(196) Facial Nerve Outcomes After Vestibular Schwannoma Surgery: Predictors and Lessons

Introduction: The main objective is reporting facial nerve outcomes after surgery for vestibular schwannoma in our cohort and determining predictors for postoperative facial nerve morbidity together with lessons learned to improve these outcomes.

Methods: All surgically treated vestibular schwannoma patients, over a 5-year period, with preoperative normal facial nerve function at a tertiary care facility were enrolled in this retrospective analysis. Basic demographic, clinical, radiological, preoperative, intraoperative and postoperative data were evaluated. Intraoperative facial nerve monitoring was used in all cases and stimulation threshold at the end of the surgery was recorded. Facial nerve function is assessed using House-Brackmann grading scale preoperatively, in the early postoperative period and at one year after surgery. The minimum follow-up period for included cases is one year and cases with incomplete follow-up were excluded. A multivariate logistic regression analysis is used to test the correlation between clinical factors and facial nerve outcomes.

Results: 56 patients were enrolled up to the current date. The preliminary results showed that at the end of one year, 64% of cases had a good postoperative facial function (House-Brackmann I-II), 29% had acceptable facial function (House-Brackmann III-IV). 21.42% of patients had postoperative immediate facial paralysis (grade VI), 67% of them recovered to grade III at the end of one year. Primary evaluations showed that tumoral cystic component and strong facial-tumor adhesions are associated with poor outcomes. These represent results from early experimental statistical analysis. However, the process of assessing the remaining research work and correlation studies is still ongoing.

Conclusions: Assessment of possible predictors that can affect postoperative facial function in vestibular schwannoma surgery is crucial for both surgeons, to prepare a suitable intervention plan for both tumor and facial nerve, and patients, to have realistic expectations.