Corticosteroid Effect on Facial Function after Cerebellopontine Angle Tumor Resection: A Double-Blind Study versus Placebo

Objectives: The aim of this study was to assess the effect of corticosteroids administered intra- and postoperatively on the occurrence of facial palsy secondary to a cerebellopontine angle (CPA) tumor resection, and to investigate pre- and intraoperative prognostic factors.

Materials and Methods: A multicenter, prospective, randomized, double-blind, and versus placebo study was conducted between 2006 and 2010. Three hundred and ten patients operated on for a CPA tumor (96% vestibular schwannomas, 4% miscellaneous) were included from five participating centers. Population was stratified into small tumors (≤15 mm in CPA on axial MRI views) and large tumors. In each group, patients were randomized into placebo or corticosteroid subgroup. Patients received either IV methylprednisolone at 1 mg/kg/j or placebo intraoperatively, and from postoperative days 1 to 5. The principal judgment criterion was the proportion of patients with a facial function > 2 at postoperative day 8. Patients were followed up 30 days after surgery.

Results: Corticosteroids did not affect facial function according to the principal judgment criterion and by both intention to treat and per protocol analyses. Similarly, corticosteroids did not affect facial function at postoperative day 30. Incidence of postoperative complications (digestive, metabolic, infectious, psychiatric) were similar in placebo and corticosteroid groups.

Conclusions: Administration of corticosteroids during and after CPA tumor surgery does not affect short-term facial function as assessed by the House and Brackmann grading system.