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Simon M, Althaus L, Burggraf M, Albrecht A, Schipper J, Kristin J. Delayed facial nerve palsy after vestibular schwannoma resection: risk factors, extent and prognosis. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08883-8. [PMID: 39127799 DOI: 10.1007/s00405-024-08883-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024]
Abstract
INTRODUCTION Facial nerve palsies may develop during the postoperative period of microsurgical removal of vestibular schwannomas (VSs), even after normal facial function for days or weeks after surgery. The aim of this study was to identify the pathomechanism and predictive factors of delayed palsy. MATERIAL AND METHOD The clinical data of 193 patients who underwent vestibular schwannoma surgery between 2012 and 2021 were retrospectively analyzed. A total of 134 patients were included. The patients showed intact facial nerve function up to 24 h after surgery. All patients (n = 20) with palsy from postoperative day 4 were included and collectively referred to as delayed facial nerve palsy (DFNP). Various factors were checked using a binomial regression analysis. RESULTS The mean age of patients with DFNP was 57.8 years (55% female, 45% male). 70% had VS with KOOS ≥ 3, and 60% underwent surgery via a translabyrinthine approach Among the 16 patients with DFNP-related neurotropic pathogens, 25% were seropositive for herpes simplex virus. Most patients (n = 9/20) experienced onset of palsy between postoperative days 6 and 10. Of the four variables included in the significance test, three were significant: KOOS ≥ 3 (p < .04), ipsilateral vestibular organ failure (p < .05), and age group (p < .03). After therapy, 100% of patients recovered almost complete facial nerve function. The parameters mentioned above (KOOS classification and ipsilateral vestibular dysfunction) could be proven risk factors for the occurrence of DFNP.
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Affiliation(s)
- Miriam Simon
- Department of Otorhinolaryngology, University Hospital Düesseldorf Head and Neck Surgery, Moorenstrasse 5, 40225, Düsseldorf, Germany.
| | - Laurenz Althaus
- Department of Otorhinolaryngology, University Hospital Düesseldorf Head and Neck Surgery, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Manuel Burggraf
- Department of Trauma surgery and Orthopedics, Essen University Hospital, Hufelandstraße 55, 45147, Essen, Germany
| | - Angelika Albrecht
- Department of Otorhinolaryngology, University Hospital Düesseldorf Head and Neck Surgery, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Jörg Schipper
- Department of Otorhinolaryngology, University Hospital Düesseldorf Head and Neck Surgery, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Julia Kristin
- Department of Otorhinolaryngology, University Hospital Düesseldorf Head and Neck Surgery, Moorenstrasse 5, 40225, Düsseldorf, Germany
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Kamogawa M, Tanino S, Miyahara K, Shuto T, Matsunaga S, Okada T, Noda N, Sekiguchi N, Suzuki K, Tanaka Y, Uriu Y. Surgical and radiosurgical outcomes for Koos grade 3 vestibular schwannomas. Neurosurg Rev 2024; 47:398. [PMID: 39095539 DOI: 10.1007/s10143-024-02637-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 06/07/2024] [Accepted: 07/29/2024] [Indexed: 08/04/2024]
Abstract
This study aimed to reveal the preferred initial treatment for Koos grade 3 vestibular schwannomas (VS). We performed a two-institutional retrospective study on 21 patients with Koos grade 3 VS undergoing resection at Yokohama Medical Center and 37 patients undergoing radiosurgery at Yokohama Rosai Hospital from 2010 to 2021. Tumor control, complications, and functional preservation were compared. The median pre-treatment volume and follow-up duration were 2845 mm3 and 57.0 months, respectively, in the resection group and 2127 mm3 and 81.7 months, respectively, in the radiosurgery group. In the resection group, 16 (76.2%) underwent gross total resection, and three patients (14.3%) experienced regrowth; however, no one required additional treatment. In the radiosurgery group, the tumor control rate was 86.5%, and three cases (8.1%) required surgical resection because of symptomatic brainstem compression. Kaplan-Meier analyses revealed that tumors with delayed continuous enlargement and large thin-walled cysts were significantly associated with poor prognostic factors (p = 0.0027, p < 0.001). The pre-radiosurgery growth rate was also associated with the volume increase (p = 0.013). Two cases (9.5%) required additional operation due to complications such as post-operative hematoma and cerebrospinal fluid leaks in the resection group, whereas temporary cranial neuropathies were observed in the radiosurgery group. Two patients (9.5%) had poor facial nerve function (House-Brackmann grading grade 3) in the resection group, while no one developed facial paresis in the radiosurgery group. Trigeminal neuropathy improved only in the resection group.Radiosurgery can be considered for the treatment of Koos grade 3 VS for functional preservation. However, resection may also be considered for patients with severe trigeminal neuropathy or a high risk of volume increments, such as large thin-walled cysts and rapid pre-treatment growth.
