Preoperative Facial Nerve Palsy in Patients With Vestibular Schwannoma: Clinical Features and Postoperative Functional Prognosis in a Case Series of 34 Among 1228 Consecutive Patients

AbstractObjectiveThis study aimed to investigate the possible association between recurrent facial nerve palsy and migraines.MethodThis study was a prospective case series with a two-year follow-up at an academic, tertiary referral centre and included patients with at least four episodes of recurrent lower motor neuron facial nerve palsy. All patients underwent standardised diagnostic tests.ResultsFour patients fulfilled the inclusion criteria. The patients were all female with an average age at presentation of 40.75 years (range, 33–60 years) and an average age at the initial episode of 14 years (range, 12–16 years). The number of episodes varied between six and nine. All patients had at least one episode of facial nerve palsy on the contralateral side. Two patients were diagnosed and treated for migraine with aura remaining asymptomatic following prophylactic medication for migraines.ConclusionThe results raise the possibility of an association between recurrent facial nerve palsy and migraines. Prospective studies in patients with even fewer episodes of facial nerve palsy could shed more light on this association.

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27. Facial nerve palsy after vestibular schwannoma surgery: Dynamic risk-stratification based on continuous EMG-monitoring

Clinical Neurophysiology ◽

10.1016/j.clinph.2013.12.030 ◽

2014 ◽

Vol 125 (5) ◽

pp. e21

Author(s):

Julian Prell ◽

Christian Strauss ◽

Stefan Rampp

Keyword(s):

Risk Stratification ◽

Facial Nerve ◽

Vestibular Schwannoma ◽

Nerve Palsy ◽

Facial Nerve Palsy ◽

Dynamic Risk

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Facial Nerve Palsy in COVID-19-Associated Mucormycosis Patients: A Case Series

Cureus ◽

10.7759/cureus.19208 ◽

2021 ◽

Author(s):

Rupa Mehta ◽

Nitin M Nagarkar ◽

Krishna Sasanka KSBS ◽

Sree Sudha TY ◽

Ripu Daman Arora ◽

...

Keyword(s):

Facial Nerve ◽

Nerve Palsy ◽

Facial Nerve Palsy ◽

Case Series

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

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0037-1607320 ◽

2017 ◽

Vol 79 (03) ◽

pp. 309-313 ◽

Cited By ~ 1

Author(s):

Michael Mooney ◽

Benjamin Hendricks ◽

Christina Sarris ◽

Robert Spetzler ◽

Randall Porter ◽

...

Keyword(s):

Facial Nerve ◽

Vestibular Schwannoma ◽

Nerve Palsy ◽

Facial Nerve Palsy ◽

Tumor Diameter ◽

Nerve Function ◽

Facial Nerve Function ◽

Microsurgical Resection ◽

Grade Iii

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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Nervus intermedius dysfunctions after vestibular schwannoma surgery: a prospective clinical study

Journal of Neurosurgery ◽

10.3171/2018.4.jns1818 ◽

2019 ◽

Vol 131 (2) ◽

pp. 555-560 ◽

Cited By ~ 1

Author(s):

Hussam Metwali ◽

Katja Kniese ◽

Babak Kardavani ◽

Venelin Gerganov ◽

Madjid Samii

Keyword(s):

