

Nida Fatima ◽

Gregory P. Lekovic

Keyword(s):

Facial Nerve ◽

Vestibular Schwannoma ◽

Extent Of Resection ◽

Subtotal Resection ◽

Grading System ◽

Nerve Function ◽

Facial Nerve Function ◽

Total Resection ◽

Mesh Terms ◽

Large Vestibular Schwannoma

Abstract Objectives: The objective of this study was to determine the relationship between facial nerve function and extent of resection (EOR) as outcomes in the surgical management of large vestibular schwannoma (VS) (≥ 2.5 cm maximal) and evaluate use of a new grading system that incorporates both outcomes.Methods: We conducted a systematic review of the electronic databases using different MeSH terms from 1990 to 2021. 5,623 patients from 56 studies were found appropriate for inclusion in the study. Surgical approach was reported in 5,144 patients, including translabyrinthine approach (TL) in 43.3% (n=2,225), retrosigmoid (RS) approach in 56.3% (n=2,899), retrolabyrinthine (RL) approach in 0.3% (n=16), and extended translabyrinthine (EX) approach in 0.1% (n=4). The proposed VS Grading System defines outcomes of gross total resection (GTR), near total resection (NTR) and subtotal resection (STR) with good facial nerve function [House-Brackmann (HB) Grade I-II] as Classes A, B and C respectively. Those with poor facial nerve outcome (HB III-VI) are graded as Classes D, E and F, respectively. Results:. As expected, patients with STR had a higher likelihood of better facial nerve outcomes (HB I-II) compared to NTR [Odds Ratio (OR): 7.30, 95%CI: 2.45-12.1, p=0.004] and GTR (OR: 9.61, 95%CI: 3.61-15.6, p=0.002), while NTR had better facial nerve outcome than GTR (OR: 1.5, 95%CI: 1.14-4.6, p<0.0001). A Class A result, representing the best possible outcome, was obtained in 55.8% of TL vs. 49.4% undergoing RS approach. Conclusion: Complete surgical resection with preservation of facial nerve function is the gold standard for large VS.

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Long-term facial nerve clinical evaluation following vestibular schwannoma surgery

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2008000200010 ◽

2008 ◽

Vol 66 (2a) ◽

pp. 194-198 ◽

Cited By ~ 15

Author(s):

Rafaela Julia Batista Veronezi ◽

Yvens Barbosa Fernandes ◽

Guilherme Borges ◽

Ricardo Ramina

Keyword(s):

Facial Nerve ◽

Vestibular Schwannoma ◽

Tumor Size ◽

Nerve Function ◽

Facial Nerve Function ◽

Significant Difference ◽

Long Term Follow Up ◽

Facial Function

BACKGROUND: Facial function is important in accompaniment of patients operated on vestibular schwannoma (VS). OBJETIVE: To evaluate long term facial nerve function in patients undergoing VS resection and to correlate tumor size and facial function in a long-term follow-up. METHOD: Transversal study of 20 patients with VS operated by the retrosigmoid approach. House-Brackmann Scale was used preoperatively, immediately after surgery and in a long-term follow-up. Student t test was applied for statistic analysis. RESULTS: In the immediate postoperative evaluation, 65% of patients presented FP of different grades. Improvement of facial nerve function (at least of one grade) occurred in 53% in the long-term follow-up. There was statistically significant difference in facial nerve outcome in long-term follow-up when tumor size was considered (p<0.05). Conclusion: The majority of patients had improvement of FP in a long-term follow-up and tumor size was detected to be a factor associated with the postoperative prognostic.

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Delayed Facial Nerve Paralysis after Vestibular Schwannoma Resection

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0038-1669941 ◽

2018 ◽

Vol 80 (03) ◽

pp. 283-286

Author(s):

Robert J. Yawn ◽

Matthew M. Dedmon ◽

Deborah Xie ◽

Reid C. Thompson ◽

Matthew R. O'Malley ◽

...

Keyword(s):

Facial Nerve ◽

Surgical Resection ◽

Vestibular Schwannoma ◽

Retrospective Chart Review ◽

Facial Nerve Paralysis ◽

Nerve Function ◽

Facial Nerve Function ◽

Nerve Paralysis ◽

The Mean

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.

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