Delayed Facial Nerve Palsy Following Resection of Vestibular Schwannoma: Clinical and Surgical Characteristics.
Otol Neurotol
; 43(2): 244-250, 2022 02 01.
Article
em En
| MEDLINE
| ID: mdl-34699397
ABSTRACT
OBJECTIVE:
Analyze delayed facial nerve palsy (DFNP) following resection of vestibular schwannoma (VS) to describe distinct characteristics and facial nerve (FN) functional course. STUDYDESIGN:
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, <30âdays follow-up.INTERVENTIONS:
VS resection with intraoperative electromyographic monitoring. MAIN OUTCOMEMEASURES:
FN outcomes utilizing the HB scale; comparison between patients with DFNP (deterioration greater than one HB grade 24âhours to 30âdays postoperatively) vs. those with HBI-II throughout.RESULTS:
Two hundred eighty-eight patients met criteria mean age 47.6âyears, 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 8.1âdays. 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. 18.7âmm, pâ=â0.014), lower rate of gross-total resection (54.8% vs. 75.5%, pâ=â0.014), and lower rate of ≥100âµV FN response to 0.05âmA stimulus intraoperatively (80.6% vs. 94.9%, pâ=â0.002). Compared to overall incidence of DFNP, translabyrinthine approach demonstrated higher incidence (15.3%, pâ=â0.017) while retrosigmoid lower (3.7%, pâ=â0.014). In multivariable logistic regression, patients with FN response ≥100âµV to 0.05âmA stimulus were 72.0% less likely to develop DFNP (pâ=â0.021).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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Base de dados:
MEDLINE
Assunto principal:
Neuroma Acústico
/
Paralisia de Bell
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Paralisia Facial
Idioma:
En
Ano de publicação:
2022
Tipo de documento:
Article