• Matthew L Carlson, Kathryn M Van Abel, William R Schmitt, Colin L Driscoll, Brian A Neff, and Michael J Link.
• Department of Otolaryngology Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota 55905, USA. link.michael@mayo.edu
• Neurosurgery. 2012 Dec 1;71(6):1125-30; discussion 1130.

BackgroundPermanent facial nerve (FN) paresis after vestibular schwannoma surgery is distressing to both the patient and surgeon. Intraoperative electrophysiological testing has proven invaluable in reducing the incidence of FN injury and may assist in prognosticating long-term function.ObjectiveTo report definitive FN outcomes among a cohort of patients with an unevokable but anatomically intact seventh nerve after microsurgical vestibular schwannoma resection.MethodsAll patients undergoing vestibular schwannoma surgery between 2000 and 2010 at a single tertiary academic referral center were identified. Intraoperative FN monitoring data and definitive FN outcomes were reviewed, and all patients with an anatomically intact but electrically unresponsive FN were included.ResultsEleven patients met the inclusion criteria. The median preoperative and definitive postoperative FN scores were House-Brackmann grades 1 and 3, respectively. The median time to definitive FN recovery was 9.4 months.ConclusionThese data demonstrate that even among this extreme subset, modern electroprognostic testing strategies are incapable of reliably predicting poor outcomes. Therefore, if FN continuity is maintained, attempts at same-surgery FN repair should not be pursued.

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