Long-Term Facial Function after Facial Nerve Repair Using A VII-XII Anastomosis after Vestibular Schwannoma Removal

Objective: The aim of this study is to analyze the recovery of long-term facial function who underwent hypoglossal-facial nerve anastomosis following vestibular schwannoma surgery.

Method: This study included 14 patients with vestibular schwannomas removal. All patients had large tumors with a mean tumor volume of 10.71 ± 8.10 cm3. Preoperatively, all patients had normal facial functions, and gross total tumor removal with a translabyrinthine approach or retrosigmoid approach was achieved. During surgery, the facial nerve was interrupted in and facial reanimation using hypoglossal-facial (VII-XII) anastomosis was performed.

Facial nerve function and tongue atrophy were analyzed upon 3months, 6months, and more than 1 year and an average follow-up period of 1.2 years.

Result: Facial nerve had been resected and immediately reconstructed in 9 patients and most of their facial function was recovered as House-Brackmann grade III. In 5 patients, the interval between tumor resection and reconstruction was more than 9months and their facial recovery was poorer than immediate reconstructed cases.

End- to- end VII-XII anastomosis group (n = 7) exhibited a marked improvement in their facial function (H-B GIII), but marked tongue atrophy. The split XII –VII anastomosis group (n = 4) showed no difference in facial function and reduced hemiglossal atrophy compared with end-to- end anastomosis group. Lastly, End-to-side VII-XII anastomosis group (n = 3) showed poorer facial recovery but no tongue atrophy.

Conclusion: Immediate split hypoglossal-facial nerve anastomosis results in good facial reanimation and may reduce the degree of hemiglossal atrophy and recommended in case of iatrogenic injury during vestibular schwannoma removal.