Side-to-end hypoglossal-facial neurorrhaphy for treatment of complete and irreversible facial paralysis after vestibular schwannoma removal by means of a retrosigmoid approach: A clinical and anatomical study.

BACKGROUND: Facial paralysis secondary to a complete and irreversible anatomical or functional lesion of the facial nerve (FN) causes severe functional and psychological disorders for the patient. A large number of surgical techniques have therefore been developed for FN repair.

OBJECTIVE: To propose a surgical FN reanimation protocol for patients with irreversible anatomical or functional post-surgical injury of the FN in the cerebellopontine angle after vestibular schwannoma resection.

METHODS: The clinical study included a total of 16 patients undergoing side-to-end hypoglossal-facial neurorrhaphy (SEHFN) since 2010, in which the FN injury was always secondary to VS surgery in the CPA using a retrosigmoid approach. All patients had complete clinical facial paralysis at the time of the SEHFN. The anatomical study was conducted using three heads and necks (six SEHFN) RESULTS: Twelve months after surgery, facial nerve function assessment with the H&B scale showed two patients with grade II, 13 patients grade III and only one patient with grade IV, and after two years, four patients had grade II, 11 grade III and one patient grade IV. The average length of the anastomotic translocation portion of the FN in the anatomical study was 34.76 mm.

CONCLUSION: Side-to-end epineural suture of the FN, mobilizing its mastoid segment on the HN with partial section of the dorsal aspect of the HN, is a safe anatomical surgical technique for FN reanimation with outstanding clinical results.