{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T12:57:25Z","timestamp":1781009845173,"version":"3.54.1"},"reference-count":31,"publisher":"MJS Publishing, Medical Journals Sweden AB","license":[{"start":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T00:00:00Z","timestamp":1780963200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPHS"],"abstract":"<jats:p>Background: After tumour control, facial nerve preservation is a primary objective in vestibular schwannoma surgery. Predicting long-term recovery remains challenging, and the prognostic value of the Koos grade is unclear.\nObjective: The primary outcome was facial palsy at 12 months (partial or severe). Secondary outcomes included Day 1 function, recovery trajectory, intraoperative signal status, Koos grade, complications and difference in surgical approaches.\nMethods: Retrospective cohort study at Sahlgrenska University Hospital (2006\u20132024). Two reviewers independently extracted clinical data and assigned blinded Koos grades. Predictors were assessed using multivariable logistic regression.\nResults: Of 293 surgically treated patients, 213 with complete follow-up formed the study cohort (retrosigmoid 121, translabyrinthine 92). Sixty-four (30.0%) had any palsy at 12 months: 50 (23.5%) partial and 14 (6.6%) severe. Day 1 facial function dominated all models: severe palsy at Day 1 carried an adjusted odds ratio (OR) of 222.08 (95% CI 26.45\u20131864.44; Firth-corrected OR 128, 21\u2013762), while partial function had an OR of 8.83 (3.93\u201319.83). Female sex was independently associated with palsy (OR 2.87, p = 0.013); surgical approach was not (OR 0.77, p = 0.550). Koos grade showed no association (OR 1.19, p = 0.730). Among patients with normal Day 1 function, 90% remained palsy free at 1 year; among those with severe palsy, only 4.5% recovered.Conclusions: A single bedside examination on post-operative Day 1 predicts long-term facial nerve outcome more powerfully than any variable tested, including Koos grade; comparison of surgical approaches remained inconclusive owing to era confounding. Three recovery trajectories provide a framework for tailored post-operative management.<\/jats:p>","DOI":"10.2340\/jphs.v61.45989","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T11:57:30Z","timestamp":1781006250000},"page":"153-160","source":"Crossref","is-referenced-by-count":0,"title":["Facial nerve recovery trajectories and predictors after vestibular schwannoma surgery: a single-centre cohort study of 213 patients"],"prefix":"10.2340","volume":"61","author":[{"given":"Lina","family":"Nord","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3628-7686","authenticated-orcid":false,"given":"Tobias","family":"Hall\u00e9n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-7547-0339","authenticated-orcid":false,"given":"Linus","family":"K\u00f6ster","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna-Lena","family":"Roos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lena","family":"Koll\u00e9n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5569-0588","authenticated-orcid":false,"given":"Madiha","family":"Bhatti-S\u00f8fteland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1183","published-online":{"date-parts":[[2026,6,9]]},"reference":[{"key":"158069","doi-asserted-by":"crossref","unstructured":"Goldbrunner R, Weller M, Regis J, et al. EANO guideline on the diagnosis and treatment of vestibular schwannoma. Neuro Oncol. 2020;22(1):31\u201345.","DOI":"10.1093\/neuonc\/noz153"},{"key":"158070","doi-asserted-by":"crossref","unstructured":"Cioffi G, Yeboa DN, Kelly M, et al. Epidemiology of vestibular schwannoma in the United States, 2004\u20132016. Neuro Oncol Adv. 2020;2(1):vdaa135.","DOI":"10.1093\/noajnl\/vdaa135"},{"key":"158071","doi-asserted-by":"crossref","unstructured":"Marinelli JP, Lohse CM, Carlson ML. Incidence of vestibular schwannoma over the past half-century: a population-based study of Olmsted County, Minnesota. Otolaryngol Head Neck Surg. 2018;159(4):717\u2013723.","DOI":"10.1177\/0194599818770629"},{"key":"158072","doi-asserted-by":"crossref","unstructured":"Stangerup SE, Tos M, Caye-Thomasen P, et al. Increasing annual incidence of vestibular schwannoma and age at diagnosis. J Laryngol Otol. 2004;118(8):622\u2013627.","DOI":"10.1258\/0022215041917989"},{"key":"158073","doi-asserted-by":"crossref","unstructured":"Link MJ, Driscoll CL, Neff BA, et al. A 25-year update on the facial nerve sparing approach for vestibular schwannoma. World Neurosurg. 