Evidence map›Paper›PMID 41984336›Full record

ArticleNeurosurgical review2026

Temporal patterns of facial nerve palsy after microsurgical resection of vestibular schwannoma: immediate vs. delayed onset, management, and outcomes.

Sai Chandan Reddy, S Farzad Maroufi, James Feghali, A Karim Ahmed, Nicole Page, Omar Selim, Melissa Canales, Shaan Bhandarkar, Patrick Kramer, Deepa Galaiya and 15 more

Abstract read
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In one paragraph

Article in Neurosurgical review, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

25 authors.

Sai Chandan ReddyDepartment of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Phipps 102, Baltimore, MD, USA.
S Farzad MaroufiDepartment of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Phipps 102, Baltimore, MD, USA.
James FeghaliDepartment of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Phipps 102, Baltimore, MD, USA.
A Karim AhmedDepartment of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Phipps 102, Baltimore, MD, USA.
Nicole PageDepartment of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Phipps 102, Baltimore, MD, USA.
Omar SelimDepartment of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Phipps 102, Baltimore, MD, USA.
Melissa CanalesDepartment of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Phipps 102, Baltimore, MD, USA.
Shaan BhandarkarDepartment of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Phipps 102, Baltimore, MD, USA.
Patrick KramerDepartment of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Phipps 102, Baltimore, MD, USA.
Deepa GalaiyaDepartment of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Bryan WardDepartment of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Charles Della SantinaDepartment of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
C Matthew StewartDepartment of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Francis CreightonDepartment of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
John CareyDepartment of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Jason C NellisDepartment of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Kofi O BoaheneDepartment of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Michael LimDepartment of Neurosurgery, Stanford School of Medicine, Stanford, CA, USA.
Risheng XuDepartment of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Phipps 102, Baltimore, MD, USA.
Justin M CaplanDepartment of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Phipps 102, Baltimore, MD, USA.
Chetan BettegowdaDepartment of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Phipps 102, Baltimore, MD, USA.
Jon WeingartDepartment of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Phipps 102, Baltimore, MD, USA.
Henry BremDepartment of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Phipps 102, Baltimore, MD, USA.
Rafael J TamargoDepartment of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Phipps 102, Baltimore, MD, USA.
Christopher M JacksonDepartment of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Phipps 102, Baltimore, MD, USA. cjacks53@jhmi.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Facial nerve (FN) palsy is a significant complication of microsurgical resection of vestibular schwannoma (VS) and can profoundly impact patient quality of life. Patients exhibit two distinct trajectories of FN dysfunction: immediate facial nerve palsy (IFNP), occurring early in the postoperative period, and delayed facial nerve palsy (DFNP), characterized by new-onset weakness after an initially normal postoperative examination. In this study, we aimed to identify preoperative, intraoperative, and postoperative predictors of facial nerve trajectory to inform patient counseling and improve long-term functional outcomes. Electronic health records at our institution were reviewed to identify patients who underwent microsurgical resection of VS between July 2016 and April 2024. Preoperative data included demographic characteristics, tumor features, and baseline facial nerve function, classified according to the House-Brackmann (HB) grading scale. Univariable and multivariable logistic regression analyses were performed to identify independent predictors of IFNP and DFNP. Cox regression analysis was used to evaluate factors associated with intrinsic recovery among patients with IFNP. Among 433 patients who underwent vestibular schwannoma resection, 36.3% developed IFNP and 10.9% DFNP. DFNP was typically transient, with 90% of patients (27/30) achieving good recovery within two months. In contrast, only 35% of IFNP patients (N = 55) experienced intrinsic recovery, and approximately 60% of those without recovery (N = 66) required facial reanimation surgery. On multivariable analysis, larger tumor size (> 2 cm) independently predicted IFNP, while younger age (< 33 years) independently predicted DFNP. In this study, we found that larger tumors increased the risk of immediate FN palsy, while younger age was associated with delayed onset palsy. High HB scores at discharge predicted slower or incomplete recovery in immediate cases, whereas nearly all delayed cases recovered without intervention. Systematically characterizing these postoperative trajectories can enhance patient counseling, guide risk stratification, and inform timely interventions to optimize long-term facial nerve function.

Indexed as

Facial Nerve InjuriesFacial ParalysisMicrosurgeryNeuroma, AcousticNeurosurgical ProceduresPostoperative ComplicationsAdultAgedFacial NerveFemaleHumansMaleMiddle AgedRetrospective StudiesTime FactorsTreatment OutcomeFacial nerve palsyMicrosurgical resectionPredictorsRecoveryTimingVestibular schwannoma

Identifiers

PMID41984336

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.