Delayed facial palsy after resection of vestibular schwannoma

被引:53
作者
Grant, GA
Rostomily, RR
Kim, DK
Mayberg, MR
Farrell, D
Avellino, A
Duckert, LG
Gates, GA
Winn, HR
机构
[1] Univ Washington, Harborview Med Ctr, Dept Neurol Surg, Seattle, WA 98104 USA
[2] Univ Washington, Harborview Med Ctr, Dept Neurol, Seattle, WA 98104 USA
[3] Univ Washington, Harborview Med Ctr, Dept Otolaryngol, Seattle, WA 98104 USA
关键词
delayed facial palsy; acoustic neuroma; vestibular schwannoma; facial nerve;
D O I
10.3171/jns.2002.97.1.0093
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Object. In this study the authors investigate delayed facial palsy (DFP), which is an underreported phenomenon after surgery for vestibular schwannoma (VS). The authors identified 15 (4.8%) patients from a consecutive series of 314 who underwent surgery for VS between 1988 and 2000, and in whom DFP developed. Delayed facial palsy was defined as a deterioration of facial nerve function from House-Brackmann Grades 1 or 2 more than 3 days postoperatively. Methods. All patients underwent intraoperative neuropbysiological monitoring of facial nerve function. The average latency of DFP was 10.9 days (range 4-30 days). In six patients (40%) minor deterioration (: two House-Brackmann grades) had occurred at a mean of 10.2 days postsurgery, whereas in nine patients (60%) moderate deterioration (less than or equal to three House-Brackmann grades) had occurred at a mean of 11.8 days postoperatively. Five (33%) of 15 patients recovered to Grade 1 of 2 function within 6 weeks of DFP onset. Of the 15 patients with DFP, 14 had completed 1 year of follow up at the time of this study. Twelve (80%) of these 15 patients recovered to Grade 1 or 2 function within 3 months, and 13 (93%) of 14 patients recovered within 1 year. In all cases, stimulation of the seventh cranial nerve on completion of tumor resection revealed the nerve to be intact, both anatomically and functionally, to proximal and distal stimulation at 0.1 mA. A smaller tumor diameter correlated with greater recovery of facial nerve function. There was no correlation between the latency or severity of or recovery from DFP, and the patient's age or sex, the surgical approach, frequency of neurotonic seventh nerve discharges, anatomical relationship of the facial nerve to the tumor, patient's history of tobacco use, or cardiovascular disease. Conclusions. It appears that DFP is an uncommon consequence of surgery for VS. Although excellent recovery of facial nerve function to its original postoperative status nearly always occurs after DFP, the magnitude and time course of the disorder were not predictors for subsequent recovery of facial nerve function.
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页码:93 / 96
页数:4
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