2025;195:e123603.","DOI":"10.1016\/j.wneu.2024.123603"},{"key":"158074","doi-asserted-by":"crossref","unstructured":"Starnoni D, Daniel RT, Tuleasca C, et al. Systematic review and meta-analysis of the technique of subtotal resection and stereotactic radiosurgery for large vestibular schwannomas: a \u2018nerve-centred\u2019 approach. Neurosurg Focus. 2018;44(3):E4.","DOI":"10.3171\/2017.12.FOCUS17669"},{"key":"158075","doi-asserted-by":"crossref","unstructured":"Garcia-Torrico F, Mendieta CD, De Nigris Vasconcellos F, et al. Evaluating the effectiveness and complications of the retrosigmoid, translabyrinthine and middle fossa approaches in vestibular schwannoma surgical management: a comprehensive systematic review and meta-analysis of 6,889 patients. Neurosurg Rev. 2025;48:229.","DOI":"10.1007\/s10143-025-03237-2"},{"key":"158076","doi-asserted-by":"crossref","unstructured":"Ansari SF, Terry C, Cohen-Gadol AA. Surgery for vestibular schwannomas: a systematic review of complications by approach. Neurosurg Focus. 2012;33(3):E14.","DOI":"10.3171\/2012.6.FOCUS12163"},{"key":"158077","doi-asserted-by":"crossref","unstructured":"Gibbon FL, Lindner RJ, Vial ADM, et al. Translabyrinthine versus retrosigmoid approach for vestibular schwannoma: a systematic review and an updated meta-analysis. Otolaryngol Head Neck Surg. 2025;172(3):774\u2013786.","DOI":"10.1002\/ohn.1031"},{"key":"158078","doi-asserted-by":"crossref","unstructured":"Pruijn IMJ, van Heemskerken P, Kunst HPM, et al. Patient-preferred outcomes in patients with vestibular schwannoma: a qualitative content analysis of symptoms, side effects and their impact on health-related quality of life. Qual Life Res. 2023;32(10):2887\u20132897.","DOI":"10.1007\/s11136-023-03433-x"},{"key":"158079","doi-asserted-by":"crossref","unstructured":"Cross T, Sheard CE, Garsten M, et al. Functional outcomes and self-reported quality of life in patients with facial nerve impairment following vestibular schwannoma surgery. Diagnostics. 2024;14(21):2387.","DOI":"10.3390\/diagnostics14212387"},{"key":"158080","doi-asserted-by":"crossref","unstructured":"Jain Y, Jumah F, Chaudhry S, et al. Total facial paralysis after vestibular schwannoma surgery: probability of regaining normal function. Ann Otol Rhinol Laryngol. 2004;113(9):706\u2013710.","DOI":"10.1177\/000348940411300906"},{"key":"158081","doi-asserted-by":"crossref","unstructured":"Bartek J, Jr, Forander P, Thurin E, et al. Short-term surgical outcome for vestibular schwannoma in Sweden: a nation-wide registry study. Front Neurol. 2019;10:43.","DOI":"10.3389\/fneur.2019.00043"},{"key":"158082","doi-asserted-by":"crossref","unstructured":"Yawn RJ, Dedmon MM, Xie D, et al. Delayed facial nerve paralysis after vestibular schwannoma resection. J Neurol Surg B. 2019;80:283\u2013286.","DOI":"10.1055\/s-0038-1669941"},{"key":"158083","doi-asserted-by":"crossref","unstructured":"Zhang X, Wen H, Chen G, et al. Incidence and risk factors of delayed facial paralysis after vestibular schwannoma resection: a systematic review and meta-analysis. World Neurosurg. 2025;197:123938.","DOI":"10.1016\/j.wneu.2025.123938"},{"key":"158084","doi-asserted-by":"crossref","unstructured":"Khan AJ, Szczepura A, Palmer S, et al. Physical therapy for facial nerve paralysis (Bell\u2019s palsy): an updated and extended systematic review of the evidence for facial exercise therapy. Clin Rehabil. 