2026 Poster Presentations
P507: A SURVEY OF 105 SURGEONS MANAGE PATIENTS WITH VESTIBULAR SCHWANNOMA. INSIGHTS INTO THE MANAGEMENT OF FACIAL PARALYSIS SYMPTOMS AND SEQUELAE.
Amit Kochhar, MD; Garni Barkhoudarian, MD; Courtney Voelker, MD, PhD; Walavan Sivakumar, MD; Shanthi Gowrinathan, MD; Pacific Neuroscience Institute
Objective: The aim of this study was to evaluate how patients with vestibular schwannoma (VS) were prepared for facial paralysis (FP).
Study Design: Online survey of the American Skull Base Society.
Methods: A 25-question survey gathering information on surgeon experience related to management of FP was created. Associations between specialty, practice setting, experience, and surgical volume were analyzed using R 4.3.2. Significance was considered at p-values < 0.05.
Results: 105 surgeons responded. 73% were neurosurgeons, and 27% were neurotologists. The majority (61%) were in academic practices, followed by hybrid (28%) and private practice (12%). 58% of respondents had practiced for over 15 years, and one-third performed more than 35 cases per year. Nearly all surgeons reviewed the risks of facial nerve injury prior to surgery. The majority (70%) offered educational handouts discussing surgical risks, but only 8% discussed the possibility of requiring facial reanimation after surgery. More than half (53%) referred patients to a reconstructive surgeon if facial nerve weakness persisted 7-12 months, with 27% recommending referral within 6 months. After surgery, 27% assessed patients’ quality of life, and 66% referred patients to speech language pathology. 33% assessed for depression and 17% for anxiety. 37% referred patients to psychologists when appropriate. 89% referred patients to facial retraining physical therapy.
Conclusion: Neurosurgeons and neurotologists recognize the importance of discussing the risk for facial weakness in VS management. However, significant inconsistencies exist in FP management, including education, identification of functional and emotional sequelae, and referrals to experts. Improved education, screening tools, and preoperative counseling with reconstructive surgeons are recommended.