Botulinum toxin for temporary corneal protection after surgery for vestibular schwannoma

Object High-grade postoperative facial nerve paresis after surgery for vestibular schwannoma with insufficient eye closure involves a risk for severe ocular complications. When conservative measurements are not sufficient, conventional invasive treatments include tarsorrhaphy and eyelid loading. In this study, injection of botulinum toxin into the levator palpebrae muscle was investigated as an alternative for temporary iatrogenic eye closure. Methods Injection of botulinum toxin was indicated by an interdisciplinary decision (neurosurgery and ophthalmology) in patients with a postoperative facial nerve paresis corresponding to a House-Brackmann Grade of IV or greater and documented abnormalities concerning corneal status such as keratopathia or conjunctival redness. Twenty-five IUs of botulinum toxin were injected transcutaneously and transconjunctivally. Results Six of 11 patients with high-grade paresis showed abnormal corneal findings in the early postoperative period. In 4 of these patients, botulinum toxin was injected; 1 patient declined the treatment, and in 1 patient it was not performed because of contralateral blindness. Temporary eye closure was achieved for 2 to 6 months in all cases. In all cases, facial nerve function had recovered sufficiently in terms of eye closure when the effect of botulinum toxin subsided. Conclusion The application of botulinum toxin for temporary iatrogenic eye closure is an excellent low-risk and temporary alternative to other invasive measures for the treatment of postoperative high-grade facial nerve paresis when the facial nerve is anatomically intact.

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Bell's palsy

InnovAiT Education and inspiration for general practice ◽

10.1177/17557380211046284 ◽

2021 ◽

Vol 14 (12) ◽

pp. 733-741

Author(s):

Frith Cull ◽

Holli Coleman

Keyword(s):

Facial Nerve ◽

Complete Recovery ◽

Rapid Onset ◽

Bell’S Palsy ◽

Bell's Palsy ◽

Ocular Complications ◽

The United Kingdom ◽

Common Diagnosis ◽

Nerve Paresis ◽

And Function

Bell's palsy is the term given to an idiopathic lower motor neurone facial nerve paresis or paralysis. It is of rapid onset, almost always unilateral, and may be associated with facial or retro-auricular pain or otalgia. It is the most common diagnosis associated with facial nerve palsy; a GP will see a case approximately every 2 years in practice in the United Kingdom. Early diagnosis and steroid treatment increase the likelihood of full recovery, whereas ocular complications can be prevented by lubricants and lid taping. Over 70% of patients recover within a year. Options to improve facial appearance and function, in those who do not experience a complete recovery, include surgery.

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Botulinum Toxin A Treatment for Patients with Periorbital Spasm after Facial Nerve Paresis

Journal of the Korean Ophthalmological Society ◽

10.3341/jkos.2011.52.8.910 ◽

2011 ◽

Vol 52 (8) ◽

pp. 910 ◽

Cited By ~ 1

Author(s):

Jae Yeun Lee ◽

Jong Seo Park ◽

Helen Lew

Keyword(s):

Botulinum Toxin ◽

Facial Nerve ◽

Botulinum Toxin A ◽

Toxin A ◽

Nerve Paresis

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Factors Associated With Facial Nerve Paresis Following Gamma Knife for Vestibular Schwannoma

Otology & Neurotology ◽

10.1097/mao.0000000000002401 ◽

2020 ◽

Vol 41 (1) ◽

pp. e83-e88 ◽

Cited By ~ 2

Author(s):

David K. Lerner ◽

Daniel Lee ◽

James G. Naples ◽

Jason A. Brant ◽

Douglas Bigelow ◽

...

Keyword(s):

Facial Nerve ◽

Gamma Knife ◽

Vestibular Schwannoma ◽

Factors Associated ◽

Nerve Paresis

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Hearing preservation in patients undergoing vestibular schwannoma surgery: comparison of middle fossa and retrosigmoid approaches

Journal of Neurosurgery ◽

10.3171/jns.1998.88.5.0840 ◽

1998 ◽

Vol 88 (5) ◽

pp. 840-845 ◽

Cited By ~ 87

Author(s):

Richard M. Irving ◽

Robert K. Jackler ◽

Lawrence H. Pitts

Keyword(s):

