Postoperative rehabilitation strategies and facial nerve recovery after cerebellopontine angle tumor surgery.

Abstract

Facial nerve injury remains a challenging complication of Cerebellopontine Angle (CPA) tumor surgery, often resulting in prolonged functional impairment. The present study aimed to examine the association between different postoperative rehabilitation strategies and long-term clinical and electrophysiological recovery following facial nerve reconstruction. We conducted a single-center retrospective cohort study including adult patients who underwent CPA tumor resection with intraoperatively confirmed facial nerve injury requiring reconstructive intervention between 2018 and 2023. Based on rehabilitation approaches applied in routine clinical practice, patients were classified into three groups: standard postoperative therapy, standard therapy combined with Transcutaneous Electrical Nerve Stimulation (TENS), and a multimodal rehabilitation strategy integrating TENS with targeted pharmacological support. Clinical follow-up extended to 12 months. Facial nerve function was evaluated using the House-Brackmann scale, Yanagihara system, Sunnybrook Facial Grading System, and Facial Disability Index, alongside surface and needle electromyographic parameters. Multivariable analyses were performed to account for demographic, tumor-related, surgical, and baseline functional factors. All groups demonstrated progressive improvement in facial nerve function over the follow-up period. Patients receiving rehabilitation protocols that included TENS exhibited greater improvements across clinical grading scales and electrophysiological measures compared with those receiving standard therapy alone. The multimodal rehabilitation group showed the largest magnitude of functional recovery, reflected by improved facial symmetry, voluntary movement, patient-reported physical and social function, and more favorable electromyographic patterns. These associations remained consistent after adjustment for potential confounders. In this retrospective cohort, postoperative rehabilitation strategies incorporating electrical stimulation were associated with enhanced functional and electrophysiological recovery after facial nerve reconstruction. Multimodal rehabilitation approaches may offer added translational value in clinical neurorehabilitation following CPA tumor surgery. Prospective studies are warranted to further refine and validate optimized rehabilitation protocols.