J Neurol Surg B Skull Base 2014; 75 - a244
DOI: 10.1055/s-0034-1384146

Effect of Corticosteroids on Facial Function after Cerebellopontine Angle Tumor Removal: A Double-Blind Study versus Placebo

Alexis Bozorg Grayeli 1, E. Ferrary 2, F. Tubach 3, I. Bernat 4, O. Deguine 5, V. Darrouzet 6, A. Robier 7, S. Zaouche 8, C. Dubreuil 8, M. Marx 5, M. Kalamrides 9, B. Fraysse 5, O. Sterkers 10
  • 1Dijon Hospital University, France
  • 2Department of Otolaryngology, APHP, Beaujon University Hospital, Clichy, and Inserm UMRS-867, Université Paris Diderot, France
  • 3APHP, Hôpital Bichat, Unité de Recherche Clinique, Paris, France, France
  • 4Department of Neurophysiology, Groupe Hospitalier Pitié-Salpétrière, APHP, Paris, France
  • 5Department of Otolaryngology, Hôpital de Purpan, Toulouse, France
  • 6Department of Otolaryngology, Bordeaux University Hospital, France
  • 7Department of Otolaryngology, Tours University Hospital, France
  • 8Department of Otolaryngology, Lyon University Hospital, France
  • 9Department of Neurosurgery, APHP, Groupe Hospitalier Pitié-Salpétrière, Clichy, France
  • 10Department of Otolaryngology, Groupe Hospitalier Pitié-Salpétrière, APHP, Paris, France

Objective: The aim of this study was to assess the effect of corticosteroids administered intra- and postoperatively on the occurrence of facial palsy after a cerebellopontine angle (CPA) tumor resection, and to investigate pre- and intraoperative prognostic factors. Study Design: This multicenter, prospective, randomized, double-blind and versus placebo study was conducted between 2006 and 2010. Patients and Methods: Overall 310 patients operated on for a CPA tumor (96% vestibular schwannomas, 4% miscellaneous) were included by five participating centers. Population was stratified into small (<15 mm in CPA on axial MRI views) and large tumors. In each group, patients were randomized intocorticosteroid (1 mg/kg/d IV methylprednisolone intraoperatively, and from postoperative days 1-5) or placebo. The principal judgment criterion was the proportion of patients with a facial function >grade 2 (House-Brackmann) at postoperative day 8. Patients were followed up 30 days after surgery. Results: Steroids did not affect the facial function at postoperative day 8 after intention-to-treat analysis in small lesions (82% of grades 1-2, n = 104 in steroid vs.81%, n = 94 in placebo, not significant, chi-square test) and in large tumors (51% of grades 1-2, n = 56 in steroid vs.46%, n = 56 in placebo not significant, chi-square test). Facial function at postoperative days 1 and 30 and per protocol analysis did not show an effect. Postoperative complications were also similar in the groups. Conclusion: Administration of corticosteroids during and after CPA tumor surgery does not affect facial function as assessed by the House-Brackmann grading system.