Delayed facial palsy after microvascular decompression for hemifacial spasm

Delayed facial palsy after microvascular decompression for hemifacial spasm

Delayed facial palsy after microvascular decompression for hemifacial spasm can occur even when hemifacial spasms disappear immediately after microvascular decompression, but the patients with delayed facial palsy can fully recover within weeks 1) 2).

The earlier that DFP develops, the shorter will be the time to recovery 3). Results also suggest that arterial hypertension contributes to DFP 4).

Findings suggested that delayed facial palsy after MVD was caused by a re-activation of varicella zoster virus 5).

The etiology of DFP and its association with herpes infection should be further clarified 6).


1)

Lee JM, Park HR, Choi YD, Kim SM, Jeon B, Kim HJ, Kim DG, Paek SH. Delayed facial palsy after microvascular decompression for hemifacial spasm: friend or foe? J Neurosurg. 2018 Aug;129(2):299-307. doi: 10.3171/2017.3.JNS162869. Epub 2017 Sep 1. PMID: 28862543.
2)

Hua Z, Da TY, Hui WX, Tingting Y, Jin Z, Yan Y, Shiting L. Delayed Facial Palsy After Microvascular Decompression for Hemifacial Spasm. J Craniofac Surg. 2016 May;27(3):781-3. doi: 10.1097/SCS.0000000000002521. PMID: 27046467.
3)

Kong CC, Guo ZL, Xu XL, Yu YB, Yang WQ, Wang Q, Zhang L. Delayed Facial Palsy After Microvascular Decompression for Hemifacial Spasm. World Neurosurg. 2020 Feb;134:e12-e15. doi: 10.1016/j.wneu.2019.08.105. Epub 2019 Aug 26. PMID: 31465849.
4)

Liu LX, Zhang CW, Ren PW, Xiang SW, Xu D, Xie XD, Zhang H. Prognosis research of delayed facial palsy after microvascular decompression for hemifacial spasm. Acta Neurochir (Wien). 2016 Feb;158(2):379-85. doi: 10.1007/s00701-015-2652-9. Epub 2015 Dec 11. PMID: 26659255.
5)

Furukawa K, Sakoh M, Kumon Y, Teraoka M, Ohta S, Ohue S, Hatoh N, Ohnishi T. [Delayed facial palsy after microvascular decompression for hemifacial spasm due to reactivation of varicella-zoster virus]. No Shinkei Geka. 2003 Aug;31(8):899-902. Japanese. PMID: 12968493.
6)

Rhee DJ, Kong DS, Park K, Lee JA. Frequency and prognosis of delayed facial palsy after microvascular decompression for hemifacial spasm. Acta Neurochir (Wien). 2006 Aug;148(8):839-43; discussion 843. doi: 10.1007/s00701-006-0847-9. Epub 2006 Jun 29. PMID: 16804640.

Facial nerve schwannoma

Facial nerve schwannoma

Facial nerve schwannoma may arise in any portion of the facial nerve, with a predilection for the geniculate ganglion 1) 2).

They can occur anywhere from the internal auditory canal to the parotid gland. Schwannomas arising from the greater superficial petrosal nerve are exceedingly rare 3).

Clinical

Even in these tumors, hearing loss tends to precede facial paresis. Hearing loss may be sensorineural from VIII cranial nerve compression from tumors arising in the proximal portion of VII cranial nerve (cisternal or internal auditory canal (IAC) segment), or it may be conductive from erosion of the ossicles by tumors arising in the second (tympanic, or horizontal) segment of VII. Facial palsy (peripheral) may also develop, usually late 4).

Diagnosis

Computed tomography (CT) of the temporal bone is important for evaluating the impact on the surrounding structures 5).

Treatment

Treatment for intracranial facial nerve schwannomas depends on clinical presentation, tumor size, preoperative facial, and hearing function.

Conservative management is recommended for asymptomatic patients with small tumors. Stereotactic radiosurgery may be an option for smaller and symptomatic tumors with good facial function. If tumor is large or the patient has facial paralysis, surgical resection should be indicated. If preservation of the facial nerve is not possible, total resection with nerve grafting should be performed for those patients with facial paralysis, whereas subtotal resection is best for those patients with good facial function 6).

see Middle Fossa Approach for Facial Nerve Schwannoma.


