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Facial Paralysis Related to Acoustic Neuroma
and Other Skull Base Surgery
Occasionally, removal of an acoustic neuroma (vestibular schwannoma)
or other skull base tumor in a similar location, results in postoperative
facial weakness. This is related to manipulation of the facial nerve during
tumor removal. Nerves are exquisitely sensitive to manipulation, and can
be either temporarily or permanently damaged by surgical dissection around
them. Tumors are often intimately associated with the facial nerve, and
adherent to it. Removal of larger tumors has a higher probability of causing
facial nerve dysfunction than removal of smaller tumors.
When the tumor is removed and the facial nerve is intact, but somewhat
stretched during tumor removal, one can expect near complete to complete
recovery over weeks to months. When the nerve is intact, but severely
stretched or manipulated, partial recovery usually ensues over months
to a year. Severely manipulated nerves that are not repairable occasionally
do not yield any satisfactory recovery after 12-18 months. In these cases,
facial reanimation options must be considered. Finally, sometimes the
facial nerve must be divided for tumor removal. When grafting is not possible
based on the anatomy, early facial reanimation procedures are appropriate.
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