title: Multivariate Analysis of Factors Influencing Facial Nerve Outcome following Microsurgical Resection of Vestibular Schwannoma.
abstract: Objective To assess through multivariate analysis the clinical pre- and intraoperative factors of facial nerve outcomes at day 8 and 1-year recovery of facial palsy, as compared with day 8 status among patients who underwent total resection of unilateral vestibular schwannoma. Study Design Case series with chart review. Setting Tertiary referral center. Subjects and Methods This study included 229 patients with preoperative normal facial function and anatomic preservation of the facial nerve. Clinical, radiologic, and intraoperative factors were assessed according to facial nerve function at day 8 and 1 year. Results We observed that 74% and 84% of patients had good facial function (House-Brackmann [HB] I-II) at day 8 and 1 year, respectively. Of 60 patients, 26 (43%) who had impaired facial function (HB III-VI) at day 8 recovered good facial function (HB I-II) 1 year after surgery. A structured equation model showed that advanced tumor stage and strong facial nerve adhesion were independently associated with facial nerve conduction block at day 8. No predictive factor of impaired facial function recovery was seen at 1 year. In terms of the extracanalicular diameter of the tumor, the cutoff point to minimize the risk of impaired facial function was 16 mm. Conclusion At day 8 after vestibular schwannoma resection, facial function was impaired in the case of large tumors or strong facial nerve adhesion to the tumor. After 1 year, less than half of the patients recovered good facial function, and no predictive factor was found to be associated with this possible recovery.
authors.affiliation: 1 Unit of Otology, Auditory Implants and Skull Base Surgery, Otorhinolaryngology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.|2 Sorbonne Universities, UPMC Univ, France.|3 "Minimally Invasive Robot-based Hearing Rehabilitation", Inserm, UMR S-1159, Paris, France.
authors.forename: Renato
authors.initials: R
authors.lastname: Torres
authors.affiliation: 1 Unit of Otology, Auditory Implants and Skull Base Surgery, Otorhinolaryngology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.|2 Sorbonne Universities, UPMC Univ, France.|3 "Minimally Invasive Robot-based Hearing Rehabilitation", Inserm, UMR S-1159, Paris, France.
authors.forename: Yann
authors.initials: Y
authors.lastname: Nguyen
authors.affiliation: 2 Sorbonne Universities, UPMC Univ, France.|4 Biostatistics Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Vanier
authors.affiliation: 1 Unit of Otology, Auditory Implants and Skull Base Surgery, Otorhinolaryngology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.
authors.forename: Mustapha
authors.initials: M
authors.lastname: Smail
authors.affiliation: 1 Unit of Otology, Auditory Implants and Skull Base Surgery, Otorhinolaryngology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.|2 Sorbonne Universities, UPMC Univ, France.|3 "Minimally Invasive Robot-based Hearing Rehabilitation", Inserm, UMR S-1159, Paris, France.
authors.forename: Evelyne
authors.initials: E
authors.lastname: Ferrary
authors.affiliation: 1 Unit of Otology, Auditory Implants and Skull Base Surgery, Otorhinolaryngology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.|2 Sorbonne Universities, UPMC Univ, France.|3 "Minimally Invasive Robot-based Hearing Rehabilitation", Inserm, UMR S-1159, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Sterkers
authors.affiliation: 2 Sorbonne Universities, UPMC Univ, France.|5 Neurosurgery Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Kalamarides
authors.affiliation: 1 Unit of Otology, Auditory Implants and Skull Base Surgery, Otorhinolaryngology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.|2 Sorbonne Universities, UPMC Univ, France.|3 "Minimally Invasive Robot-based Hearing Rehabilitation", Inserm, UMR S-1159, Paris, France.
authors.forename: Daniele
authors.initials: D
authors.lastname: Bernardeschi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005154:Facial Nerve; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D015999:Multivariate Analysis; D009464:Neuroma, Acoustic / Q000601:surgery*; D019635:Neurosurgical Procedures; D020127:Recovery of Function; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: acoustic neuroma; delayed facial palsy; facial palsy; microsurgery; total resection; tumor adhesion; tumor volume