Facial Nerve ◽

Vestibular Schwannoma ◽

Small Sample Size ◽

Hearing Preservation ◽

Early Postoperative Period ◽

Small Sample ◽

T Test ◽

Middle Fossa ◽

Content Type ◽

Fine Print

Object. The goal of this retrospective study was to evaluate hearing preservation after surgery for vestibular schwannoma in which the middle fossa (MF) or retrosigmoid (RS) approaches were used. Hearing preservation in vestibular schwannoma surgery can be achieved by using either the MR or RS approach. Comparative outcome data between these approaches are lacking, and, as a result, selection has generally been determined by the surgeon's preference. Methods. The authors have compared removal of small vestibular schwannomas via MF and RS approaches with regard to hearing preservation and facial nerve function. The study group was composed of consecutively treated patients with vestibular schwannoma, 48 of whom underwent operation via an MF approach and 50 of whom underwent the same number of RS operations. Tumors were divided into size-matched groups. Hearing results were recorded according to the American Academy of Otolaryngology—Head and Neck Surgery criteria, and facial nerve outcome was recorded as the House—Brackmann grade. Overall, 26 (52%) of the patients treated via the MF approach achieved a Class B or better hearing result compared with seven (14%) of the RS group. Some hearing was preserved in 32 (64%) of the patients in the MF group and in 17 (34%) of the RS group. The results obtained by using the MF approach were superior for intracanalicular tumors (p = 0.009, t-test), and for tumors with a cerebellopontine angle (CPA) component measuring 0.1 to 1 cm (p = 0.006, t-test). For tumors in the CPA that were 1.1 to 2 cm in size, our data were inconclusive because of the small sample size. Facial weakness was seen more frequently after MF surgery in the early postoperative period, but results were equal at 1 year. Conclusions. The results of this study have demonstrated a more favorable hearing outcome for patients with intracanalicular tumors and tumors extending up to 1 cm into the CPA that were removed via the MF when compared with the RS approach.

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Train time as a quantitative electromyographic parameter for facial nerve function in patients undergoing surgery for vestibular schwannoma

Journal of Neurosurgery ◽

10.3171/jns.2007.106.5.826 ◽

2007 ◽

Vol 106 (5) ◽

pp. 826-832 ◽

Cited By ~ 69

Author(s):

Julian Prell ◽

Stefan Rampp ◽

Johann Romstöck ◽

Rudolf Fahlbusch ◽

Christian Strauss

Keyword(s):

Facial Nerve ◽

Vestibular Schwannoma ◽

Operative Procedure ◽

Automated Detection ◽

Nerve Function ◽

Facial Nerve Function ◽

Quantitative Parameter ◽

Time Intervals ◽

Nerve Paresis ◽

Free Running

Object The authors describe a quantitative electromyographic (EMG) parameter for intraoperative monitoring of facial nerve function during vestibular schwannoma removal. This parameter is based on the automated detection of A trains, an EMG pattern that is known to be associated with postoperative facial nerve paresis. Methods For this study, 40 patients were examined. During the entire operative procedure, free-running EMG signals were recorded in muscles targeted by the facial nerve. A software program specifically designed for this purpose was used to analyze these continuous recordings offline. By automatically adding up time intervals during which A trains occurred, a quantitative parameter was calculated, which was named “train time.” A strong correlation between the length of train time (measured in seconds) and deterioration of postoperative facial nerve function was demonstrated. Certain consecutive safety thresholds at 0.5 and 10 seconds were defined. Their transgression reliably indicated postoperative facial nerve paresis. At less than a 10-second train time, discrete worsening, and at more than 10 seconds, profound deterioration of facial nerve function can be anticipated. Conclusions Train time as a quantitative parameter was shown to be a reliable indicator of facial nerve paresis after surgery for vestibular schwannoma.

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Vestibular Schwannoma with Contralateral Facial Nerve Palsy: A False Localizing Sign

Indian Journal of Neurosurgery ◽

10.1055/s-0037-1602753 ◽

2017 ◽

Vol 06 (02) ◽

pp. 141-143 ◽

Cited By ~ 1

Author(s):

Mukesh Bhaskar ◽

Rakesh Kumar ◽

Sunil Singh ◽

M. Meel

Keyword(s):

Facial Nerve ◽

Vestibular Schwannoma ◽

Cerebellopontine Angle ◽

Nerve Palsy ◽

Facial Nerve Palsy ◽

Large Mass ◽

Atypical Presentation ◽

Facial Nerves ◽

Nerve Paresis ◽

False Localizing Sign

AbstractVestibular schwannomas are the most common cerebellopontine angle tumors. These tumors commonly present with ipsilateral dysfunction of acoustic, vestibular, trigeminal, and facial nerves. Vestibular schwannoma with involvement of contralateral facial nerve is very unusual, and whenever present, it is considered as a false localizing sign. It seems that displacement and distortion of the brainstem by the large mass lesion may lead to this atypical presentation. We report a case of vestibular schwannoma with contralateral abducens and facial nerve paresis.

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