• Neurosurgery · Sep 2015

    Incidence and Risk Factors of Delayed Facial Palsy After Vestibular Schwannoma Resection.

    • Lucas P Carlstrom, William R Copeland, Brian A Neff, Marina L Castner, Colin L W Driscoll, and Michael J Link.
    • *Medical Scientist Training Program, Mayo Clinic, Rochester, Minnesota; ‡Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota; §Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota.
    • Neurosurgery. 2015 Sep 8.

    BackgroundPreservation of facial nerve function following vestibular schwannoma surgery is a high priority. Even those patients with normal to near-normal function in the early postoperative period remain at risk for delayed facial palsy (DFP).ObjectiveTo evaluate the incidence and prognosis of DFP and to identify risk factors for its occurrence.MethodsA retrospective cohort study of 489 patients who underwent vestibular schwannoma resection at our institution between 2000 and 2014. Delayed facial palsy was defined as deterioration in facial function of at least 2 House-Brackmann (HB) grades between postoperative days 5 to 30. Only patients with a HB grade of I to III by postoperative day 5 were eligible for study inclusion.ResultsOne hundred twenty-one patients with HB grade IV to VI facial weakness at postoperative day 5 were excluded from analysis. Of the remaining 368, 60 (16%) patients developed DFP (mean 12 days postoperatively, range: 5-25 days). All patients recovered function to HB grade I to II by a mean of 33 days (range: 7-86 days). Patients that developed DFP had higher rates of gross total resections (83% vs 71%, P = .05) and retrosigmoid approaches (72% vs 52%, P < .01). There was no difference in recovery time between patients who received treatment with steroids, steroids with antivirals, or no treatment at all (P = .530).ConclusionPatients with a gross total tumor resection or undergoing a retrosigmoid approach may be at higher risk of DFP. The prognosis is favorable, with patients likely recovering to normal or near-normal facial function within 1 month of onset.AbbreviationsCI, confidence intervalDFP, delayed facial palsyGTR, gross total resectionHB, House-BrackmannNFP, no facial palsyOR, odds ratioRS, retrosigmoidTL, translabyrinthineVS, vestibular schwannoma.

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