Management of cranial nerves I through VII following skull base surgery

Cranial nerve injuries are common with skull base surgery. While injuries to the seventh and tenth cranial nerves can be corrected to satisfactory degrees, rehabilitation of the third, fourth, and sixth nerves is possible to only a limited degree. This study stresses the management of facial paralysis following skull base surgery and is based upon the author's experiences in dealing with 38 patients who suffered such a facial paralysis. The best results of rehabilitative surgical treatment were achieved with techniques that connect the central stump to the peripheral system. The time between nerve injury and repair was the most significant determinant of the success of the surgical procedure: when the nerve was repaired within three months of the injury, the best results were obtained; when the central stump was not available or the injury was more than two years old, repair was not as satisfactory. In the latter case the procedure of choice was the 12th-7th nerve hookup. Indications and results of facial nerve grafting, cross faciofacial nerve hookups, muscle swings, free muscle implantations, and eye reanimation techniques are discussed.