Abstract
Objective To describe the incidence and clinical course of patients who develop delayed facial
nerve paralysis (DFNP) after surgical resection of vestibular schwannoma.
Setting Tertiary skull base center.
Methods Retrospective chart review.
Results Two hundred and forty six consecutive patients, who underwent surgical resection
for vestibular schwannoma at a single center between 2010 and 2015, were analyzed.
Of these patients, 22 (8.9%) developed DFNP, defined here as deterioration of function
by at least 2 House–Brackmann (HB) grades within 30 days in patients with immediate
postoperative HB ≤ 3. The mean age of DFNP patients was 47.2 years (range: 17–67)
and 16 (73%) were female. The mean tumor size in greatest dimension was 2.1 cm (range:
0.7–3.5 cm). At the conclusion of each case, the facial nerve stimulated at the brainstem.
Mean immediate postoperative facial nerve function was HB 1.8 (range: 1–3). Average
facial nerve function at the 3-week-postoperative visit was 4.4 (range: 2–6). In 1-year,
8 patients (36%) recovered HB 1 function, 10 patients (46%) recovered to HB 2, and
2 patients (9%) were HB 3. The remaining 2 patients did not recover function and were
HB 6 at last follow-up. Initial postoperative facial nerve function (HB 1 or HB 2)
was associated with improved recovery to normal (HB 1) function (p = 0.018).
Conclusion A majority of patients that develop delayed paralysis will recover excellent facial
nerve function. Patients should be counseled; however, a small percentage of patients
will not recover function long-term, despite having a previously functioning and anatomically
intact nerve.
Keywords
vestibular schwannoma - acoustic neuroma - facial paralysis - skull base surgery -
translabyrinthine - suboccipital - retrosigmoid - delayed facial paralysis
