Antiviral Prophylaxis for Delayed Facial Nerve Palsy Following Vestibular Schwannoma Resection: Single Institutional Series With Systematic Literature Review and Meta-Analyses of 7136 Patients

AND OBJECTIVES: Delayed facial nerve palsy (DFNP) is a recognized complication of vestibular schwannoma resection, with proposed mechanisms including viral reactivation, inflammation, and ischemia. Elevated herpes simplex virus and varicella zoster virus titers and responses to antiviral therapy have been reported, but evidence supporting prophylactic antiviral use remains limited....

Evidence from this meta-analysis may support considering antiviral prophylaxis post-vestibular schwannoma resection to reduce delayed facial nerve palsy risk, but clinicians should review the study's effect sizes and quality of included studies before changing protocol — multidisciplinary neurosurgical team consensus is advisable.

Delayed facial nerve palsy is a distressing post-surgical complication, and establishing a preventable viral mechanism could meaningfully shift post-operative management protocols for vestibular schwannoma surgery.

1. 01Meta-analysis pooled data from 7,136 patients who underwent vestibular schwannoma resection.
2. 02Investigates whether antiviral prophylaxis reduces incidence of delayed facial nerve palsy (sudden post-op facial weakness).
3. 03Viral reactivation (e.g., herpes family viruses) is proposed as a key mechanism for this complication.
4. 04Systematic review methodology strengthens the evidence base compared to single-institution studies.
5. 05Findings published in Neurosurgery, a high-impact peer-reviewed journal.

PMID

42223257

DOI

10.1227/neu.0000000000004096.

Journal

Neurosurgery

Publication type

meta_analysis

Evidence level

1a

Sample size

7,136

Population

Patients undergoing vestibular schwannoma resection

Intervention

Antiviral prophylaxis (post-operative)

Comparator

No antiviral prophylaxis