"Take the Facial Nerve Out of the Picture": A Novel Approach for Skull Base Recurrences and Facial Nerve Tumors.

Introduction: Facial paralysis secondary to skull base recurrences or facial nerve tumors presents a significant challenge, as tumor resection usually worsens facial function. Objective: The aim of this study is to show an alternative approach, ensuring facial reanimation irrespective of the evolution of the tumor, the so-called "take the facial nerve out of the picture." Methods: Retrospective study of patients with a skull base recurrence or a facial nerve tumor who underwent facial reanimation prior to tumor management. Facial function was assessed using the House-Brackmann and Sunnybrook Facial Grading Scale. Results: Four patients with skull base recurrences and eight with facial nerve tumors underwent facial reanimation with nerve transfers (n = 11) and a microvascular flap (n = 1) before tumor treatment. In all cases, facial function improved to House-Brackmann grades III or IV, with improvement of average Sunnybrook Facial Grading Scale scores from 25.25 (standard deviation [SD] 20.45) to 57.67 (SD 10.3) (p = 0.004). Three patients with skull base recurrence underwent tumor resection uneventfully, while the eight patients with facial nerve tumor remain observed. Conclusions: Early facial reanimation can preserve long-term facial function, facilitate tumor resection, and provide flexibility in managing complex skull base recurrences and facial nerve tumors.