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Facial nerve paralysis may occur along the natural progression of an untreated vestibular schwannoma, as a surgical complication following vestibular schwannoma resection, or as a late sequela of stereotactic radiation. However, facial paralysis occurring as a subacute complication of CyberKnife (Accuray, Inc., Sunnyvale, CA, USA) stereotactic radiation has not previously been reported. A 47-year-old male presented with a right vestibular schwannoma measuring 3.1 cm in greatest dimension with House-Brackmann grade I/VI facial function and American Academy of Otolaryngology – Head and Neck Surgery class a hearing. After deferring surgery, he elected to undergo CyberKnife stereotactic radiation to a total dose of 18 Gy in three stages. Within three months, the patient noticed gradual ipsilateral facial paralysis that progressed to House-Brackmann grade VI/VI over the course of four weeks. The patient’s facial function was assessed continuously for one year with no volitional function or resting tone. He thus underwent a hypoglossal-facial transfer, restoring facial function to House-Brackmann IV/VI, with durable results at a follow-up length of five years. To our knowledge, this is the first reported case of subacute facial paralysis following CyberKnife stereotactic radiation for vestibular schwannoma.

Subacute Facial Nerve Paralysis Following Cyberknife Treatment for Vestibular Schwannoma