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A Model for Early Prediction of Facial Nerve Recovery After Vestibular Schwannoma Surgery.
MedLine Citation:
PMID:  21527865     Owner:  NLM     Status:  Publisher    
OBJECTIVE:: To identify early predictors of long-term facial nerve function after vestibular schwannoma resection. STUDY DESIGN:: Retrospective chart review. SETTING:: Tertiary referral center. PATIENTS:: Subjects with facial nerve weakness despite anatomic preservation of the nerve after removal of vestibular schwannoma. INTERVENTION:: Surgical resection of vestibular schwannoma. MAIN OUTCOME MEASURE:: Facial function after 1 postoperative year. Independent variables included patient demographics, presenting symptoms, tumor size and location, and serial postoperative function within the first year. RESULTS:: Among 281 patients with postoperative facial weakness, 81% improved to a House-Brackmann (HB) III or better (good outcome) after 12 months of recovery, whereas 12% remained HB IV or worse (poor outcome). For patients starting with HB V or VI function, recovery rate was the most reliable predictor of poor outcome after 1 year. The resulting predictive model using rate of functional improvement as the independent variable was found to anticipate poor outcome before 1 year in more than 50% of cases with 97% sensitivity and 97% specificity. Although associated with facial nerve outcome, tumor size, tumor vascularity, preoperative facial function, age at surgery, and ability to stimulate the nerve intraoperatively did not contribute significantly to the predictive model. CONCLUSION:: The rate of recovery within the first postoperative year serves as a useful early predictor of long-term facial nerve function. We present a novel predictive model using rate of recovery that can be used to select candidates for reanimation surgery sooner than the traditional waiting period of 1 year, potentially improving the outcome of this intervention.
Alejandro Rivas; Kofi D Boahene; Héctor Corrada Bravo; Marietta Tan; Rafael J Tamargo; Howard W Francis
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-4-28
Journal Detail:
Title:  Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology     Volume:  -     ISSN:  1537-4505     ISO Abbreviation:  -     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-4-29     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100961504     Medline TA:  Otol Neurotol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
*Department of Otolaryngology - Head and Neck Surgery, †Department of Biostatistics, Bloomberg School of Public Health, and ‡Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, U.S.A.
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