2026 Poster Presentations
P513: PREDICTORS OF FACIAL NERVE DYSFUNCTION BY TIME OF DISCHARGE FOLLOWING VESTIBULAR SCHWANNOMA RESECTION
Rithvik Ramesh, BA; Lourdes Kaufman, BA; Ruben Hernandez, BS; Stephanie Younan; Nadeem Al-Adli, MD; Philip V Theodosopoulos, MD; Steven W Cheung, MD; Nicole T Jiam, MD; Ramin A Morshed, MD; University of California, San Francisco
Introduction: Facial nerve (FN) preservation is a critical consideration in vestibular schwannoma resection, as dysfunction can substantially impair patient quality of life. While long-term FN outcomes are important, early postoperative function at the time of discharge is also clinically meaningful. FN status at discharge reflects the patient’s initial recovery trajectory, influences the need for rehabilitation services, and informs patient and family counseling during the immediate postoperative period. Identifying predictors of FN dysfunction at discharge may therefore provide valuable insights for surgical planning and perioperative management. We investigated predictors of FN dysfunction at discharge following vestibular schwannoma resection.
Methods: We retrospectively reviewed patients who underwent vestibular schwannoma resection at a large urban tertiary care center between 2004 and 2024. FN function was graded using the House-Brackmann (HB) scale at discharge. Moderate FN dysfunction was defined as HB III or IV while severe FN dysfunction was HB V or VI. Demographic, clinical, and tumor characteristics were compared between FN dysfunction groups using appropriate parametric and non-parametric tests. Variables with p<0.20 on univariate analysis were included in multivariable ordinal logistic regression to identify independent predictors of HB grade at discharge, with adjusted odds ratios (aOR) and 95% confidence intervals (CI) reported.
Results: Of the 321 patients with HB grades recorded at discharge, 48.0% had normal FN function (HB I), 21.2% had mild dysfunction (HB II), 19.9% had moderate dysfunction (HB III–IV), and 10.9% had severe dysfunction (HB V–VI). Patients with normal facial function at discharge were more likely to have undergone an initial observation period of >6 months prior to resection compared to those with higher HB grades (40.7% vs 16.1–21.0%; p<0.001). Patients with severe palsy more frequently presented with pretreatment hydrocephalus (47.1% vs 15.2–21.0%; p<0.001) and larger mean tumor volumes (17.3 cm³ vs 8.1–11.8 cm³; p<0.001). Moderate and severe palsy were associated with longer operative times compared to patients with no facial nerve dysfunction (419 and 468 min vs 356 min; p<0.001). On multivariable ordinal logistic regression, the strongest predictors of worse HB grades at discharge were absence of an observation period >6 months (p=0.001), larger preoperative tumor volume (p=0.049), and longer surgical duration (p=0.004). Patients who had an observation period >6 months prior to surgery had approximately 51% lower odds of worse HB grades at discharge compared with those who did not. Each additional cm³ of tumor volume increased the odds of having poorer FN function at discharge by approximately 3%, while each additional hour of surgery increased these odds by roughly 19%.
Conclusions: The majority of patients maintained normal to near normal FN function at discharge following vestibular schwannoma resection, while approximately 1 in 10 experienced severe palsy. Factors associated with worse FN outcomes included larger tumor volumes, longer operative duration, and absence of a prolonged observation period prior to surgery, likely reflecting smaller tumors that were initially observed rather than resected immediately. These findings highlight key preoperative considerations that may inform surgical decision-making, optimize FN preservation, and guide patient counseling.
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