Unterschiedliche Rate der postoperative Erholung der Facialisfunktion nach retrosigmoidaler Resektion von Vestibularisschwannomen

Postoperative facial palsy after microsurgical resection of vestibular schwannoma (VS) is often only temporary. This study aims to in detail analyze the long-term recovery rates and development of facial motoric function after surgical tumor resection according early post-operative motoric facial status.

Patients treated between 2008 and 2015 with primary retrosigmoid resection for vestibular schwannoma via retrosigmoid approach with anatomical preservation of the facial nerve and sufficient follow-up were included. Patients with pre-operative facial nerve affection were excluded. Facial motoric function was quantified by House-Brackman (HB) scale and patients photographs were taken prospectively. Other clinical information was retrospectively analyzed. HB I-II was defined as good and HB III-VI as poor facial outcome.

N=521 patients were included in this analysis. Overall, long-term good facial outcome was achieved in 85%, while 15% presented with long-term relevant facial palsy. 46% (N=241/521) of all patients presented with early post-operative HB I. 20% (N=106/521) presented with a slight post-operative deterioration of HB II, of which 94% (N=100/106) recovered spontaneously after one year to HB I. Only one patient experienced a worsening of early-postoperative HB II to long-term HB III. 11% (N=58/521) had an early post-operative HB III, of which 84% recovered spontaneously at one year follow-up to good facial outcome. 16% (N=82/521) presented with early post-operative HB IV, of which 50% had recovered to good facial outcome at 1-year-FU. HB V was present early-post operative in 6% (N=31/521), of which 32% recovered to good facial outcome. 0.6% (N=3/521) presented with HB VI, of which only one recovered to HB II. Post-operative facial palsy recovery was independent of patient sex, and patient age (p=0.432; p=0.458).

Long-term post-operative recovery rate after VS surgery of a direct postoperative status of HB II to HB I is 94%. If severe facial deterioration (HB III-IV) occurred, the best recovery rate was at HB III with 84%, followed by 50% at HB IV, and only 32 % at HB V. Postoperative facial palsy recovery was independent of patient demographics (age, sex, etc).