Botulinum toxin for temporary corneal protection after surgery for vestibular schwannoma.
OBJECTIVE
High-grade postoperative facial nerve paresis after surgery for vestibular schwannoma with insufficient eye closure involves a risk for severe ocular complications. When conservative measurements are not sufficient, conventional invasive treatments include tarsorrhaphy and eyelid loading. In this study, injection of botulinum toxin into the levator palpebrae muscle was investigated as an alternative for temporary iatrogenic eye closure.


METHODS
Injection of botulinum toxin was indicated by an interdisciplinary decision (neurosurgery and ophthalmology) in patients with a postoperative facial nerve paresis corresponding to a House-Brackmann Grade of IV or greater and documented abnormalities concerning corneal status such as keratopathia or conjunctival redness. Twenty-five IUs of botulinum toxin were injected transcutaneously and transconjunctivally.


RESULTS
Six of 11 patients with high-grade paresis showed abnormal corneal findings in the early postoperative period. In 4 of these patients, botulinum toxin was injected; 1 patient declined the treatment, and in 1 patient it was not performed because of contralateral blindness. Temporary eye closure was achieved for 2 to 6 months in all cases. In all cases, facial nerve function had recovered sufficiently in terms of eye closure when the effect of botulinum toxin subsided.


CONCLUSIONS
The application of botulinum toxin for temporary iatrogenic eye closure is an excellent low-risk and temporary alternative to other invasive measures for the treatment of postoperative high-grade facial nerve paresis when the facial nerve is anatomically intact.
Department of Neurosurgery, University of Halle, Germany. julian.prell@medizin.uni-halle.de
Julian
J
Prell
Stefan
S
Rampp
Jens
J
Rachinger
Christian
C
Scheller
Alex
A
Alfieri
Liane
L
Marquardt
Christian
C
Strauss
Viktoria
V
Bau
D000328:Adult; D000368:Aged; D001905:Botulinum Toxins / Q000627:therapeutic use*; D003315:Cornea / Q000503:physiopathology* / Q000601:surgery; D005143:Eyelids / Q000503:physiopathology* / Q000601:surgery; D005158:Facial Paralysis / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D011184:Postoperative Period; D016896:Treatment Outcome
D001905:Botulinum Toxins