Facial Nerve ◽

Prospective Study ◽

Vestibular Schwannoma ◽

Nerve Palsy ◽

Facial Nerve Palsy ◽

Nasal Secretion ◽

Prospective Clinical Study ◽

Taste Sensation ◽

Nervus Intermedius

OBJECTIVEThe purpose of this prospective study was to evaluate the dysfunction of the nervus intermedius (NI) after vestibular schwannoma (VS) surgery. The authors present a clinically feasible method for this purpose.METHODSIn this prospective study, the authors included 30 patients who underwent surgery at the International Neuroscience Institute between May 2014 and February 2017 for resection of VS. The patients’ taste sensation was examined using taste strips. Lacrimation was tested using the Schirmer I test. The clinical evaluation was performed before surgery and repeated at 2 weeks and at 6 months after surgery as well as during the follow-up, which extended up to 2 years. The authors tested the correlation between the NI dysfunctions and the House-Brackmann grade of facial nerve palsy.RESULTSThe taste sensation was lost on the side of surgery in 2 patients (6.6%) and decreased in 4 patients (13.3%). The disturbance of taste sensation was not statistically correlated with dysfunctions of the motor portion of the facial nerve. The taste impairment resolved in 4 patients within 6 months, but 2 patients suffered from persistent loss of the taste sensation on the side of surgery during the follow-up. In 23 patients (76.6%), the baseline lacrimation was lower on the side of surgery, and it was significantly correlated with outcome for dysfunctions of the motor portion of the facial nerve. During the follow-up, baseline lacrimation improved in correlation with the improvement in the dysfunctions of the motor portion of the facial nerve. None of the patients reported change in salivation or nasal secretion.CONCLUSIONSThe NI can be affected after VS surgery. The disturbance of baseline lacrimal secretion was correlated with dysfunctions of the motor portion of the facial nerve. However, the disturbance of the taste sensation was not correlated with the grade of facial nerve palsy. Dysfunctions of the NI should be evaluated and separately reported while analyzing facial nerve outcome after VS surgery.

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Ophthalmologic Clinical Features of Facial Nerve Palsy Patients

Korean Journal of Ophthalmology ◽

10.3341/kjo.2018.0010 ◽

2019 ◽

Vol 33 (1) ◽

pp. 1 ◽

Cited By ~ 1

Author(s):

Seunghyun Lee ◽

Helen Lew

Keyword(s):

Facial Nerve ◽

Clinical Features ◽

Nerve Palsy ◽

Facial Nerve Palsy

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Applicability of contemporary quality indicators in vestibular surgery—do they accurately measure tumor inherent postoperative complications of vestibular schwannomas?

Acta Neurochirurgica ◽

10.1007/s00701-021-05044-2 ◽

2021 ◽

Author(s):

Stephanie Schipmann ◽

Sebastian Lohmann ◽

Bilal Al Barim ◽

Eric Suero Molina ◽

Michael Schwake ◽

...

Keyword(s):

Nosocomial Infection ◽

Facial Nerve ◽

Hearing Impairment ◽

Quality Indicators ◽

Vestibular Schwannoma ◽

Nerve Palsy ◽

Facial Nerve Palsy ◽

Care Delivery ◽

Csf Leak ◽

Neurosurgical Procedures

Abstract Background Due to rising costs in health care delivery, reimbursement decisions have progressively been based on quality measures. Such quality indicators have been developed for neurosurgical procedures, collectively. We aimed to evaluate their applicability in patients that underwent surgery for vestibular schwannoma and to identify potential new disease-specific quality indicators. Methods One hundred and three patients operated due to vestibular schwannoma were subject to analysis. The primary outcomes of interest were 30-day and 90-day reoperation, readmission, mortality, nosocomial infection and surgical site infection (SSI) rates, postoperative cerebral spinal fluid (CSF) leak, facial, and hearing function. The secondary aim was the identification of prognostic factors for the mentioned primary outcomes. Results Thirty-day (90-days) outcomes in terms of reoperation were 10.7% (14.6%), readmission 9.7% (13.6%), mortality 1% (1%), nosocomial infection 5.8%, and SSI 1% (1%). A 30- versus 90-day outcome in terms of CSF leak were 6.8% vs. 10.7%, new facial nerve palsy 16.5% vs. 6.1%. Hearing impairment from serviceable to non-serviceable hearing was 6.8% at both 30- and 90-day outcome. The degree of tumor extension has a significant impact on reoperation (p < 0.001), infection (p = 0.015), postoperative hemorrhage (p < 0.001), and postoperative hearing loss (p = 0.026). Conclusions Our data demonstrate the importance of entity-specific quality measurements being applied even after 30 days. We identified the occurrence of a CSF leak within 90 days postoperatively, new persistent facial nerve palsy still present 90 days postoperatively, and persisting postoperative hearing impairment to non-serviceable hearing as potential new quality measurement variables for patients undergoing surgery for vestibular schwannoma.

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