Delayed Facial Nerve Palsy after Vestibular Schwannoma Surgery in the COVID-19 Pandemic

Facial nerve palsy is the most common complication after vestibular schwannoma surgery. Its etiology is unknown and, in a small group of patients, it can manifest as delayed palsy.

To focus on delayed palsy itself and its possible association with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

Only patients with primary surgery were included in the current study. Delayed palsy was defined as the new onset of facial nerve palsy that occurred more than 72 hours after surgery. The results were correlated with information from the database of the Institute of Health Information and Statistics of the Czech Republic.

From January 2017 to December 2022, a total of 194 patients were operated on for vestibular schwannoma, out of whom 143 met the inclusion criteria. Delayed facial nerve palsy occurred in 9 patients, more frequently in the coronavirus disease 2019 (COVID-19)-related years, with a ratio of 1:8 ( p  = 0.0046) when comparing the periods of 2017 to 2019 and 2020 to 2022. There was a difference in the age of patients with delayed palsy (average: 44.0 years) and those without delayed palsy (average 49.9 years; p  = 0.04). The age distribution in the individual years did not differ ( p  = 0.38); however, the distribution of patients coincided with the overall appearance of SARS-CoV-2 infection in the population across different age groups ( p  < 0.0001).

Delayed facial nerve palsy is a rare entity after vestibular schwannoma surgery. The increase in its incidence during the COVID-19 pandemic is evident and corresponds to the general epidemiological situation with respect to age distribution.