These tumors must be assessed with imaging studies, incisional biopsy is not recommended. The treatment is surgical resection in symptomatic patients with facial paralysis greater than grade III of House-Brackmann, with immediate reconstruction of the nerve 7).

Case series

Facial nerve schwannoma case series.

Case reports

Facial nerve schwannoma case reports.

References

1) , 4)

Inoue Y, Tabuchi T, Hakuba A, et al. Facial Nerve Neuromas: CT Findings. J Comput Assist Tomogr. 1987; 11:942–947
2)

Tew JM, Yeh HS, Miller GW, Shahbabian S. Intratemporal Schwannoma of the Facial Nerve. Neurosurgery. 1983; 13:186–188
3)

Sade B, Lee JH. Recovery of low-frequency sensorineural hearing loss following resection of a greater superficial petrosal nerve schwannoma. Case report. J Neurosurg. 2007 Jul;107(1):181-4. PubMed PMID: 17639892.
5)

Loos E, Wuyts L, Puls T, Foer B, Casselman JW, Bernaerts A, Vanspauwen R, Offeciers E, Dinther JV, Zarowski A, Somers T. Cochlear Erosion due to a Facial Nerve Schwannoma. J Int Adv Otol. 2019 Jul 9. doi: 10.5152/iao.2019.5304. [Epub ahead of print] PubMed PMID: 31287431.
6)

Xu F, Pan S, Alonso F, Dekker SE, Bambakidis NC. Intracranial Facial Nerve Schwannomas: Current Management and Review of Literature. World Neurosurg. 2017 Apr;100:444-449. doi: 10.1016/j.wneu.2016.09.082. Epub 2016 Sep 28. Review. PubMed PMID: 27693767.
7)

Prado-Calleros HM, Corvera-Behar G, García-de-la-Cruz M, Calderón-Wengerman Ó, Prado A, Pombo-Nava A. Tympanic-mastoid and parotid schwannomas of the facial nerve: clinical presentation related to the anatomic site of origin. Cir Cir. 2019;87(4):377-384. doi: 10.24875/CIRU.18000449. PubMed PMID: 31264987.

Book: Atlas of the Facial Nerve and Related Structures

Atlas of the Facial Nerve and Related Structures

By Nobutaka Yoshioka, Albert L. Rhoton

Atlas of the Facial Nerve and Related Structures

List Price: $89.99
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Nobutaka Yoshioka, MD, PhD and Albert L. Rhoton Jr., MD have created an anatomical atlas of astounding precision. An unparalleled teaching tool, this atlas opens a unique window into the anatomical intricacies of complex facial nerves and related structures.
An internationally renowned author, educator, brain anatomist, and neurosurgeon, Dr. Rhoton is regarded by colleagues as one of the fathers of modern microscopic neurosurgery. Dr. Yoshioka, an esteemed craniofacial reconstructive surgeon in Japan, mastered this precise dissection technique while undertaking a fellowship at Dr. Rhotons microanatomy lab, writing in the preface that within such precision images lies potential for surgical innovation.
Special Features:

  • Includes a pair of 3D glasses to view the extraordinary images that are available online in the Thieme MediaCenter
  • Exquisite color photographs, prepared from carefully dissected latex injected cadavers, reveal anatomy layer by layer, with remarkable detail and clarity
  • Major sections include intracranial region and skull, upper facial and midfacial region, and lower facial and posterolateral neck region

Organized by region, each layered dissection elucidates specific nerves and structures with pinpoint accuracy, providing the clinician with in-depth anatomical insights. Precise clinical explanations accompany each photograph. In tandem, the images and text provide an excellent foundation for understanding the nerves and structures impacted by neurosurgical-related pathologies as well as other conditions and injuries.
An exceptionally stunning anatomical reference, this book is a must-have reference for residents, and advanced clinicians specializing in neurosurgery, facial plastic surgery, otolaryngology, maxillofacial surgery, and craniofacial surgery.


Product Details

  • Original language: English
  • Number of items: 1
  • Dimensions: .0″ h x .0″ w x .0″ l, .0 pounds
  • Binding: Hardcover
  • 128 pages
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