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Affiliation(s)
- Misaki Kamogawa
- Department of Neurosurgery, National Hospital Organization, Yokohama Medical Center, 3-60-2, Harajuku, Totsuka-ku City, Yokohama, Kanagawa, 245-8575, Japan.
| | - Shin Tanino
- Department of Neurosurgery, National Hospital Organization, Yokohama Medical Center, 3-60-2, Harajuku, Totsuka-ku City, Yokohama, Kanagawa, 245-8575, Japan
| | - Kosuke Miyahara
- Department of Neurosurgery, National Hospital Organization, Yokohama Medical Center, 3-60-2, Harajuku, Totsuka-ku City, Yokohama, Kanagawa, 245-8575, Japan
| | - Takashi Shuto
- Department of Neurosurgery, Yokohama Rosai Hospital, 3211 Kozukue-cho, Kohoku-ku, Yokohama, Kanagawa, 222-0036, Japan
| | - Shigeo Matsunaga
- Department of Neurosurgery, Yokohama Rosai Hospital, 3211 Kozukue-cho, Kohoku-ku, Yokohama, Kanagawa, 222-0036, Japan
| | - Tomu Okada
- Department of Neurosurgery, National Hospital Organization, Yokohama Medical Center, 3-60-2, Harajuku, Totsuka-ku City, Yokohama, Kanagawa, 245-8575, Japan
| | - Naoyuki Noda
- Department of Neurosurgery, National Hospital Organization, Yokohama Medical Center, 3-60-2, Harajuku, Totsuka-ku City, Yokohama, Kanagawa, 245-8575, Japan
| | - Noriaki Sekiguchi
- Department of Neurosurgery, National Hospital Organization, Yokohama Medical Center, 3-60-2, Harajuku, Totsuka-ku City, Yokohama, Kanagawa, 245-8575, Japan
| | - Koji Suzuki
- Department of Neurosurgery, National Hospital Organization, Yokohama Medical Center, 3-60-2, Harajuku, Totsuka-ku City, Yokohama, Kanagawa, 245-8575, Japan
| | - Yusuke Tanaka
- Department of Neurosurgery, National Hospital Organization, Yokohama Medical Center, 3-60-2, Harajuku, Totsuka-ku City, Yokohama, Kanagawa, 245-8575, Japan
| | - Yasuhiro Uriu
- Department of Neurosurgery, National Hospital Organization, Yokohama Medical Center, 3-60-2, Harajuku, Totsuka-ku City, Yokohama, Kanagawa, 245-8575, Japan
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Szymoniuk M, Kochański M, Wilk K, Miazga D, Kanonik O, Dryla A, Kamieniak P. Stereotactic radiosurgery for Koos grade IV vestibular schwannoma: a systematic review and meta-analysis. Acta Neurochir (Wien) 2024; 166:101. [PMID: 38393397 DOI: 10.1007/s00701-024-05995-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 02/01/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Stereotactic radiosurgery (SRS) is a well-established treatment option for Koos stage I-III vestibular schwannomas (VS), often used as the first line of treatment or after subtotal resection. However, the optimal treatment for Koos-IV VS remains unclear. Therefore, our study aimed to evaluate the effectiveness of SRS as a primary treatment for large VS classified as Koos-IV. METHODS A systematic search was performed on December 28th, 2022, based on PubMed, Web of Science, and Scopus according to the PRISMA statement. The review was updated on September 7th, 2023. The risk of bias was assessed using the NIH Quality Assessment Tool. The R software (ver. 4.3.2) was used for all quantitative analyses and preparation of the forest plots. Publication bias and sensitivity analysis were performed to evaluate the reliability of the obtained results. RESULTS Among 2941 screened records, ten studies (1398 patients) have been included in quantitative synthesis. The overall tumor control rate was 90.7% (95%CI 86.3-94.4). Kaplan-Meier estimates of tumor