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Comparison between VII-to-VII and XII-to-VII coaptation techniques for early facial nerve reanimation after surgical intra-cranial injuries: a systematic review and pooled analysis of the functional outcomes

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Abstract

The surgical injury of the intracranial portion of the facial nerve (FN) is a severe complication of many skull base procedures, and it represents a relevant issue in terms of patients’ discomfort, social interactions, risk for depression, and social costs. The aim of this study was to investigate the surgical and functional outcomes of the most common facial nerve rehabilitation techniques. The present study is a systematic review of the pertinent literature, according to the PRISMA guidelines. Two different online medical databases (PubMed, Scopus) were screened for studies reporting the functional outcome, measured by the House-Brackman (HB) scale, and complications, in FN early reanimation, following surgical injuries on its intracranial portion. Data on the VII-to-VII and XII-to-VII coaptation, the surgical technique, the use of a nerve graft, the duration of the deficit, and complications were collected and pooled. The XII-to-VII end-to-side coaptation seems to provide higher chances for functional restoration (HB 1–3) than the VII-to-VII (68.8% vs 60.6%), regardless of the duration of the palsy deficit, the use or not of a nerve graft, and the use of stitches or glues. However, its complication rate was as high as 28.6%, and a second procedure is then often needed. The XII-to-VII side-to-end coaptation is the most effective in providing a functional outcome (HB 1–3), even though it is associated to a higher complication rate. Further trials are needed to better investigate this relevant topic, in terms of health-related social costs and patients’ quality of life.

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Acknowledgments

We would like to thank Dr. Alessandro Rapisarda for providing us his original drawing of the surgical techniques (Fig. 2).

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  1. Luca Ricciardi and Vito Stifano contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

    Luca Ricciardi, Vito Stifano, Nicola Montano, Liverana Lauretti, Alessandro Olivi & Carmelo Lucio Sturiale

  2. Institute of Neurosurgery, Università Cattolica del Sacro Cuore, Rome, Italy

    Luca Ricciardi, Vito Stifano, Vittorio Stumpo, Nicola Montano, Liverana Lauretti & Alessandro Olivi

  3. Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy

    Luca Ricciardi & Resi Pucci

  4. Dipartimento di Scienze Odontostomatologiche e Chirurgia Maxillo-Facciale, Università La Sapienza, Rome, Italy

    Marco Della Monaca & Valentino Valentini

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Ricciardi, L., Stifano, V., Pucci, R. et al. Comparison between VII-to-VII and XII-to-VII coaptation techniques for early facial nerve reanimation after surgical intra-cranial injuries: a systematic review and pooled analysis of the functional outcomes. Neurosurg Rev 44, 153–161 (2021). https://doi.org/10.1007/s10143-019-01231-z

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