The efficacy of botulinum therapy in treatment of delayed facial palsy after resection of vestibular schwannoma

Delayed facial palsy is a complication developing 3 or more days after surgery. The etiology and pathogenesis of this condition has not been fully explored, and there are no treatment standards for it. As in the case of Bell's paralysis, glucocorticosteroids (GCSs) are currently used to treat d...

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Bibliographic Details
Published in:	Zhurnal voprosy neĭrokhirurgii imeni N. N. Burdenko Vol. 82; no. 5; p. 81
Main Authors:	Akulov, M A, Tanyashin, S V, Shimansky, V N, Usachev, D Yu, Orlova, O R, Zakharov, V O, Karnaukhov, V V, Kolycheva, M V, Khat'kova, S E, Latysheva, K D, Orlova, A S
Format:	Journal Article
Language:	Russian
Published:	Russia (Federation) 2018
Subjects:	Botulinum Toxins - therapeutic use Clostridium botulinum Facial Nerve Facial Paralysis - drug therapy Facial Paralysis - etiology Humans Neuroma, Acoustic - surgery Neurosurgical Procedures botulinum toxin A delayed facial palsy vestibular schwannoma
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Summary:	Delayed facial palsy is a complication developing 3 or more days after surgery. The etiology and pathogenesis of this condition has not been fully explored, and there are no treatment standards for it. As in the case of Bell's paralysis, glucocorticosteroids (GCSs) are currently used to treat delayed facial palsy. However, patients with contraindications to GCSs need new therapy modalities. We aimed to evaluate the efficacy and safety of botulinum therapy in patients with delayed facial palsy after neurosurgical interventions. We examined 33 patients with delayed facial palsy developed 3 or more days after resection of vestibular schwannoma. The main group included 18 patients with contraindications to GCSs who received injections of botulinum toxin A (BTA) into the facial muscles of the healthy side for muscle relaxation. The comparison group consisted of 15 patients who received a course of prednisolone (1 mg/kg/day) for 5-7 days. The efficacy of treatment was assessed using the House-Brackmann scale and Clinical Global Impression Scale. The follow-up period after therapy was 3 months. Delayed facial palsy was more common in the following cases: the facial nerve was located near the antero-inferior tumor pole; the tumor was adherent to the facial nerve; the tumor extended in the oral direction; the tumor had with unclear borders and was 11 to 30 mm in size. In most patients of both groups, facial muscle palsy developed more than 11 days after surgery. Treatment both in the main and control groups resulted in a significant improvement: complete regression of the facial asymmetry in patients of the main group and comparison groups 3 months after treatment onset was 83.3 and 93.3% (House-Brackmann scale), respectively. Botulinum therapy may be recommended for patients with delayed facial palsy developed after vestibular schwannoma resection, who have contraindications to GCSs.
ISSN:	0042-8817
DOI:	10.17116/neiro20188205181