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J Neurol Surg B Skull Base
DOI: 10.1055/a-2724-4037
Original Article

The Price of Paralysis: Analyzing the Direct Cost of Facial Rehabilitation after Vestibular Schwannoma Resection

Authors

  • Robert James Macielak

    1   Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, United States (Ringgold ID: RIN12306)

  • Micah Harris

    2   Otolaryngology, University of Pittsburgh Medical Center Health System, Pittsburgh, United States (Ringgold ID: RIN6595)

  • Vivian Kaul

    3   Department of Otorhinolaryngology-Head and Neck Surgery, The University of Texas Health Science Center at Houston, Houston, United States (Ringgold ID: RIN12340)

  • Leslie Kim

  • Shana McGrath

    4   Outpatient Rehabilitation, The Ohio State University Wexner Medical Center, Columbus, United States (Ringgold ID: RIN12306)

  • Desi Schoo

    5   Otolaryngology - Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, United States (Ringgold ID: RIN12306)

  • Kyle C. Wu

    6   Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, United States (Ringgold ID: RIN12306)

  • Edward Dodson

    7   Otolaryngology, The Ohio State University, Columbus, United States (Ringgold ID: RIN2647)

  • Daniel Prevedello

    8   The Ohio State University, Columbus, United States (Ringgold ID: RIN2647)

  • Oliver F. Adunka

    9   Otolaryngology-Head & Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, United States

  • Yin Ren

    10   Otolaryngology, The Ohio State University Wexner Medical Center, Columbus, United States (Ringgold ID: RIN12306)
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Objective: To estimate the direct costs associated with facial nerve rehabilitation for patients with facial paralysis after vestibular schwannoma (VS) resection. Study Design: Retrospective cohort study Setting: Academic tertiary referral center Participants: Patients treated sequentially between 9/2016 and 5/2021 that experienced any degree of facial nerve dysfunction after VS resection and received rehabilitative interventions Main Outcome Measure: Estimated costs calculated based on institutional billing data Results: Fifteen patients (67% female, median age at surgery of 56-years-old) were identified. Fourteen of the patients (93%) had tumors with cerebellopontine angle extension, with a median size of 20.7 mm (Interquartile Range [IQR] 13.8-23.5). The median House-Brackmann (HB) grade immediately after surgery was 6 (IQR 3-6), and the median HB grade at most recent evaluation was 5 (IQR 4-6) with a median follow-up of 29 months (IQR 17-44). A total of 11 patients (73%) underwent periocular procedures; 4 (27%) underwent extensive rehabilitative surgeries, including nerve transfer and static sling procedures; 5 (33%) underwent chemodenervation therapy; and 9 (60%) performed facial retraining therapy with treatment being initiated at a median of 6.2 months (IQR 3.2-9.3) after surgery. The median cost for all patients was $3,125 (IQR $1,120-$14,843), with the median cost of extensive rehabilitative surgery being $15,970 (IQR $14,907-$29,289). Conclusions: The median cost associated with facial rehabilitation is relatively low at $3,125; however, this amount varies based on the type of procedures pursued and individual need. Ultimately, a dedicated team of specialists is required to appropriately manage postoperative facial dysfunction in a cost-effective manner.



Publication History

Received: 28 July 2025

Accepted after revision: 13 October 2025

Accepted Manuscript online:
17 October 2025

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