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


OBJECTIVE
To evaluate the incidence and prognosis of DFP and to identify risk factors for its occurrence.


METHODS
A 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.


RESULTS
One 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).


CONCLUSIONS
Patients 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.
*Medical Scientist Training Program, Mayo Clinic, Rochester, Minnesota; ‡Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota; §Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota.
Lucas P
LP
Carlstrom
William R
WR
Copeland
Brian A
BA
Neff
Marina L
ML
Castner
Colin L W
CL
Driscoll
Michael J
MJ
Link
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005158:Facial Paralysis / Q000175:diagnosis* / Q000209:etiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000175:diagnosis* / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult