Long-Term Facial Nerve Outcomes after Microsurgical Resection of Vestibular Schwannomas in Patients with Preoperative Facial Nerve Palsy

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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Delayed facial nerve palsy after vestibular schwannoma surgery

JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA ◽

10.22290/jbnc.v20i1.727 ◽

2018 ◽

Vol 20 (1) ◽

pp. 84-88

Author(s):

Walter J. Fagundes Pereyra ◽

Alonso Luis De Sousa ◽

Karlo Faria Nunes ◽

Deborah Nunes De Angeli

Keyword(s):

Facial Nerve ◽

Vestibular Schwannoma ◽

Nerve Palsy ◽

Facial Nerve Palsy ◽

Surgical Removal ◽

Electromyographic Activity ◽

Immunological Study ◽

Nerve Function ◽

Facial Nerve Function ◽

Nerve Dysfunction

Background: Facial nerve dysfunction may occur immediately after vestibular schwanoma surgery. Electromyographyc monitoring of motor cranial nerves during cerebellopontine angle surgery has become an essential tool. Although delayed onset of facial nerve dysfunction hours to months following vestibular schwanoma surgery are rare. Case description: We describe the case of a 70-years-old male who was admitted with a left side tinnitus and hearing loss of the last 3 years. Magnetic resonance imaging (MRI) T1-weighted demonstrated an isointensity lesion, 30mm in diameter, at the left cerebello-pontine angle with a small portion in the internal auditory canal. The patient was surgically treated by means of a standart suboccipital retrosigmoid approach. The facial nerve was monitored by continuously during surgery. Surgical removal was macroscopically complete. The facial nerve was well-preserved during surgery and showed at the end of the procedure normal electromyographic activity. The patient did well postoperatively and was discharged at the 4th postoperative day and facial function was normal (House-Brackmann grade I). On the 10th postoperative day he notices difficult closing his left eye that progressed to complete facial nerve palsy (House-Brackmann grade III). Steroid therapy was performed for five days associated with physical therapy. One month later his facial nerve function had completely recovered. After six months, the patient remains asymptomatic and neurologically intact. MRI obtained at the 16th postoperative day showed intense enhancement of the intracranial facial nerve segment and also demonstrated no residual tumor. Immunological study at the time of onset showed herpes simplex virus antibody titer normal as well as those for herpes zoster virus. Conclusions: Delayed facial nerve palsy remains an under reported and consequently not very known phenomenon in the neurosurgical practice and literature. Because of the 2009favorable rate of recovery, patients should be reassured in the interim and should not undergo any corrective surgical procedures to improve facial nerve function. Delayed facial nerve palsy is uncommon after vestibular schwannoma surgery. Excellent recovery of facial nerve function to the original postoperative status nearly always occurs in those circumstances.

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Predicting recovery of facial nerve function following injury from a basilar skull fracture

Journal of Neurosurgery ◽

10.3171/jns.1991.75.5.0759 ◽

1991 ◽

Vol 75 (5) ◽

pp. 759-762 ◽

Cited By ~ 15

Author(s):

Andrew B. Adegbite ◽

Moe I. Khan ◽

L. Tan

Keyword(s):

Facial Nerve ◽

Nerve Palsy ◽

Facial Nerve Palsy ◽

Recovery Of Function ◽

Statistical Significance ◽

Complete Recovery ◽

Partial Recovery ◽

Nerve Function ◽

Facial Nerve Function ◽

Partial Lesion

✓ Twenty-five patients with posttraumatic facial nerve palsy were studied. Partial recovery of function had occurred in 95% of these patients by 18 months after injury. At 5 months posttrauma, there was some recovery in 92.5% of those with a partial lesion compared with 10% of those with a complete lesion. This difference attains statistical significance. Complete recovery of nerve function had occurred by 10.5 months in 53.5% of the patients; in 62% of patients with a partial lesion, complete recovery had occurred by 4 months compared with 0% in those with a complete lesion. This difference also attains statistical significance. There was no statistically significant difference in recovery of function between patients with an immediate as opposed to a delayed onset of facial nerve palsy. It was determined that the degree of palsy had a statistically significant influence on recovery of facial nerve function, whereas the time of onset did not. The data presented support a conservative approach to these injuries and it is recommended that the possibility of surgical treatment should be entertained in patients with complete facial palsy persisting for 12 to 18 months after injury.

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

World Neurosurgery ◽

10.1016/j.wneu.2019.03.218 ◽

2019 ◽

Vol 127 ◽

pp. e599-e608 ◽

Cited By ~ 5

Author(s):

Lucas Troude ◽

Mohamed Boucekine ◽

Marion Montava ◽

Jean-Pierre Lavieille ◽

Jean-Marie Régis ◽

...

Keyword(s):

Facial Nerve ◽

Vestibular Schwannoma ◽

Predictive Factors ◽

Nerve Function ◽

Facial Nerve Function ◽

Large Vestibular Schwannoma

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Idiopatic facial nerve palsy in pregnancy – facts and myths

Polski Przegląd Otorynolaryngologiczny ◽

10.5604/01.3001.0012.1466 ◽

2018 ◽

Vol 7 (1) ◽

pp. 1-5

Author(s):

Anna Rzepakowska ◽

K Rybak ◽

Kazimierz Niemczyk ◽

P Rybak

Keyword(s):

Facial Nerve ◽

Pregnant Women ◽

Nerve Palsy ◽

Facial Nerve Palsy ◽

Age Group ◽

Nerve Function ◽

Facial Nerve Function ◽

Facial Paresis ◽

Proven Efficacy ◽

Bell Palsy

Idiopathic facial nerve palsy, called also Bell palsy, can be a challenge for clinicians if a pregnant woman reports symptoms of facial paresis. The incidence of Bell's paralysis in pregnant women is almost three times higher than in the non-pregnant women's age group. The problem is the lack of guidelines for the treatment of idiopatic facial nerve palsy in this group of patients. In randomized studies, but without participation of pregnant women, greater efficacy was found in the return of nerve function after early treatment with corticosteroids than with other methods. The dilemma concerning therapy is intensified by the fact that the prognosis regarding the return of facial nerve function in pregnant women is significantly worse than in the remaining population and the weakness of facial muscles is yet diagnosed in a young woman. In the article we present the example of a patient consulted in our department and the review of current literature. We introduce recommendations for the treatment of pregnant women with facial nerve palsy. There are discussed benefits, advised medicines, doses, necessary precautions and potential side effects of corticosteroids, which are the only ones that have proven efficacy in the treatment of Bell's paralysis in pregnant women.

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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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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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Facial nerve function after vestibular schwannoma surgery

Journal of Neurosurgery ◽

10.3171/2011.5.jns101597 ◽

2011 ◽

Vol 115 (4) ◽

pp. 820-826 ◽

Cited By ~ 54

Author(s):

Maurizio Falcioni ◽

Paolo Fois ◽

Abdelkader Taibah ◽

Mario Sanna

Keyword(s):

Facial Nerve ◽

Vestibular Schwannoma ◽

Tumor Size ◽

Middle Cranial Fossa ◽

Optimal Size ◽

Tumor Diameter ◽

Nerve Function ◽

Facial Nerve Function ◽

Tumor Removal ◽

Total Tumor Removal

Object The object of this study was to evaluate long-term postoperative facial nerve (FN) function in patients undergoing vestibular schwannoma (VS) surgery. Methods The authors retrospectively reviewed the clinical course of patients affected by isolated VSs with normal preoperative FN function, with no previous surgical or radiotherapeutic treatment, and who underwent surgery between 1987 and 2007. Facial nerve function was clinically evaluated according to the House-Brackmann (HB) scale. The minimum postoperative follow-up was 12 months. Results Among the 1550 patients surgically treated at the authors' center, 1151 matched inclusion criteria for the present study. The FN was anatomically interrupted in 48 cases (4.2%), and 51 patients (4.4%) underwent subtotal tumor removal and were considered separately. Among the 1052 patients with anatomically preserved FNs and total tumor removal, 684 (65%) enjoyed postoperative HB Grade I or II and 309 (29.4%) enjoyed Grade III, with the remaining 59 cases (5.6%) suffering unsatisfactory results (HB Grades IV–VI). As expected, FN function results deteriorated in cases of larger tumors. Conclusions The main factor influencing postoperative FN function was tumor size. Although there was a progressive deterioration in FN function outcome in relation to tumor size, a cutoff point between satisfactory and unsatisfactory results could be identified at around 2 cm in maximum extrameatal tumor diameter, with the “optimal size” for surgery identified at < 1 cm. This finding emphasizes the importance of an early diagnosis and should be kept in mind when selecting the correct timing for VS removal. For small lesions, the results following a middle cranial fossa approach were significantly worse as compared with those following the translabyrinthine and retrosigmoidretrolabyrinthine approaches.

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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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Predictive Factors of Long-term Facial Nerve Function after Vestibular Schwannoma Surgery

Otology & Neurotology ◽

10.1097/00129492-200205000-00027 ◽

2002 ◽

Vol 23 (3) ◽

pp. 388-392 ◽

Cited By ~ 37

Author(s):

John E. Fenton ◽

R. Y. Chin ◽

P. A. Fagan ◽

O. Sterkers ◽

J. M. Sterkers

Keyword(s):

Facial Nerve ◽

Vestibular Schwannoma ◽

Predictive Factors ◽

Nerve Function ◽

Facial Nerve Function

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Traumatic facial nerve palsy: evaluation and surgical management

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20202209 ◽

2020 ◽

Vol 6 (6) ◽

pp. 1111

Author(s):

Chaitry K. Shah ◽

Shalu Gupta ◽

Bela J. Prajapati ◽

Devang P. Gupta ◽

Viral Prajapati

Keyword(s):

Facial Nerve ◽

Surgical Management ◽

Facial Palsy ◽

Nerve Palsy ◽

Facial Nerve Palsy ◽

Cranial Nerves ◽

Surgical Decompression ◽

Nerve Function ◽

Good Recovery ◽

Facial Nerve Function

Background: Acute facial paralysis can result from various causes, among which intra temporal facial palsy is relatively common. Of all the cranial nerves, the facial nerve is most susceptible to injury due to its long course within the skull. Diagnosis of facial palsy is usually made by a good clinical history, examination and radiological investigations. Electrophysiological tests are important for prognosis and optimal time for surgery. The aim is to study the evaluation and surgical management in traumatic cause of facial nerve palsy.Methods: This prospective cross-sectional study was carried out in 50 patients presented with facial nerve palsy due to trauma in civil hospital Ahmedabad over a period of 1 year from May 2018 to 2019. Patients were examined and graded using House and Brackmann grading system. All the patients were evaluated and treated by surgical decompression. Follow up was carried out upto 6 months. Results: The cause of facial nerve palsy in all 50 patients was accidental head trauma. All the patients were managed by surgical decompression. 46 out of 50 patients managed surgically had good recovery with restoration of complete facial nerve function. 4 out 50 patients had poor recovery due to late presentation. Conclusions: Early initiation of treatment is important for favorable recovery of facial nerve function after trauma. Surgical treatment is indicated in suspected bony impingement of nerve. Surgical decompression if done early usually results in very good recovery.

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