Prognostic factors for the incidence and recovery of delayed facial nerve palsy after vestibular schwannoma resection

Clinical article

View More View Less
  • 1 Stritch School of Medicine, and
  • 2 Departments of Neurological Surgery, and
  • 3 Otolaryngology, Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

Object

Preservation of facial nerve function in vestibular schwannoma (VS) resections remains a significant operative challenge. Delayed facial palsy (DFP) is one specific challenge yet to be fully elucidated. The aim of this study was to evaluate DFP among VS resection cases to identify significant prognostic factors associated with its incidence and clinical recovery.

Methods

This investigation involves a retrospective review of 104 cases of VS resection that occurred between December 2005 and May 2007. Patients who developed DFP were compared with patients exhibiting no facial palsy postoperatively with regard to surgical approach, severity and day of palsy onset, tumor size, intraoperative facial nerve monitoring, and postoperative recovery and treatment. Patients who demonstrated immediate facial palsy (IFP) following VS resection were also analyzed. Furthermore, specific analyses were performed in 2 distinct DFP patient groups: those who developed DFP after postoperative Day 3 (“late onset DFP”), and those whose palsy worsened after initial DFP identification (“deteriorators”).

Results

Of the 104 patients who underwent VS resection, 25.0% developed DFP and 8.6% demonstrated IFP postoperatively. The DFP group did not differ significantly in any measure when compared with patients with no postoperative facial palsy. However, patients with DFP presented with significantly smaller tumor sizes than patients with IFP. This IFP group averaged significantly smaller intraoperative facial nerve responses than patients without facial palsy, and larger tumor sizes than both the DFP and no facial palsy groups. Within the DFP group, patients with late onset DFP showed diminished intraoperative facial nerve responses when compared with the total DFP patient population. In total, 25 (96.2%) of 26 patients with DFP and 7 (77.8%) of 9 patients with IFP recovered to normal or near-normal facial function (House-Brackmann Grade I or II) at longest clinical follow-up.

Conclusions

Although patients with DFP did not exhibit any distinguishable characteristics when compared with patients without postoperative facial palsy, our analysis identified significant differences in patients with palsy presenting immediately postoperatively. Further study of patients with DFP should be undertaken to predict its incidence following VS resection.

Abbreviations used in this paper: DFP = delayed facial palsy; IAC = internal auditory canal; IFP = immediate facial palsy; VS = vestibular schwannoma.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Current affiliation for Dr. Ackerman: Department of Neurological Surgery, Loyola University Medical Center.

Address correspondence to: Douglas E. Anderson, M.D., Department of Neurological Surgery, Loyola University Medical Center, 2160 S. First Avenue, Maywood, Illinois 60153. email: dander1@lumc.edu.

Please include this information when citing this paper: published online June 25, 2010; DOI: 10.3171/2010.5.JNS091854.

  • 1

    Brackmann DE, , Fisher LM, , Hansen M, , Halim A, & Slattery WH: The effect of famciclovir on delayed facial paralysis after acoustic tumor resection. Laryngoscope 118:16171620, 2008

    • Search Google Scholar
    • Export Citation
  • 2

    Fenton JE, , Chin RYK, , Shirazi A, , Fagan PA, & Fagan PA: Prediction of postoperative facial nerve function in acoustic neuroma surgery. Clin Otolaryngol Allied Sci 24:483486, 1999

    • Search Google Scholar
    • Export Citation
  • 3

    Franco-Vidal V, , Nguyen DQ, , Guerin J, & Darrouzet V: Delayed facial paralysis after vestibular schwannoma surgery: role of herpes viruses reactivation—our experience in eight cases. Otol Neurotol 25:805810, 2004

    • Search Google Scholar
    • Export Citation
  • 4

    Gianoli GJ: Viral titers and delayed facial palsy after acoustic neuroma surgery. Otolaryngol Head Neck Surg 127:427431, 2002

  • 5

    Gianoli GJ, & Kartush JM: Delayed facial palsy after acoustic neuroma resection: the role of viral reactivation. Am J Otol 17:625629, 1996

    • Search Google Scholar
    • Export Citation
  • 6

    Grant GA, , Rostomily RR, , Kim DK, , Mayberg MR, , Farrell D, & Avellino A, : Delayed facial palsy after resection of vestibular schwannoma. J Neurosurg 97:9396, 2002

    • Search Google Scholar
    • Export Citation
  • 7

    Grayeli AB, , Guindi S, , Kalamarides M, , El Garem H, , Smail M, & Rey A, : Four-channel electromyography of the facial nerve in vestibular schwannoma surgery: sensitivity and prognostic value for short-term facial function outcome. Otol Neurotol 26:114120, 2005

    • Search Google Scholar
    • Export Citation
  • 8

    House JW, & Brackmann DE: Facial nerve grading system. Otolaryngol Head Neck Surg 93:146147, 1985

  • 9

    Ito K, , Kurita H, , Sugasawa K, , Okuno T, , Mizuno M, & Sasaki T: Neuro-otological findings after radiosurgery for acoustic neurinomas. Arch Otolaryngol Head Neck Surg 122:12291233, 1996

    • Search Google Scholar
    • Export Citation
  • 10

    Magliulo G, , D'Amico R, & Di Cello P: Delayed facial palsy after vestibular schwannoma resection: clinical data and prognosis. J Otolaryngol 32:400404, 2003

    • Search Google Scholar
    • Export Citation
  • 11

    Magliulo G, , Sepe C, , Varacalli S, & Crupi J: Acoustic neuroma surgery and delayed facial palsy. Eur Arch Otorhinolaryngol 255:124126, 1998

    • Search Google Scholar
    • Export Citation
  • 12

    Megerian CA, , McKenna MJ, & Ojemann RG: Delayed facial paralysis after acoustic neuroma surgery: factors influencing recovery. Am J Otol 17:630633, 1996

    • Search Google Scholar
    • Export Citation
  • 13

    Ohata K, , Nunta-aree S, , Morino M, , Tsuyuguchi N, , Haque M, & Inoue Y, : Aetiology of delayed facial palsy after vestibular schwannoma surgery: clinical data and hypothesis. Acta Neurochir (Wien) 140:913917, 1998

    • Search Google Scholar
    • Export Citation
  • 14

    Sargent EW, , Kartush JM, & Graham MD: Meatal facial nerve decompression in acoustic neuroma resection. Am J Otol 16:457464, 1995

  • 15

    Scheller C, , Strauss C, , Fahlbusch R, & Romstöck J: Delayed facial nerve paresis following acoustic neuroma resection and postoperative vasoactive treatment. Zentralbl Neurochir 65:103107, 2004

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 465 198 16
Full Text Views 189 28 1
PDF Downloads 167 13 2
EPUB Downloads 0 0 0