control at 2, 6, and 10 years were 96.0% (95% CI 92.9-97.6%), 88.8% (95% CI 86.9-89.8%), and 84.5% (95% CI, 81.2-85.8%), respectively. The overall hearing preservation rate was 56.5% (95%CI 37-75.1). Kaplan-Meier estimates of hearing preservation rate at 2, 6, and 10 years were 77.1% (95% CI 67.9-82.5%), 53.5% (95% CI 44.2-58.5%), and 38.1% (95% CI 23.4-40.7%), respectively. The overall facial nerve preservation rate was 100% (95%CI 99.9-100.0). The overall trigeminal neuropathy rate reached 5.7% (95%CI 2.9-9.2). The overall rate of new-onset hydrocephalus was 5.6% (95%CI 3-9). The overall rates of worsening or new-onset tinnitus and vertigo were 6.8% (95%CI 4.2-10.0) and 9.1% (95%CI 2.1-19.6) respectively. No publication bias was detected according to the used methods. CONCLUSIONS Our systematic review and meta-analysis demonstrated a high overall tumor control rate, excellent facial nerve preservation, and low incidence of new-onset or worsened tinnitus and vertigo. However, several drawbacks associated with SRS should be noted, such as the presence of post-SRS hydrocephalus risk, mediocre long-term hearing preservation, and the lack of immediate tumor decompression. Nevertheless, the use of SRS may be beneficial in appropriately selected cases of Koos-IV VS. Moreover, further prospective studies directly comparing SRS with surgery are necessary to determine the optimal treatment for large VS and verify our results on a higher level of evidence. Registration and protocol: CRD42023389856.
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Affiliation(s)
- Michał Szymoniuk
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, Ul. Jaczewskiego 8, 20-954, Lublin, Poland.
| | - Marek Kochański
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, Ul. Jaczewskiego 8, 20-954, Lublin, Poland
| | - Karolina Wilk
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, Ul. Jaczewskiego 8, 20-954, Lublin, Poland
| | - Dominika Miazga
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, Ul. Jaczewskiego 8, 20-954, Lublin, Poland
| | - Oliwia Kanonik
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, Ul. Jaczewskiego 8, 20-954, Lublin, Poland
| | - Aleksandra Dryla
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, Ul. Jaczewskiego 8, 20-954, Lublin, Poland
| | - Piotr Kamieniak
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, Ul. Jaczewskiego 8, 20-954, Lublin, Poland
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Kanaya K, Horiuchi T. Postoperative hematoma can be a risk factor in delayed facial palsy after vestibular schwannoma resection via a retrosigmoid approach: a retrospective single-center cohort study. Acta Neurol Belg 2023; 123:1703-1707. [PMID: 35674908 DOI: 10.1007/s13760-022-01959-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/13/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE Delayed facial palsy (DFP) is a rare postoperative complication after vestibular schwannoma (VS) surgery. The exact mechanism of DFP remains uncertain and the risk factors for DFP are still controversial. The authors aimed to investigate the characteristics, risk factors, and etiology of DFP after VS resection retrospectively. METHODS Ninety-one consecutive surgeries with VS were analyzed. Patients with neurofibromatosis 2 in eight surgeries and postoperative facial palsy House-Brackmann (HB) grade more than 3 in two surgeries were excluded. Eighty-one surgeries were