The Effect of Famciclovir on Delayed Facial Paralysis After Acoustic Tumor Resection

Objectives/Hypothesis: To determine the efficacy of prophylactic famciclovir to significantly reduce the percentage of patients experiencing postoperative delayed facial paresis. Study Design: Prospective evaluation of facial nerve grade for two groups (treated and untreated) with famciclovir before and after surgery. All procedures were conducted by the same group of experienced neurotologists. Methods: In a tertiary neurotologic private practice, the percentage of 1,023 patients with delayed facial paresis after undergoing microsurgical removal of unilateral acoustic tumor with no preoperative treatment was compared to the percentage of 530 patients with preoperative famciclovir treatment. Patients were prescribed famciclovir 500 mg BID for 3 days before surgery and 5 days postoperative. The House-Brackmann Facial Nerve Grade was assessed prospectively at preoperative, immediate postoperative, and discharge from the hospital in both groups. Results: Twenty-five percent of the no famciclovir group experienced delayed facial palsy compared to 20% in the famciclovir group, a statistically significant difference (P < .04). The famciclovir group undergoing translabyrinthine craniotomy showed a significantly greater decrease in percentage of patients with delayed facial palsy than those undergoing middle fossa craniotomies (P < .003). Conclusions: Famciclovir administered preoperatively and after craniotomies resulted in a smaller percentage of patients developing delayed facial weakness. We are continuing the routine use of famciclovir in perioperative acoustic tumor management and recommend that others do so.