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KMID : 1037420170120010017
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Journal of Korean Skull Base Society
2017 Volume.12 No. 1 p.17 ~ p.23
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The characteristics and the optimal treatments of facial paralysis caused by vestibular schwannoma
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Han Byung-Hyun
Lee Jeon-Mi
Kim Jin
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Abstract
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Among all the complications of vestibular schwannoma, facial nerve palsy is one of the most serious complications to avoid in the treatment of vestibular schwannoma, that lowers the quality of life, due to persistent symptoms. Facial paralysis caused by vestibular schwannoma can be categorized in four different groups. The purpose of this study is to investigate the characteristics of facial paralysis caused by vestibular schwannoma, and to find out the best way to preserve facial nerve in the treatment by analyzing various treatment modalities. From March 2013 to February 2017, 40 patients who experienced schwannoma-induced facial palsy at Inje University, Ilsan Paik Hospital were included. Group 1 consists of candidates who experienced slowly progressing facial paralysis due to the compression caused by the growth of tumor. Treatment with lifting or botox injection was selectively applied to the cases with small sized tumor, or to the cases with facial paralysis with less than grade 3 on House-Brackmann(HB) grading scale. Patients with sudden facial paralysis were included in group 2. In most cases with sudden facial palsy, steroid therapy improved symptom to the HB grade 1 or 2. Patients with surgery induced facial palsy were categorized into group 3. Three patients who experienced facial palsy for less than a year received hypoglossal-facial nerve anastomosis in order to preserve facial function. In the case of complete paralysis sustained for more than a year, various options of treatments could be applied to different cases. The group 4 consists of candidates with facial palsy induced by radiation injury. Most of patients experienced high satisfaction in improvement of symptoms with botox injection alone. The degree of facial damage and the duration after the injury may change the method of treatment, and the treatment could be applied individually, depending on the patient's expectation, life expectancy, sex, personality, and so forth. The clinicians who provide therapeutic procedures for vestibular schwannoma should always pay attention to the removal of tumors as well as the preservation of facial function which influences one's quality of life significantly.
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KEYWORD
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Vestibular schwannoma, Acoustic neuroma, Facial, Quality of life
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