Association Between Prednisone and Delayed Facial Nerve Palsy After Acoustic Neuroma Resection

To evaluate whether discharge with a prednisone taper is associated with a reduced incidence of delayed facial nerve palsy (DFP) following acoustic neuroma resection.

We conducted a retrospective weighted case-control study of patients undergoing acoustic neuroma resection via middle fossa, retrosigmoid, or translabyrinthine approaches. Inclusion was restricted to patients with normal facial nerve function (House-Brackmann grade I) preoperatively and at discharge. Cases were patients who developed DFP after discharge, defined as new-onset House-Brackmann grade ≥ II occurring ≥ 72 h postoperatively. Controls were patients without DFP from the same source population. The primary exposure was discharge with a standardized oral prednisone taper (60 mg daily for 9 days followed by a 10 mg/day taper). Inverse probability weighting (IPW) based on propensity scores was used to adjust for confounding by indication. Weighted logistic regression was performed to estimate the association between prednisone taper and DFP.

The study included 74 cases and 187 controls. Steroid taper was prescribed to 44.6% of cases and 51.3% of controls. In unadjusted analysis, prednisone taper was not associated with a reduction in DFP risk. After IPW adjustment, prednisone taper was not associated with DFP (OR 0.99, 95% CI: 0.48-2.07). Covariate balance was achieved after weighting (SMD < 0.1). Steroid attributable side effects were documented in 10% of treated patients.

Discharge with a prednisone taper was not associated with a reduced incidence of delayed facial nerve palsy following acoustic neuroma resection. These findings do not support prophylactic corticosteroid use for prevention of DFP.