included in this research. Facial nerve function was evaluated using the HB grade. Delayed facial palsy was defined as deterioration in the facial function of at least 1 HB grade more than 1 day after undergoing VS resection. The characteristics of patients with VS and risk factors for DFP were analyzed. RESULTS All surgeries were performed via a retrosigmoid approach. DFP was observed in nine patients. There were no statistically significant differences between the DFP group and non-DFP group in terms of the following characteristics: sex, age, side, size, Koos grading system, postoperative facial palsy, or extent of resection. Postoperative hematoma in the cerebellopontine angle (CPA) cistern was significantly higher in the DFP group than in the non-DFP group (p = 0.0023), and was significantly associated with DFP after VS surgery (odds ratio 18.40, p < 0.001). DFP improved in seven patients, but two patients did not improve. CONCLUSION DFP occurred in 11.1% of patients after VS surgery. This study revealed that postoperative hematoma in the CPA cistern was significantly associated with DFP after VS surgery.
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Affiliation(s)
- Kohei Kanaya
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan.
| | - Tetsuyoshi Horiuchi
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
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Gazia F, Callejo À, Pérez-Grau M, Lareo S, Prades J, Roca-Ribas F, Amilibia E. Pre- and intra-operative prognostic factors of facial nerve function in cerebellopontine angle surgery. Eur Arch Otorhinolaryngol 2023; 280:1055-1062. [PMID: 35907000 PMCID: PMC9899719 DOI: 10.1007/s00405-022-07556-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 07/12/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE The study assesses whether pre- and intraoperative factors linked to electromyography and direct electrical stimulation (DES) of facial nerve can predict facial nerve function in the short- (12 days) and long-term (1 year) after cerebellopontine angle (CPA) tumor resection. METHODS 157 patients who underwent surgical resection of CPA tumors with facial nerve monitoring. Pre-operative factors (age, tumor size, pure tone average), surgical time and intra-operative parameters regarding facial function, minimum stimulation threshold (MST), compound muscle action potential (CMAP) and the difference between proximal and distal CMAP (DPDC) were evaluated. RESULTS A correlation between tumor size, MST, CMAP and facial function in both short and long term was found. A higher grade of immediate facial paralysis corresponded to a higher risk of poor outcome after one year. A postoperative House-Brackmann (HB) score of V or VI was correlated with poor outcome in 88.8% and 93.8% of cases. A risk of HB 3 or more, in the long term, was correlated with a tumor size of 20.2 mm. Using an MST of 0.1 mA, for long-term predictions, sensitivity and specificity were 0.62 (95% CI 0.46-0.75) and 0.73 (95% CI 0.61-0.82), respectively. With a CMAP cut-off < 200 µV, for long-term prediction, sensitivity was 0.73 (95% CI 0.53-0.87) and specificity 0.73 (95% CI 0.55-0.85). CONCLUSION The assessment based on the cut-offs described increases the ability to predict facial function. Improving predictive accuracy enables surgeons to address patients' expectations and to establish an intervention timeline for planning facial reanimation.