2022;36(11):1424\u20131449.","DOI":"10.1177\/02692155221110727"},{"key":"158085","doi-asserted-by":"crossref","unstructured":"Hohman MH, Hadlock TA. Etiology, diagnosis, and management of facial palsy: 2000 patients at a facial nerve center. Laryngoscope. 2014;124(7):E283\u2013E293.","DOI":"10.1002\/lary.24542"},{"key":"158086","doi-asserted-by":"crossref","unstructured":"Koos WT, Day JD, Matula C, et al. Neurotopographic considerations in the microsurgical treatment of small acoustic neurinomas. J Neurosurg. 1998;88(3):506\u2013512.","DOI":"10.3171\/jns.1998.88.3.0506"},{"key":"158087","doi-asserted-by":"crossref","unstructured":"Firth D. Bias reduction of maximum likelihood estimates. Biometrika. 1993;80(1):27\u201338.","DOI":"10.1093\/biomet\/80.1.27"},{"key":"158088","doi-asserted-by":"crossref","unstructured":"Heinze G, Schemper M. A solution to the problem of separation in logistic regression. 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Otolaryngol Head Neck Surg. 2021;164(5):1085\u20131093.","DOI":"10.1177\/0194599820961389"},{"key":"158092","doi-asserted-by":"crossref","unstructured":"Sharples L, Papachristofi O, Rex S, et al. Exploring mechanisms of action in clinical trials of complex surgical interventions using mediation analysis. Clin Trials. 2020;17(6):701\u2013712.","DOI":"10.1177\/1740774520947644"},{"key":"158093","doi-asserted-by":"crossref","unstructured":"Troude L, Boucekine M, Montava M, et al. Predictive factors of early postoperative and long-term facial nerve function after large vestibular schwannoma surgery. World Neurosurg. 2019;127:e599\u2013e608.","DOI":"10.1016\/j.wneu.2019.03.218"},{"key":"158094","unstructured":"Xu F, Pan S, Alsulami FM, et al. Development of a nomogram integrating preoperative and intraoperative variables for predicting facial nerve outcomes in vestibular schwannoma surgery. Front Neurol. 2021;12:817071."},{"key":"158095","doi-asserted-by":"crossref","unstructured":"D\u00edaz-Aristizabal U, Vald\u00e9s-Vilches LF, Chaverri-Fierro D, et al. Correlations between impairment, psychological distress, disability, and quality of life in peripheral facial palsy. Neurologia (Engl Ed). 2019;34(7):423\u2013428.","DOI":"10.1016\/j.nrleng.2019.03.001"},{"key":"158096","doi-asserted-by":"crossref","unstructured":"Fu W, Liang J, Li M, et al. Effect of modified facial paralysis rehabilitation nursing on patients with facial paralysis after vestibular schwannoma surgery. Heliyon. 2024;10:e35060.","DOI":"10.1016\/j.heliyon.2024.e35060"},{"key":"158097","unstructured":"Patel AJ, Vivas EX, Carlson ML, et al. Congress of neurological surgeons systematic review and evidence-based guidelines on intraoperative cranial nerve monitoring in vestibular schwannoma surgery: 2025 update. Neurosurgery. 2025;96(Suppl 1):S1\u2013S8."},{"key":"158098","doi-asserted-by":"crossref","unstructured":"Machetanz K, Wang SS, Naros G, et al. Sex-specific difference in treatment success\/failure after vestibular schwannoma treatment. Neuro Oncol Adv. 2025;7(1):vdaf025.","DOI":"10.1093\/noajnl\/vdaf025"},{"key":"158099","doi-asserted-by":"crossref","unstructured":"Hatch JL, Bauschard MJ, Nguyen SA, et al. National trends in vestibular schwannoma surgery: influence of patient characteristics on outcomes. Otolaryngol Head Neck Surg. 2018;159(1): 102\u2013109.","DOI":"10.1177\/0194599818765717"}],"container-title":["Journal of Plastic Surgery and Hand Surgery"],"original-title":[],"link":[{"URL":"https:\/\/medicaljournalssweden.se\/JPHS\/article\/download\/45989\/54276","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/medicaljournalssweden.se\/JPHS\/article\/download\/45989\/54276","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T11:57:51Z","timestamp":1781006271000},"score":1,"resource":{"primary":{"URL":"https:\/\/medicaljournalssweden.se\/JPHS\/article\/view\/45989"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,9]]},"references-count":31,"URL":"https:\/\/doi.org\/10.2340\/jphs.v61.45989","relation":{},"ISSN":["2000-6764"],"issn-type":[{"value":"2000-6764","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,9]]}}}