Acoustic neuroma surgery and delayed facial palsy

Abstract

Delayed onset of facial palsy is possibly an underestimated but distressing complication of acoustic neuroma surgery. The incidence of this complication reported in the literature has varied from 11.7 to 41%. This study reviewed retrospectively 60 primary acoustic neuroma surgeries performed by a single neurotologist. The delayed onset of facial dysfunction was defined according to the guidelines described by of Lalwani Butt, Jackler, Pitts and Jingling in 1995. They considered either a deterioration of facial function from normal to abnormal or an increased severity of the degree of facial paralysis, which was grouped using the House-Brackmann scale system. Fifteen of the 60 patients (25%) were found to have a deterioration of facial function. The incidence of delayed facial palsy was not influenced by age, sex or tumor size. The majority of the patients had a favorable prognosis. Only three patients had a grade III-IV facial function at 1 year. It is possible that these latter cases might have benefited from intraoperative meatal facial nerve decompression, as advocated by Sargent, Kartush and Graham.

Psycho-socio-economic outcomes in acoustic neuroma patients and their carers related to tumour size

“…Indeed, the overall results, in clinical terms, i.e. counts of morbidity and mortality, were as good or better than recent reports in the literature 3–5,10,20,22,25,26 . The key differences between the cohorts emerged in the psychosocial outcomes.…”

“…In view of the growing focus on clinical audit and the greater emphasis upon the needs of patients’ informal ‘carers’, predominately the family, 24–26 it is timely to explore the psychosocial–economic issues identified by the patients and their carers.…”

Delayed Facial Nerve Paresis Following Acoustic Neuroma Resection and Postoperative Vasoactive Treatment

“…Secondary deterioration of cranial nerve function following acoustic neuroma resection is a well known clinical phenomenon [4,5,10,13,15], which usually occurs early during the postoperative course. Experimental studies on the cochlear nerve have focused on a disturbed microcirculation at the Obersteiner-Redlich zone [20].…”

“…Other pathophysiological factors include secondary edema [18,20] and, specifically for the facial nerve, reactivation of the herpes simplex virus [5,16] has been discussed. The prognosis is generally considered to be excellent for spontaneous recovery [10], although poor outcomes have been reported [13,18]. There is no established definition in the literature [4], but the onset, similar to delayed hearing loss, is usually within the first days after the surgical procedure.…”

“…Lalwani [10] considered either deterioration of facial function from normal to abnormal or an increased severity of the degree of facial paralysis as indicative of delayed facial paresis. The incidence varies from 11.7 to 41 % [5,10,13,18] and is not influenced by age, sex or tumor size [10,13]. Clinical and electrophysiological data in patients, who developed a delayed facial nerve palsy after termination of vasoactive treatment for hearing preservation, are of particular interest with respect to a similar underlying pathophysiological mechanism for both delayed hearing loss and secondary deterioration of facial nerve function.…”