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Microvascular decompression for hemifacial spasm: long-term outcome and prognostic factors, with emphasis on delayed cure

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Abstract

The postoperative course of microvascular decompression (MVD) for hemifacial spasm (HFS) is variable, and the optimal time for assessing the results is unclear. From April 1997 to October 2007, MVD for HFS was performed in 801 patients. Patients were divided into two groups (cured or failed) according to subjective patient assessments over a 3-year period. We analyzed patient characteristics and surgical findings to determine prognostic factors. Medical records were analyzed retrospectively over the 3-year follow-up period. Of the 801 patients who underwent surgery, 743 (92.8 %) appeared to be cured, 70 (8.7 %) had residual or recurrent spasms more than 1 year after surgery, 11 (1.3 %) had gradual improvement over 3 years, and 1 (0.1 %) had delayed improvement more than 3 years after surgery. Fifty-eight patients (7.2 %) had residual or recurrent spasms more than 3 years after surgery, of which 19 (2.4 %) had recurrence after initial relief. The mean time to spasm recurrence was 18.9 months. Intraoperative resolution of the lateral spread response (LSR) after decompression (p = 0.048) and severe indentation (p = 0.038) were significant predictors of good long-term outcome after MVD for HFS. In our series, 70 patients (8.7 %) had residual or recurrent spasms more than 1 year after surgery, of which 12 (17.1 %) improved gradually after 1 year. If the surgeon can confirm intraoperative resolution of the LSR and severe indentation, reoperation can be delayed until 3 years after MVD.

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Authors and Affiliations

  1. Department of Neurosurgery, The Catholic University of Korea College of Medicine, Bucheon St. Mary’s Hospital, Bucheon, South Korea

    Kwang Wook Jo

  2. Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, South Korea

    Doo-Sik Kong & Kwan Park

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  1. Kwang Wook Jo
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  2. Doo-Sik Kong
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Correspondence to Kwan Park.

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Comments

Tetsuya Goto, Matsumoto, Japan

The long-term outcome after microvascular decompression (MVD) to treat hemifacial spasm (HFS) was presented from a leading institute. They concluded that the remnant HFS after MVD should be waited for at least 3 years because their results indicated that there was 10 % of residual or recurrent spasms more than 1 year after surgery, of which 20 % of patients improved HFS gradually until 3 years later.

This conclusion should be applied only for well-experienced neurosurgeons of MVD who can be sure of the success of their own procedure. When the residual or recurrent spasms after MVD happens, we must exclude the possibility of inadequate MVD and re-compression by several factors such as shift of the prosthesis or compression by prosthesis itself. Wait-and-follow should be chosen after exclusion of these reasons of residue or recurrence. The postoperative long-standing follow-up improving rate after MVD must be superior to that of the true natural history of HFS, which has not been clarified yet.

Giorgio Iaconetta, Naples, Italy

This report by Jo et al. documents their experience on 801 patients with hemifacial spasm who were treated in 10 years by microvascular decompression.

The paper corroborates the fact that microvascular decompression is the treatment of choice for hemifacial spasm, with 92.8 % of patients free of spasm after surgery. Their results are excellent and analogous to the results reported by my Maestro Prof. Samii (92.3 %). Hearing loss is often the most common complication which occurs frequently after surgical reexploration and if the offending vessel is located in between the VII–VIII cranial nerve complex. Intraoperative monitoring of brain stem evoked potentials is imperative in diminishing the risk of hearing loss. As reported in the paper by an experienced group, this surgical procedure, if perfectly performed, is a low-risk treatment, well-tolerated even by elderly patients, associated to a low recurrence rate, and represents the definitive treatment for more than 90 % of patients. Botulinum toxin and medical therapy should be reserved for patients who are not suitable for surgery.

Makoto Nakamura, Hannover, Germany

Jo et al. present an impressive series of 801 patients, who underwent microvascular decompression (MVD) for hemifacial spasm (HFS) during a time period of 10 years. Surgical results were analyzed retrospectively over a mean follow-up of 64 months.

It is a well-known phenomenon that HFS may persist after successful MVD for several months. In our experience, the majority (>90 %) of patients are spasm-free after 6–12 months.

The authors report an excellent surgical outcome with 743 out of 801 patients (92.8 %) achieving definitive cure after a 3-year follow-up period. However, 11 patients among them showed a gradual improvement of spasm even 1–3 years after surgery. The chance of delayed cure, even up to 3 years after MVD, deserves special consideration.

Most interestingly, the authors found that intraoperative resolution of the lateral spread response (LSR) after decompression and severe indentation were significant predictors of good long-term outcome after MVD for HFS. Based on their retrospective data, they therefore recommend delay of reoperation until 3 years after MVD, when the surgeon was able to confirm intraoperative resolution of the LSR and severe indentation of the root entry zone.

Although the retrospective nature of the study limits the data available for evaluation of long-term outcome, the reported intraoperative observations are important and may help in the decision pro or contra reoperation in residual HFS.

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Jo, K.W., Kong, DS. & Park, K. Microvascular decompression for hemifacial spasm: long-term outcome and prognostic factors, with emphasis on delayed cure. Neurosurg Rev 36, 297–302 (2013). https://doi.org/10.1007/s10143-012-0420-3

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  • DOI: https://doi.org/10.1007/s10143-012-0420-3

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