(0966) The Price of Paralysis: Cost Analysis of Facial Rehabilitation After Vestibular Schwannoma Resection

Introduction: Facial dysfunction after vestibular schwannoma (VS) resection is a source of morbidity for patients, but the cost of associated rehabilitation is not well defined. The present study seeks to quantify these costs.

Methods: A retrospective cohort study was performed at a tertiary referral center to evaluate the cost of rehabilitative therapies for patients treated sequentially between 9/2016 and 5/2021 that experienced facial nerve dysfunction after resection of VS. Estimated costs were calculated based on CPT codes and institutional billing data.

Results: Fifteen patients (67% female, median age at surgery of 56-years-old) were identified as having facial dysfunction that was managed postoperatively. Fourteen of the patients (93%) had tumors with cerebellopontine angle extension, with a median size of 20.7 mm (Interquartile Range [IQR] 13.8-23.5). One patient (7%) had an intracanalicular tumor that was 8.8 mm. The median House-Brackmann (HB) grade immediately after surgery was 6 (IQR 3-6), and the median HB grade at most recent evaluation was 5 (IQR 4-6) with a median follow-up of 29 months (IQR 17-44). During management, 11 patients (73%) underwent periocular procedures, 4 patients (27%) underwent extensive rehabilitative surgeries, 5 patients (33%) underwent Botox therapy, and 8 patients (53%) performed facial retraining therapy. The median cost associated with these treatments was $3,125 (IQR $1,120-$14,843), with the cost of extensive rehabilitative surgery ranging from $14,843 to $41,607. There was no significant difference in cost between patients that had a HB grade < 5 (n=7) and ≥5 (n=8) ($5,349.29 vs. $11,233.63, p=0.3). For patients with synkinesis, 4 patients (n=9, 44%) did not undergo Botox, and of the patients offered advanced rehabilitative surgeries, 2 patients (n=6, 33%) did not pursue surgery.

Conclusions: The cost associated with facial rehabilitation is reasonable no matter the degree of facial dysfunction. Despite this, some patients elect to not pursue rehabilitative therapies, serving as a point of education for patients and providers alike.