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A significant correlation between delayed cure after microvascular decompression and positive response to preoperative anticonvulsant therapy in patients with hemifacial spasm

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Abstract

Although microvascular decompression (MVD) is a reliable treatment for hemifacial spasm (HFS), the postoperative course is varied. We retrospectively analyzed the resolution pattern of the spasm and specified predictors for delayed cure after MVD. This study included 114 consecutive patients with typical HFS. All of them were followed up for at least 1 year after operation. Patients were divided into three groups depending on the postoperative course: immediate cure, delayed cure, and failure. To identify the predictive factors for delayed cure after MVD, logistic regression analyses were applied using candidate clinical factors, such as duration of symptom, the tendency of the spasm, preoperative medical treatment, and offending vessels. Among the 114 patients, 107 patients were cured. For those cured, 65 patients were classified as immediate cure and 42 patients were classified as delayed cure. Cumulative spasm-free rates after 1 week, 1 month, and 3 months after MVD were 70, 88, and 97 %, respectively. No predictive factors between the cured and failure groups were observed. According to multivariate analysis, preoperative anticonvulsant therapy was found to be the sole significant predictive factor for delayed cure after MVD (p = 0.025). A significant correlation between delayed cure and preoperative anticonvulsant therapy was found in our study, which suggests that hyperexcitation of the facial nucleus plays an important role in pathogenesis of delayed cure. Therefore, if a patient demonstrating a positive response to preoperative anticonvulsant therapy showed a persistent spasm after MVD, reoperation should be delayed for at least 3 months after the initial operation.

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References

  1. BarkerII FG, Jannetta PJ, Bissonette DJ, Shields PT, Larkins MV, Jho HD (1995) Microvascular decompression for hemifacial spasm. J Neurosurg 82:201–210

    Article  Google Scholar 

  2. Fernandez-Conejero I, Ulkatan S, Sen C, Deletis V (2012) Intra-operative neurophysiology during microvascular decompression for hemifacial spasm. Clin Neurophysiol 123:78–83

    Article  CAS  PubMed  Google Scholar 

  3. Hatem S, Sindou M, Vial C (2001) Intraoperative monitoring of facial EMG responses during microvascular decompression for hemifacial spasm. Prognostic value for long-term outcome: a study in a 33-patient series. Br J Neurosurgery 15:496–499

    Article  CAS  Google Scholar 

  4. Hirano S, Yamakami I, Sato M, Kada K, Fukuda K, Nakamaru T, Higuchi Y, Saeki N (2014) Contineous intraoperative monitoring fo a abnormal muscle response in microvascular decompression for hemifacial spasm; a real-time navigator for complete relief. Neurosurg Rev 37:311–320

    Article  Google Scholar 

  5. Ishikawa M, Nakanishi T, Takamiya Y, Namiki J (2001) Delayed resolution of redidual hemifacial spasm after microvascular decompression operations. Neurosurgery 49:847–856

    CAS  PubMed  Google Scholar 

  6. Jo KW, Kong D-S, Park K (2013) Microvascular decompression for hemifacial spasm: long-term outcome and prognostic factors, with emphasis on delayed cure. Neurosurg Rev 36:297–302

    Article  PubMed  Google Scholar 

  7. Kalkanis SN, Eskandar EN, Carter BS, Barker FG II (2003) Microvascular decompression surgery in the United States, 1996 to 2000: mortality rates, morbidity rates, and the effect of hospital and surgeon volumes. Neurosurgery 52:1251–1262

    Article  PubMed  Google Scholar 

  8. Kim HR, Rhee D-J, Kong D-S, Park K (2009) Prognostic factors of hemifacial spasm after microvascular decompression. J Korean Neurosurg Soc 45:336–340

    Article  PubMed  PubMed Central  Google Scholar 

  9. Kong D-S, Park K, Shin B-G, Lee JA, Eum D-O (2007) Prognostic value of the lateral spread response for intraoperative electromyography monitoring of the facial musculature during microvascular decompression for hemifacial spasm. J Neurosurg 106:384–387

    Article  PubMed  Google Scholar 

  10. Kureshi SA, Wilkins HR (1998) Posterior fossa reexploration for persistent or recurrenct trigeminal neuralgia or hemifacial spasm: Surgical findings and therapeutic implications. Neurosurgery 43:1111–1117

    Article  CAS  PubMed  Google Scholar 

  11. Li CS (2005) Varied pattern of postoperative course of disappearance of hemifacial spasm after microvascular decompression. Acta Neurochir 147:617–620

    Article  CAS  PubMed  Google Scholar 

  12. Miller LE, Miller VM (2012) Safety and effectiveness of microvascular decompression for treatment of hemifacial spasm: a systematic review. Br J Neurosurgery 26:138–444

    Article  Google Scholar 

  13. Moller AR (1995) Neurophysiological monitoring in cranial nerve surgery. Neurosurg Q 5:55–72

    Article  Google Scholar 

  14. Moller AR (1999) Vascular compression of ctanial nerves II. Pathophysiology. Neurol Res 21:439–443

    CAS  PubMed  Google Scholar 

  15. Oh E-T, Kim E, Hyun D-K, Yoon SH, Park H, Park H-C (2008) Time course of symptom disappearance after microvascular decompression for hemifacial spasm. J Korean Neurosurg Soc 44:245–248

    Article  PubMed  PubMed Central  Google Scholar 

  16. Park YS, Chang JH, Cho J, Park YG, Chung SS, Chang JW (2006) Reoperation for persistent or recurrent hemifacial spasm after microvascular decompression. Neurosurgery 58:1162–1167

