Results of Hemihypoglossal-Facial Nerve Anastomosis in the Treatment of Facial Nerve Paralysis after Failed Stereotactic Radiosurgery for Vestibular Schwannoma

Background: Vestibular schwannoma treatment with stereotactic radiosurgery (SRS) carries a risk of facial nerve (CNVII) palsy that is lower than that with microneurosurgery. This study assessed hemihypoglossal-facial nerve anastomosis (HHFA) in CNVII palsy after failed SRS. Methods: The first four consecutive patients (three women; median age 58.5 years, range 46-74 years) who underwent HHFA due to failed SRS were included. All patients were admitted due to progressive peripheral facial nerve palsy. Three patients received retrosigmoid craniotomy due to tumor enlargement that resulted in facial nerve paralysis. Results: All patients achieved satisfactory (House-Brackmann grade III) CNVII regeneration. No or minimal tongue atrophy occurred on the side of the anastomosis. Patients reported no problems with phonation or swallowing, except patients with preexisting lower cranial nerve deficits. Conclusions: HHFA effectively treats facial palsy after failed SRS with minimal risk of tongue atrophy and minimal morbidity.