{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T14:29:55Z","timestamp":1787236195312,"version":"build-2736575974"},"reference-count":16,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2012,5]]},"abstract":"\n Object<\/jats:title>\n Crocodile tears syndrome (CTS) is a lacrimal hypersecretion disorder characterized by excessive tearing with gustatory stimulation while eating, drinking, or smelling food. Surgeons tend to overlook CTS after vestibular schwannoma (VS) surgery because its symptoms are less obvious compared with facial paralysis. The authors aim to elucidate the precise incidence and the detailed natural course of CTS after VS surgery.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This study included 128 consecutive patients with unilateral VSs resected via a retrosigmoid, lateral suboccipital approach. Clinical information on the patients was obtained by retrospective chart review. The presence of, time of onset of, and recovery of patients from CTS were obtained from the chart or evaluated from the most recent outpatient visit.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 14 patients (10.9%) developed CTS. Motor function of the facial nerve at discharge was statistically related to the occurrence of CTS (p < 0.001). The odds ratio of House-Brackmann Grade 4 compared with Grade 1 was 86.4 (p < 0.001). A bimodal distribution of CTS onset was observed, with a mean onset of 6.1 \u00b1 4.0 months after resection. The CTS improved in 10 patients (71%) at various intervals, whereas CTS resolved in only 7 patients (50%) at a mean interval of 10.9 \u00b1 7.9 months. The mean interval to recovery in the early-onset group was 9.7 \u00b1 7.9 months, and it was 18 months in the late-onset group; the mean is given \u00b1 SD throughout.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The occurrence of CTS following VS surgery was more common than expected; however, a surgical procedure intended to protect the functioning of the facial nerve appears to be conducive to reduction of the occurrence of CTS. To reduce the distress caused by CTS, all patients should be given sufficient information and provide their informed consent prior to surgery.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2011.12.jns111859","type":"journal-article","created":{"date-parts":[[2012,2,3]],"date-time":"2012-02-03T10:04:50Z","timestamp":1328263490000},"page":"1121-1125","source":"Crossref","is-referenced-by-count":8,"title":["Crocodile tears syndrome after vestibular schwannoma surgery"],"prefix":"10.3171","volume":"116","author":[{"given":"Akira","family":"Nakamizo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koji","family":"Yoshimoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshiyuki","family":"Amano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masahiro","family":"Mizoguchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomio","family":"Sasaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns111859","series-title":"Acta Otolaryngol","first-page":"239","article-title":"The gusto-lachrymal reflex. The syndrome of crocodile tears","volume":"54","author":"Axelsson","year":"1962"},{"key":"b2-jns111859","series-title":"Arch Neurol Psychiatry","first-page":"56","article-title":"Paroxysmal lacrimation, syndrome of crocodile tears, and its surgical treatment; relation to auriculotemporal syndrome","volume":"61","author":"Boyer","year":"1949"},{"key":"b3-jns111859","series-title":"AMA Arch Neurol Psychiatry","first-page":"299","article-title":"The syndrome of crocodile tears","volume":"65","author":"Chorobski","year":"1951"},{"key":"b4-jns111859","series-title":"Br Med J","first-page":"1518","article-title":"Crocodile tears","volume":"1","author":"Golding-Wood","year":"1963"},{"key":"b5-jns111859","series-title":"J Physiol","first-page":"103","article-title":"Stimulus intensity in relation to excitation and preand post-excitatory inhibition in isolated elements of mammalian retinae","volume":"103","author":"Granit","year":"1944"},{"key":"b6-jns111859","series-title":"Crocodiles: Their Natural History, Folklore and Conservation","author":"Guggisberg","year":"1972"},{"key":"b7-jns111859","series-title":"Basic and Clinical Science Course, Section 5","first-page":"158","article-title":"Neuro-ophthalmology","author":"Hedges","year":"1997"},{"key":"b8-jns111859","series-title":"Ophthal Plast Reconstr Surg","first-page":"289","article-title":"Treatment of Frey's syndrome (gustatory sweating) and \u2018crocodile tears\u2019 (gustatory epiphora) with purified botulinum toxin","volume":"16","author":"Hofmann","year":"2000"},{"key":"b9-jns111859","series-title":"Otolaryngol Head Neck Surg","first-page":"146","article-title":"Facial nerve grading system","volume":"93","author":"House","year":"1985"},{"key":"b10-jns111859","series-title":"Laryngoscope","first-page":"809","article-title":"Nervus intermedius function after vestibular schwannoma removal: clinical features and pathophysiological mechanisms","volume":"105","author":"Irving","year":"1995"},{"key":"b11-jns111859","series-title":"Plast Reconstr Surg","first-page":"58","article-title":"The crocodile tear syndrome","volume":"63","author":"McCoy","year":"1979"},{"key":"b12-jns111859","series-title":"Ophthal Plast Reconstr Surg","first-page":"453","article-title":"Duration of botulinum toxin effect in the treatment of crocodile tears","volume":"22","author":"Nava-Casta\u00f1eda","year":"2006"},{"key":"b13-jns111859","series-title":"Ophthalmology","first-page":"2322","article-title":"Successful treatment of crocodile tears by injection of botulinum toxin into the lacrimal gland: a case report","volume":"106","author":"Riemann","year":"1999"},{"key":"b14-jns111859","series-title":"Brain Res","first-page":"403","article-title":"Postfacial palsy phenomena: faulty nerve regeneration or ephaptic transmission?","volume":"95","author":"Sadjadpour","year":"1975"},{"key":"b15-jns111859","series-title":"J Neurosurg","first-page":"648","article-title":"Histological considerations of the cleavage plane for preservation of facial and cochlear nerve functions in vestibular schwannoma surgery. Clinical article","volume":"110","author":"Sasaki","year":"2009"},{"key":"b16-jns111859","series-title":"Acta Otolaryngol","first-page":"113","article-title":"Pathological features of human facial nerve after central injury during tumor removal, with special reference to the non-motor component","volume":"93","author":"Ylikoski","year":"1982"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/116\/5\/article-p1121.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/116\/5\/article-p1121.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/116\/5\/article-p1121.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,26]],"date-time":"2023-03-26T21:07:22Z","timestamp":1679864842000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/116\/5\/article-p1121.xml"}},"subtitle":["Clinical article"],"short-title":[],"issued":{"date-parts":[[2012,5]]},"references-count":16,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.3171\/2011.12.jns111859","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2012,5]]}}}