title: The anatomically intact but electrically unresponsive facial nerve in vestibular schwannoma surgery.
abstract: BACKGROUND
  Permanent 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.
  
  
  OBJECTIVE
  To report definitive FN outcomes among a cohort of patients with an unevokable but anatomically intact seventh nerve after microsurgical vestibular schwannoma resection.
  
  
  METHODS
  All 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.
  
  
  RESULTS
  Eleven 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.
  
  
  CONCLUSIONS
  These 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.
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota 55905, USA. link.michael@mayo.edu
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Carlson
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Van Abel
authors.forename: William R
authors.initials: WR
authors.lastname: Schmitt
authors.forename: Colin L
authors.initials: CL
authors.lastname: Driscoll
authors.forename: Brian A
authors.initials: BA
authors.lastname: Neff
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Link
mesh_terms: D000328:Adult; D000368:Aged; D004576:Electromyography; D005154:Facial Nerve / Q000033:anatomy & histology / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000009:adverse effects*; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009464:Neuroma, Acoustic / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications / Q000503:physiopathology*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult