Differential Recovery in Early- and Late-Onset Delayed Facial Palsy Following Vestibular Schwannoma Resection. Issue 1 (7th May 2019)

• Record Type: Journal Article
• Authors: Chang, Stephano; Makarenko, Serge; Despot, Ivan; Dong, Charles; Westerberg, Brian D; Akagami, Ryojo
• Is Part Of: Operative neurosurgery. Volume 18:Issue 1(2020)
• Page Start: 34
• Page End: 40
• Publication Date: 2019-05-07
• Subjects: Vestibular schwannoma -- Acoustic neuroma -- Delayed facial palsy -- Pathophysiological mechanisms -- Intraoperative monitoring -- Minocycline -- Vestibular -- Acoustic -- Schwannoma -- Facial -- Palsy -- Pathophysiology; Nervous system -- Surgery -- Periodicals; 617.480590
• DOI: 10.1093/ons/opz083
• Languages: English
• ISSNs: 2332-4252

Abstract

Abstract: BACKGROUND: Delayed facial palsy (DFP) after resection of vestibular schwannomas (VS) is worsening of facial nerve function after an initially normal postoperative result. OBJECTIVE: To characterize different types of DFP, compare recovery rates, and review of series of outcomes in patients following resection of VS. METHODS: Between 2001 and 2017, 434 patients (51% female) with VS underwent resection. We categorized the patients who developed facial palsy into groups based on timing of onset after surgery, immediate facial palsy (IFP), early-onset DFP (within 48 h), and late-onset DFP (after 48 h). Introduction of facial nerve motor-evoked potentials (fMEP) in 2002 and a change of practice utilizing perioperative minocycline in 2005 allowed for historical analysis of these interventions. RESULTS: Mean age of study cohort was 49.1 yr (range 13-81 yr), with 19.8% developing facial palsy. The late-onset DFP group demonstrated a significantly faster recovery than the early-onset DFP group (2.8 ± 0.5 vs 47 ± 8 wk, P < .0001), had prolonged latency to palsy onset after initiating perioperative minocycline (7.3 vs 12.5 d, P = .001), and had a nonsignificant trend towards faster recovery from facial palsy with use of minocycline (2.6 vs 3.4 wk, P = .11). CONCLUSION: Given the timings, it is likely axonal degeneration is responsible for early-onset DFP, while demyelination and remyelination lead to faster facial nerve recovery in late-onset DFP. Reported anti-apoptotic properties of minocycline could account for the further delay in onset of DFP, and possibly reduce the rate and duration of DFP in the surgical cohort.