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Affiliation(s)
- Francesco Gazia
- Department of Otorhinolaryngology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona (UAB), Carretera del Canyet, Badalona, 08916, Barcelona, Spain
- Unit of Otorhinolaryngology, Department of Adult and Development Age Human Pathology "Gaetano Barresi", University of Messina, Messina, Italy
| | - Àngela Callejo
- Department of Otorhinolaryngology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona (UAB), Carretera del Canyet, Badalona, 08916, Barcelona, Spain
| | - Marta Pérez-Grau
- Department of Otorhinolaryngology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona (UAB), Carretera del Canyet, Badalona, 08916, Barcelona, Spain
| | - Susana Lareo
- Department of Otorhinolaryngology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona (UAB), Carretera del Canyet, Badalona, 08916, Barcelona, Spain
| | - José Prades
- Department of Otorhinolaryngology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona (UAB), Carretera del Canyet, Badalona, 08916, Barcelona, Spain
| | - Francesc Roca-Ribas
- Department of Otorhinolaryngology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona (UAB), Carretera del Canyet, Badalona, 08916, Barcelona, Spain
| | - Emilio Amilibia
- Department of Otorhinolaryngology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona (UAB), Carretera del Canyet, Badalona, 08916, Barcelona, Spain.
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Jia XH, Gao Z, Lin NE, Yuan YS, Zhao WD. Delayed Facial Nerve Paralysis After Vestibular Schwannoma Resection. World Neurosurg 2023; 170:e431-e435. [PMID: 36379361 DOI: 10.1016/j.wneu.2022.11.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To report the long-term outcome of delayed facial nerve paralysis (DFNP) after surgical resection of vestibular schwannoma and evaluate the influence of various factors on the prognosis of facial nerve function. METHODS Of 265 patients who underwent surgical excision of VS through a retrosigmoid approach between April 2019 and October 2021, 15 (5.7%) developed DFNP and were retrospectively studied. Preoperative and postoperative data were collected and analyzed. RESULTS The mean age of patients with DFNP was 42.6 years (range, 27-63 years), and 11 (73.3%) were male. Tumor size ranged from 12 to 37 mm (mean 24 mm) in largest dimension. All patients had normal (House-Brackmann [HB] I) facial nerve function preoperatively. Immediate postoperative facial nerve function was HB I in 12 patients (80%) and HB II in 3 patients (20%). The mean severity of DFNP onset was HB 4.7 (range, HB III-V). The average day of onset was postoperative day 12.6 (range, day 5-28). At 1-year follow-up, 12 patients (80%) were HB I, 1 patient (6.7%) was HB III, and 2 patients (13.3%) were HB IV. All patients who were HB III and IV at the last follow-up had immediate postoperative facial nerve function of HB II. CONCLUSIONS Most patients who develop DFNP have a favorable prognosis. However, a small proportion of patients with deteriorated facial nerve function immediately after surgery have poor long-term outcomes, despite confirmation of their facial nerve integrity anatomically and by electrical stimulation.
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Affiliation(s)
- Xian-Hao Jia
- Department of Otology and Skull Base Surgery, Eye & ENT Hospital, Fudan University, Shanghai, P.R.China; Shanghai Auditory Medical Center, Shanghai, P.R.China; NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, P.R.China
| | - Zhen Gao
- Department of Otology and Skull Base Surgery, Eye & ENT Hospital, Fudan University, Shanghai, P.R.China; Shanghai Auditory Medical Center, Shanghai, P.R.China; NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, P.R.China
| | - Nai-Er Lin
- Department of Radiology, Eye & ENT Hospital, Fudan University, Shanghai, P.R.China
| | - Ya-Sheng Yuan
- Department of Otology and Skull Base Surgery, Eye & ENT Hospital, Fudan University, Shanghai, P.R.China; Shanghai Auditory Medical Center, Shanghai, P.R.China; NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, P.R.China
| | - Wei-Dong Zhao
- Department of Otology and Skull Base Surgery, Eye & ENT Hospital, Fudan University, Shanghai, P.R.China; Shanghai Auditory Medical Center, Shanghai, P.R.China; NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, P.R.China.
