Accelerated recovery from facial paralysis using IT-TMS in one patient after Masseteric-Facial nerve end-to-end anastomosis

The resection of intracranial tumors in cerebellopontine angle area such as acoustic neuroma leads to fractures of the middle fossa and mastoid, often causing peripheral facial paralysis. The injury of Facial Nerve is the immediate cause. Studies have shown that cortical neurons repaired by peripheral nerve transfer could contribute to functional remodeling of injured nerve. Hence, nerve anastomosis is an effective method to establish nerve regeneration pathway. Current treatments include end-to-end and side-to-end hypoglossal-facial nerve anastomosis (HFA) and masseteric-facial nerve anastomosis (MFA). HFA needs to cover a relative longer distance between hypoglossal and facial nerves, complicated with either secondary dystonia or synkinetic movements that end up with a bad prognosis. Masseteric and facial nerves are located more closely with a better match in diameter, and therefore less complications in both donor and recipient sites could be expected. As reported, patients subjected to end-to-end MFA regained a normal facial function and good symmetry at about 12 months after surgery. Repetitive transcranial magnetic stimulation (rTMS) applies continuously adjustable magnetic field through repeated stimulation to achieve cumulative methods that has been successfully used in poststroke rehabilitation. However, whether rTMS can be used in promoting facial recovery from paralysis in patients after MFA remains to be explored. Here we aimed to verify the accelerated recovery from facial paralysis with a novel form of rTMS, individual-target TMS (IT-TMS), in patients after end-to-end MFA.