    Article  PubMed  Google Scholar 

  17. Sekula RFJ, Bhatia S, Frederickson AM, Jannetta PJ, Quigley MR, Small GA, Breisinger R (2009) Utility of intraoperative electromyography in microvascular decompression for hemifacial spasm: a meta-analysis. Neurosurg Focus 27:E10

    Google Scholar 

  18. Shin JC, Chung UH, Kim YC, Park CI (1997) Prospective study of microvascular decompression in hemifacial spasm. Neurosurgery 40:730–735

    Article  CAS  PubMed  Google Scholar 

  19. Sindou M, Keravel Y (2009) Neurosurgical treatment of primary hemifacial spasm with microvascular decompression. Neurochirurgie 55:236–247

    Article  CAS  PubMed  Google Scholar 

  20. Tobishima H, Hatayama T, Ohkuma H (2014) Relation between the persistence of an abnormal muscle response and the long-term clinical course aftermicrovascular decompression for hemifacial spasm. Neurol Med Chir (Tokyo) 54:474–482

    Article  Google Scholar 

  21. Wang X, Thirumala PD, Shah A, Gardner P, Habeych M, Crammond D, Balzer J, Burkhart L, Horowitz M (2013) Microvascular decompression for hemiifacial spasm: focus on late reoperation. Neurosurg Rev 36:637–644

    Article  PubMed  Google Scholar 

  22. Yamashita S, Kawaguchi T, Fukuda M, Watanabe M, Tanaka R, Kameyama S (2005) Abnormal muscle response monitoring during microvascular decompression for hemifacial spasm. Acta Neurochir 147:933–937

    Article  CAS  PubMed  Google Scholar 

  23. Zhong J, Zhu J, Li S-T, Li X-Y, Wang X-H, Yang M, Wan L, Guan H-X (2010) An analysis of failed microvascular decompression in patients with hemifacial spasm: focused on the early reoperative findings. Acta Neurochir 152:2119–2123

    Article  PubMed  Google Scholar 

  24. Zhong J, Xia L, Dou N-N, Ying T-T, Zhu J, Liu M-X, Li S-T (2015) Delayed relief of hemifacial spasm after microvascular decompression: can it be avoided? Acta Neurochir 157:93–99

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Graduate School of Medicine, Hokkaido University, N15, W7, Kita-Ku, Sapporo, 060-8638, Japan

    Shunsuke Terasaka, Shigeru Yamaguchi, Hiroyuki Kobayashi, Hiroaki Motegi & Kiyohiro Houkin

  2. Department of Neurosurgery, Teine Keijinkai Medical Center, Sapporo, Japan

    Katsuyuki Asaoka

Authors
  1. Shunsuke Terasaka
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  2. Katsuyuki Asaoka
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  3. Shigeru Yamaguchi
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  4. Hiroyuki Kobayashi
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  5. Hiroaki Motegi
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  6. Kiyohiro Houkin
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Corresponding author

Correspondence to Shunsuke Terasaka.

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Comments

Marc Sindou, Lyon, France

Not all patients get complete relief of their spasm before discharge after MVD procedure (37 % in our series). Decision of early reoperation is controversial. Our experience, like the one of the present authors, as well as of several other teams, is that secondary improvement, then cure, may be obtained after significant delay (as in two thirds of our patients who had still spasm after surgery). Delay can be from several months to one entire year, scarcely longer (only 3 in our overall series of 280 patients got (progressive) cure with a delay as long as 3 years). This experience leads us to advocate not to redo operation before term of the first year.

A number of teams use intraoperative facial EMG recordings to monitor lateral spread responses to facial branches’ stimulation, for controlling efficacy of the decompression. Our experience, like (only a few) others, convinces us of the insufficient reliability of the method to be certain of the completeness of the decompression. Waiting, when there is estimation that the conflicting vessel(s) at facial REZ/brainstem has (have) been properly dislodged, is the only (wise) mean to manage with the patient’s problem.

For the authors interested in the pathophysiology of primary HFS (among several: Aage Moller in particular), the main mechanism of this functional disease is hyperactivity of the facial nucleus, induced by the chronic, pulsatile, compression at the facial REZ/brainstem region. The fact that spasms may persist after an apparently effective decompression from the causal conflicting artery, and that cure needs a certain period of time to be achieved, is consistent with the underlying mechanism.

The merit of the present work is to provide some “helping” argument to incite waiting, especially in the patients who had responsiveness to anticonvulsant medications in their past history. We observed that in the patients with residual spasms after surgery, anticonvulsants could be (partially) effective, in spite of not having had significant effects prior their MVD.

Nicola Boari, Milan, Italy

The authors have retrospectively analyzed data about a series of 114 consecutive patients who underwent microvascular decompression (MVD) for hemifacial spasm at two institutions; the resolution patterns were considered and a multivariate statistical analysis was performed in order to find possible predictors for delayed cure. Preoperative anticonvulsivant therapy was found to be the sole significant predictive factors. I would like to congratulate the authors because the reported surgical series is numerically considerable, statistical analysis is appropriate, and a reasonable physiopathological explanation of the results is reported and discussed. The results of the study can be useful in daily clinical practice, suggesting that reoperation in patients showing a persistent spasm after MVD should be delayed for at least 3 months after initial operation, in particular in patients treated with anticonvulsivant therapy before surgery.

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Terasaka, S., Asaoka, K., Yamaguchi, S. et al. A significant correlation between delayed cure after microvascular decompression and positive response to preoperative anticonvulsant therapy in patients with hemifacial spasm. Neurosurg Rev 39, 607–613 (2016). https://doi.org/10.1007/s10143-016-0729-4

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  • DOI: https://doi.org/10.1007/s10143-016-0729-4

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