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Fliss E, Yanko R, Zaretski A, Tulchinsky R, Arad E, Kedar DJ, Fliss DM, Gur E. Facial Nerve Repair following Acute Nerve Injury. Arch Plast Surg 2022; 49:501-509. [PMID: 35919546 PMCID: PMC9340172 DOI: 10.1055/s-0042-1751105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background
Acute facial nerve iatrogenic or traumatic injury warrants rapid management with the goal of reestablishing nerve continuity within 72 hours. However, reconstructive efforts should be performed up to 12 months from the time of injury since facial musculature may still be viable and thus facial tone and function may be salvaged.
Methods
Data of all patients who underwent facial nerve repair following iatrogenic or traumatic injury were retrospectively collected and assessed. Paralysis etiology, demographics, operative data, postoperative course, and outcome were examined.
Results
Twenty patients underwent facial nerve repair during the years 2004 to 2019. Data were available for 16 of them. Iatrogenic injury was the common category (
n
= 13, 81%) with parotidectomy due to primary parotid gland malignancy being the common surgery (
n
= 7, 44%). Nerve repair was most commonly performed during the first 72 hours of injury (
n
= 12, 75%) and most of the patients underwent nerve graft repair (
n
= 15, 94%). Outcome was available for 12 patients, all of which remained with some degree of facial paresis. Six patients suffered from complete facial paralysis (50%) and three underwent secondary facial reanimation (25%). There were no major operative or postoperative complications.
Conclusion
Iatrogenic and traumatic facial nerve injuries are common etiologies of acquired facial paralysis. In such cases, immediate repair should be performed. For patients presenting with facial paralysis following previous surgery or trauma, nerve repair should be considered up to at least 6 months of injury. Longstanding paralysis is best treated with standard facial reanimation procedures.
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Affiliation(s)
- Ehud Fliss
- Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ravit Yanko
- Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Arik Zaretski
- Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Roei Tulchinsky
- Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ehud Arad
- Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Daniel J Kedar
- Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dan M Fliss
- Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Affiliated Tel-Aviv University, Tel Aviv, Israel
| | - Eyal Gur
- Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Delayed Facial Nerve Palsy Following Resection of Vestibular Schwannoma: Clinical and Surgical Characteristics. Otol Neurotol 2021; 43:244-250. [PMID: 34699397 DOI: 10.1097/mao.0000000000003392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Analyze delayed facial nerve palsy (DFNP) following resection of vestibular schwannoma (VS) to describe distinct characteristics and facial nerve (FN) functional course. STUDY DESIGN Prospective cohort with retrospective review. SETTING Academic medical center. PATIENTS Consecutive patients undergoing VS resection 11/2017 to 08/2020. Exclusion criteria: preoperative House-Brackmann (HB) ≥ III, postoperative HB ≥ III without delayed palsy, <30 days follow-up. INTERVENTIONS VS resection with intraoperative electromyographic monitoring. MAIN OUTCOME MEASURES FN outcomes utilizing the HB scale; comparison between patients with DFNP (deterioration greater than one HB grade 24 hours to 30 days postoperatively) vs. those with HBI-II throughout. RESULTS Two hundred eighty-eight patients met criteria: mean age 47.6 years, 36.1% male; 24.0% middle cranial fossa, 28.5% retrosigmoid, 47.6% translabyrinthine. DFNP occurred in 31 (10.8%) patients with average time to onset of 8.1 days. Of these, 22 (71.0%) recovered HBI-II and 3 (9.7%) recovered HBIII. Patients who experienced DFNP, on average, had larger maximum tumor diameter (23.4 vs. 18.7 mm, p = 0.014), lower rate of gross-total resection (54.8% vs. 75.5%, p = 0.014), and lower rate of ≥100 μV FN response to 0.05 mA stimulus intraoperatively (80.6% vs. 94.9%, p = 0.002). Compared to overall incidence of DFNP, translabyrinthine approach demonstrated higher incidence (15.3%, p = 0.017) while retrosigmoid lower (3.7%, p = 0.014). In multivariable logistic regression, patients with FN response ≥100 μV to 0.05 mA stimulus were 72.0% less likely to develop DFNP (p = 0.021). CONCLUSIONS Intraoperative electromyographic facial nerve response, tumor size, surgical approach, and extent of resection may play a role in development of DFNP following resection of VS. Most patients who develop DFNP recover near-normal function.
