Functional outcome of the facial nerve after surgery for vestibular schwannoma: Prediction of acceptable long-term facial nerve function based on immediate post-operative facial palsy.

Functional outcome of the facial nerve after surgery for vestibular schwannoma: Prediction of acceptable long-term facial nerve function based on immediate post-operative facial palsy.

World Neurosurg. 2016 Jan 27;

Authors: Lee S, Seol HJ, Park K, Lee JI, Nam DH, Kong DS, Cho YS

Abstract
OBJECTIVE: We examined the relationship between immediate post-operative facial palsy and later, and identified treatment strategy for VS considering long-term outcomes of facial nerve function and tumor control.
METHODS: 385 patients who underwent surgery in a single institution were reviewed retrospectively. 12 NF patients, 6 with pre-operative radiosurgery, and 14 with multiple surgeries were excluded. The generalized estimating equation method was used to show the correlation between immediate and later post-operative facial palsy, and to identify the cut-off grade of immediate post-operative facial palsy.
RESULTS: The tumor control for 1-year, 3-year, and 5-year were 88.7%, 83.9%, and 80.0%. Facial functional preservation above H-B grade 1, 2 was achieved in 47.9% of patients immediate post-operatively, 50.1% after 1 month, and 74.5% after >2 years. The immediate post-operative facial palsy grade showed a statistically significant relationship with the facial palsy grade on long-term follow-up (P < 0.001). An H-B grade 3 immediate facial palsy was identified as the cut-off grade that showed the most significant relationship between the grade of immediate post-operative facial palsy and the grades above the cut-off (H-B grade 1, 2, and 3) on long-term follow-up (P < 0.001).
CONCLUSION: Immediate post-operative facial palsy grade can predict the facial palsy at long-term follow-up, that is immediate post-operative H-B grade 3 is the lowest tolerable grade that guarantees functional improvement on long-term follow-up. Planned facial nerve preservation surgery followed by radiosurgery is thought to be optimal treatment in VS patients for both tumor control and facial nerve function.

PMID: 26826537 [PubMed - as supplied by publisher]

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