gms | German Medical Science

Objective: Besides tumour resection as the primary goal in vestibular schwannoma surgery, there is an equal focus on functional outcome. Despite good clinical results, some patients are unsatisfied and feel affected in their quality of life after surgery. Facial nerve weakness, whether slight and/or temporary, seems to play a main role in these cases.

Method: 115 patients, who underwent surgery for vestibular schwannomas, took part in this long-term evaluation of their clinical status and their life quality. Clinical evolution was documented by repeated neurological examinations, facial photo documentation, SF-36 life quality questionnaires, Nottingham Health Profile, and a specific disease related questionnaire on general status, cranial nerve symptoms, anxieties and coping with daily life. Related to their personal subjective assessment, patients were grouped in 3 classes: class A (satisfied with procedure and outcome, no major complaint), class B (satisfied, suffering from mild persisting symptoms) and class C (not satisfied, suffering from major symptoms). All groups were statistically analyzed with regard to no, persistent or temporary facial nerve palsy and life quality. The primary outcome was the objective (House-Brackmann-Scale, HB) and the subjective facial nerve function at a minimum follow-up period of one year.

Results: 83 patients were grouped in class A, 23 in class B and 9 in class C. Before surgery there were facial nerve deficits in 12% in class A, in 9% in class B, 0% in class C. After surgery severe facial palsies HB°4 to HB°5 were found in 17% in class A, 13% in class B and 44% in class C. Facial palsy improved in most of the cases to HB°1. Nevertheless, patients complained of persisting subjective facial weakness in 12% in class A, 26% in class B, and 44% class C. Statistical analysis of the questionnaire data showed significant reduction in well-being but normal physical activity in patients with pure subjective palsies compared to objective facial deficits, pointing towards a lasting depressive status and related impairment in life quality.

Conclusions: Facial nerve dysfunction after vestibular schwannoma surgery mostly shows satisfying recovery. In some patients, however, it may affect long-term life quality, regardless of its duration and severity. In these patients an increased depressive status was identified by the SF-36 and by the Nottingham Health Profile. On a prospective basis further investigations are needed to find out to which extent this constitution is pre-existing.