Descending hypoglossal branch-facial nerve anastomosis for severe facial paralysis after cerebellopontine angle tumor surgery

Abstract

Objective To investigate the clinical effect of descending hypoglossal branch-facial nerve anastomosis for severe facial paralysis after cerebellopontine angle (CPA) tumor surgery. Methods From October 2010 to February 2014, 17 patients with severe facial paralysis whose House-Brackmann (H-B) grades were 5-6 or without clear facial nerve anatomical reservation after CPA tumor surgery were treated with the descending hypoglossal branch-facial nerve anastomosis at the Department of Neurosurgery, Beijing Xuanwu Hospital, Capital Medical University. Their clinical efficacy was observed retrospectively. Results After neuroanastomosis, no disability and death, no hoarseness, dysphagia and other neurological disorders were observed. In 17 patients, 15 (88.2%) were followed up for 6 to 53 months (mean 25). Facial nerve function H-B grade 2 was in 4 patients, grade 3 in 5 (33.3%), grade 4 in 5 (33.3%), and grade 5 in 1. One patient suffered ipsilateral tongue paralysis completely after procedure. The improvement of facial paralysis was most significant for orbicularis muscles, followed by the orbicularis oculi muscles, and the worst was the improvement of frontal muscles. All the patients benefited from the anastomosis. Although there was no significant improvement for patients with facial paralysis H-B grade 5, the patients felt that the dry eyes, the degree of redness and swelling reduced compare with before procedure. Conclusion Descending hypoglossal branch-facial nerve anastomosis can not only improve the facial nerve function in patients with severe facial paralysis in tumors of CPA regions, but also can avoid the influence on the hypoglossal nerve function. Key words: Cerebellopontine angle; Central nervous system neoplasms; Facial paralysis; Anastomosis, surgical; Facial nerve; Descending hypoglossal branch