Microvascular decompression for hemifacial spasm outcome

Microvascular decompression for hemifacial spasm outcome

Microvascular decompression is an effective treatment for hemifacial spasm. Given that postoperative delayed cure was unavoidable, even with accurate identification of the offending vessel and sufficient decompression of the root exit zone, the delayed cure should be considered in patients undergoing reoperation due to lack of remission or relapse after the operation. Additionally, the timing of efficacy assessments should be delayed 1).

The definitive treatment for hemifacial spasm is microvascular decompression (MVD), which cures the disease in 85% to 95% of patients according to reported series. In expert hands, the MVD procedure can be done with relatively low morbidity.

Post-operatively, there may be episodes of mild HFS, however they usually begin to diminish 2–3 days following MVD. Severe spasm that does not abate suggests failure to achieve adequate decompression, and reoperation should be considered.

Surgical results of MVD depends on the duration of symptoms (shorter duration has better prognosis) as well as on the age of the patient (elderly patients do less well). Complete resolution of HFS occurred in 44 (81%) of 54 patients undergoing MVD, however, 6 of these patients had relapse 2). 5 patients (9%) had partial improvement, and 5 (9%) had no relief.


Complete resolution of spasm occurs in ≈ 85–93% 3) 4) 5) 6) 7). Spasm is diminished in 9%, and unchanged in 6% 8). Of 29 patients with complete relief, 25 (86%) had immediate post-op resolution, and the remaining 4 patients took from 3 mos to 3 yrs to attain quiescence.

Recurrence

References

1)

Li MW, Jiang XF, Wu M, He F, Niu C. Clinical Research on Delayed Cure after Microvascular Decompression for Hemifacial Spasm. J Neurol Surg A Cent Eur Neurosurg. 2019 Oct 10. doi: 10.1055/s-0039-1698461. [Epub ahead of print] PubMed PMID: 31600810.
2)

Auger RG, Peipgras DG, Laws ER. Hemifacial Spasm: Results of Microvascular Decompression of the Facial Nerve in 54 Patients. Mayo Clin Proc. 1986; 61:640–644
3)

Rhoton AL. Comment on Payner T D and Tew J M: Recurren ce of Hemifacial Spasm After Microvascular Decompression. Neurosurgery. 1996; 38
4)

Jannetta PJ. Neurovascular Compression in Cranial Nerve and Systemic Disease. Ann Surg. 1980; 192:518–525
5)

Loeser JD, Chen J. Hemifacial Spasm: Treatment by Microsurgical Facial Nerve Decompression. Neurosurgery. 1983; 13:141–146
6)

Huang CI, Chen IH, Lee LS. Microvascular Decompression for Hemifacial Spasm: Analyses of Operative Findings and Results in 310 Patients. Neurosurgery. 1992; 30:53–57
7) , 8)

Payner TD, Tew JM. Recurrence of Hemifacial Spasm After Microvascular Decompression. Neurosurgery. 1996; 38:686–691

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