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Perkins EL, Manzoor NF, Totten DJ, Sherry AD, Cass N, Thompson R, Tawfik K, O'Malley M, Bennett M, Haynes DS. The Influence of Extent of Resection and Tumor Morphology on Facial Nerve Outcomes Following Vestibular Schwannoma Surgery. Otol Neurotol 2021; 42:e1346-e1352. [PMID: 34238899 DOI: 10.1097/mao.0000000000003253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the influence extent of resection and tumor characteristics on facial nerve (FN) outcomes following microsurgical resection of vestibular schwannoma (VS). STUDY DESIGN Retrospective chart review. SETTING Tertiary referral center. PATIENTS Three hundred eighty-five patients who underwent VS microsurgical resection. INTERVENTIONS Microsurgical VS resection. MAIN OUTCOME MEASURES House-Brackmann (HB) scores postoperatively. Good FN function was defined as HB grade I and II and poor FN function was defined as HB grade III and VI. Gross total resection (GTR) versus subtotal resection (STR). Propensity-score matching was used in subset analysis to balance tumor volume between the surgical cohorts, followed by multivariable analysis. RESULTS Seventy-one patients (18%) underwent STR and 314 patients (82%) underwent GTR. Two hundred fourteen patients (63%) had good FN function at 2 to 3 weeks postoperatively, and 80% had good FN function at 1 year. In single predictor analysis, STR did not influence FN function at 2 to 3 weeks (p = 0.65). In propensity-score matched subset analysis (N = 178), patients with STR were less likely to have poor FN function at 2 to 3 weeks (p = 0.02) independent of tumor volume (p = 0.004), but there was no correlation between STR and FN function at 1 year (p = 0.09). Ventral extension of tumor relative to the internal auditory canal plane was associated with poor FN outcomes at 2 to 3 weeks (p = 0.0001) and 1-year postop (p = 0.002). CONCLUSIONS When accounting for tumor volume, STR is protective in immediate postoperative FN function compared to GTR. Ventral extension of the tumor is a clinical predictor of long-term FN outcomes.
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Affiliation(s)
- Elizabeth L Perkins
- Department of Otolaryngology/Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Nauman F Manzoor
- Department of Otolaryngology/Head and Neck Surgery, Case Western Reserve University School of Medicine, University Hospitals ENT Institute, Cleveland, Ohio
| | - Douglas J Totten
- Vanderbilt University School of Medicine, Vanderbilt University Medical Center
| | - Alexander D Sherry
- Vanderbilt University School of Medicine, Vanderbilt University Medical Center
| | - Nathan Cass
- Department of Otolaryngology/Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Reid Thompson
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kareem Tawfik
- Department of Otolaryngology/Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Matthew O'Malley
- Department of Otolaryngology/Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Marc Bennett
- Department of Otolaryngology/Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David S Haynes
- Department of Otolaryngology/Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Baltz JO, Jellinek NJ. Delayed Facial Nerve Palsy After Mohs Surgery. Dermatol Surg 2021; 47:1112-1113. [PMID: 34001693 DOI: 10.1097/dss.0000000000003041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Julia O Baltz
- Dermatology Professionals, Inc., East Greenwich, Rhode Island
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Nathaniel J Jellinek
- Dermatology Professionals, Inc., East Greenwich, Rhode Island
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts
- Department of Dermatology, the Warren Alpert Medical School at Brown University, Providence, Rhode Island
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Transient Subacute Facial Nerve Dysfunction After Dual Modality Treatment of Large Vestibular Schwannomas. Otol Neurotol 2020; 42:e209-e215. [DOI: 10.1097/mao.0000000000002893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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