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<p>Facial nerve (FN) palsy is a significant complication of microsurgical resection of vestibular schwannoma (VS) and can profoundly impact patient quality of life. Patients exhibit two distinct trajectories of FN dysfunction: immediate facial nerve palsy (IFNP), occurring early in the postoperative period, and delayed facial nerve palsy (DFNP), characterized by new-onset weakness after an initially normal postoperative examination. In this study, we aimed to identify preoperative, intraoperative, and postoperative predictors of facial nerve trajectory to inform patient counseling and improve long-term functional outcomes. Electronic health records at our institution were reviewed to identify patients who underwent microsurgical resection of VS between July 2016 and April 2024. Preoperative data included demographic characteristics, tumor features, and baseline facial nerve function, classified according to the House-Brackmann (HB) grading scale. Univariable and multivariable logistic regression analyses were performed to identify independent predictors of IFNP and DFNP. Cox regression analysis was used to evaluate factors associated with intrinsic recovery among patients with IFNP. Among 433 patients who underwent vestibular schwannoma resection, 36.3% developed IFNP and 10.9% DFNP. DFNP was typically transient, with 90% of patients (27/30) achieving good recovery within two months. In contrast, only 35% of IFNP patients (<i>N</i> = 55) experienced intrinsic recovery, and approximately 60% of those without recovery (<i>N</i> = 66) required facial reanimation surgery. On multivariable analysis, larger tumor size (&gt; 2&#xa0;cm) independently predicted IFNP, while younger age (&lt; 33 years) independently predicted DFNP. In this study, we found that larger tumors increased the risk of immediate FN palsy, while younger age was associated with delayed onset palsy. High HB scores at discharge predicted slower or incomplete recovery in immediate cases, whereas nearly all delayed cases recovered without intervention. Systematically characterizing these postoperative trajectories can enhance patient counseling, guide risk stratification, and inform timely interventions to optimize long-term facial nerve function.</p>

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Temporal patterns of facial nerve palsy after microsurgical resection of vestibular schwannoma: immediate vs. delayed onset, management, and outcomes

  • 期刊论文

  • 发表日期：

    2026年4月15日

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  • Sai Chandan Reddy,
  • S. Farzad Maroufi,
  • James Feghali,
  • A. Karim Ahmed,
  • Nicole Page,
  • Omar Selim,
  • Melissa Canales,
  • Shaan Bhandarkar,
  • Patrick Kramer,
  • Deepa Galaiya,
  • Bryan Ward,
  • Charles Della Santina,
  • C. Matthew Stewart,
  • Francis Creighton,
  • John Carey,
  • Jason C. Nellis,
  • Kofi O. Boahene,
  • Michael Lim,
  • Risheng Xu,
  • Justin M. Caplan,
  • Chetan Bettegowda,
  • Jon Weingart,
  • Henry Brem,
  • Rafael J. Tamargo,
  • Christopher M. Jackson

摘要

Facial nerve (FN) palsy is a significant complication of microsurgical resection of vestibular schwannoma (VS) and can profoundly impact patient quality of life. Patients exhibit two distinct trajectories of FN dysfunction: immediate facial nerve palsy (IFNP), occurring early in the postoperative period, and delayed facial nerve palsy (DFNP), characterized by new-onset weakness after an initially normal postoperative examination. In this study, we aimed to identify preoperative, intraoperative, and postoperative predictors of facial nerve trajectory to inform patient counseling and improve long-term functional outcomes. Electronic health records at our institution were reviewed to identify patients who underwent microsurgical resection of VS between July 2016 and April 2024. Preoperative data included demographic characteristics, tumor features, and baseline facial nerve function, classified according to the House-Brackmann (HB) grading scale. Univariable and multivariable logistic regression analyses were performed to identify independent predictors of IFNP and DFNP. Cox regression analysis was used to evaluate factors associated with intrinsic recovery among patients with IFNP. Among 433 patients who underwent vestibular schwannoma resection, 36.3% developed IFNP and 10.9% DFNP. DFNP was typically transient, with 90% of patients (27/30) achieving good recovery within two months. In contrast, only 35% of IFNP patients (N = 55) experienced intrinsic recovery, and approximately 60% of those without recovery (N = 66) required facial reanimation surgery. On multivariable analysis, larger tumor size (> 2 cm) independently predicted IFNP, while younger age (< 33 years) independently predicted DFNP. In this study, we found that larger tumors increased the risk of immediate FN palsy, while younger age was associated with delayed onset palsy. High HB scores at discharge predicted slower or incomplete recovery in immediate cases, whereas nearly all delayed cases recovered without intervention. Systematically characterizing these postoperative trajectories can enhance patient counseling, guide risk stratification, and inform timely interventions to optimize long-term facial nerve function.