Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, Canada.
Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, Canada.
Oper Neurosurg (Hagerstown). 2020 Jan 1;18(1):34-40. doi: 10.1093/ons/opz083.
Delayed facial palsy (DFP) after resection of vestibular schwannomas (VS) is worsening of facial nerve function after an initially normal postoperative result.
To characterize different types of DFP, compare recovery rates, and review of series of outcomes in patients following resection of VS.
Between 2001 and 2017, 434 patients (51% female) with VS underwent resection. We categorized the patients who developed facial palsy into groups based on timing of onset after surgery, immediate facial palsy (IFP), early-onset DFP (within 48 h), and late-onset DFP (after 48 h). Introduction of facial nerve motor-evoked potentials (fMEP) in 2002 and a change of practice utilizing perioperative minocycline in 2005 allowed for historical analysis of these interventions.
Mean age of study cohort was 49.1 yr (range 13-81 yr), with 19.8% developing facial palsy. The late-onset DFP group demonstrated a significantly faster recovery than the early-onset DFP group (2.8 ± 0.5 vs 47 ± 8 wk, P < .0001), had prolonged latency to palsy onset after initiating perioperative minocycline (7.3 vs 12.5 d, P = .001), and had a nonsignificant trend towards faster recovery from facial palsy with use of minocycline (2.6 vs 3.4 wk, P = .11).
Given the timings, it is likely axonal degeneration is responsible for early-onset DFP, while demyelination and remyelination lead to faster facial nerve recovery in late-onset DFP. Reported anti-apoptotic properties of minocycline could account for the further delay in onset of DFP, and possibly reduce the rate and duration of DFP in the surgical cohort.
听神经瘤切除术后迟发性面瘫（DFP）是面神经功能在术后最初正常结果后恶化。
描述不同类型的 DFP，比较恢复率，并回顾听神经瘤切除术后患者的一系列结果。
2001 年至 2017 年间，434 例（51%为女性）听神经瘤患者接受了切除术。我们根据手术后出现面瘫的时间将患者分为即刻面瘫（IFP）、早期 DFP（48 小时内）和迟发性 DFP（48 小时后）组。2002 年引入面神经运动诱发电位（fMEP），2005 年改变实践使用围手术期米诺环素，允许对这些干预措施进行历史分析。
研究队列的平均年龄为 49.1 岁（13-81 岁），19.8%发生面瘫。与早期 DFP 组相比，迟发性 DFP 组的恢复速度明显更快（2.8±0.5 vs 47±8 周，P<0.0001），在开始使用围手术期米诺环素后，面瘫发作的潜伏期延长（7.3 与 12.5 天，P=0.001），并且米诺环素的使用使面瘫恢复更快（2.6 与 3.4 周，P=0.11）。
鉴于时间，早期 DFP 可能是轴突变性引起的，而迟发性 DFP 导致面神经更快恢复可能是脱髓鞘和再髓鞘作用的结果。米诺环素的抗细胞凋亡特性可能导致 DFP 进一步延迟发作，并可能减少手术组中 DFP 的发生率和持续时间。
