Delayed transmastoid facial nerve decompression surgery in patients with Ramsay-Hunt syndrome presenting with neurophysiologically complete paralysis

Abstract

Objectives: To determine the efficacy of delayed transmastoid facial nerve decompression in patients with Ramsay Hunt Syndrome (RHS) presenting with complete facial paralysis.

Methods: Twenty-five RHS patients with complete facial nerve paralysis presenting electroneuronographic (ENoG) degeneration ≥90% underwent transmastoid facial nerve decompression more than 3 weeks after the onset of paralysis. The principal features measured were 12 months pre- and post-operative House-Brackmann (HB) grades and the presence of a direct intraoperative neural response (INR) prior to decompression procedure. Correlations between these parameters, and the time between symptom onset and surgery (within or later than 30 and 50 d) were statistically analyzed.

Results: Of the 25 patients 13 (52%) exhibited good recovery (HB grade I or II) at 12 months-post-operatively. The timing of decompression generally did not significantly influence outcome but patients treated within 50 d of symptom onset enjoyed better outcomes than those treated later (p = .047). The presence of an INR significantly influenced outcomes (p = .0003).

Conclusions: The success of delayed transmastoid facial nerve decompression in RHS patients was not affected between 25–30 and 30–40 d from symptom onset but was compromised when the delay was >50 d. The presence or absence of an INR was a good predictor of post-operative prognosis.

Chinese abstract

目的：确定延迟经乳突面神经减压对Ramsay Hunt综合征（RHS）伴完全性面神经麻痹的患者的疗效。

方法：25例完全性面神经麻痹的RHS患者的神经电图（ENoG）变性≥90%, 在麻痹发生3周后进行经乳突面神经减压术。测量的主要特征是手术前和手术后12个月的House-Brackmann（HB）等级, 以及在减压手术前直接术中神经反应（INR）的存在。统计分析这些参数之间的相关性, 以及症状发作和手术之间的时间（在30天到50天之内或之后）。

结果：25例患者中, 13例（52%）术后12个月恢复良好（HB级I或II）。什么时候减压通常不会显著影响结果, 但在症状发作后50 天内接受治疗的患者比后来接受治疗的患者获得更好的疗效（p = 0.047）。 INR的存在显著影响结果（p = .0003）。

结论：RHS患者的延迟面神经减压术的成功率在症状发作25-30天和30-40天之间不受影响, 但延迟时间大于50天时成功率大打折扣。 INR的存在或不存在是术后预后的良好预测指标。

Keywords:

• Transmastoid facial nerve decompression
• Ramsay Hunt syndrome
• electroneuronography

Disclosure statement

No potential conflict of interest was reported by the authors.