Abstract
Background
Microvascular decompression (MVD) is an effective method for directly treating hemifacial spasms (HFS). The timing for the consideration of failed MVD and reoperation has been paradoxical.
Objective
This study aimed to investigate the delayed complete remission of HFS in terms of prevalence rate, duration between surgery and delayed complete remission, and predictive factors.
Methods
A hundred patients with HFS who underwent MVD from 2012–2021 were enrolled in the study. All HFS occurred as a result of compression of the facial nerve by adjacent blood vessels. Clinical information, intraoperative findings, and surgical outcomes were incorporated for data analysis.
Results
In the first week after MVD, 67 of 100 patients achieved complete remission of HFS, while the remaining 33 had incomplete remission. In long-term follow-up, 26 individuals gradually developed delayed complete remission with a median duration of 9.1 months. Finally, 86 of 100 patients achieved complete long-term remission. Recurrent HFS and incomplete remission were found in 7 and 7 patients, respectively. Factors associated with postoperative complete remission in the first week were a severe degree of facial nerve compression (p = 0.047, OR 2.75, 95% CI 1.01–7.40), with long-term complete remission was left-sided HFS (p = 0.012, OR 5.73, 95% CI 1.47–22.36), and with the appearance of delayed complete remission was the prolonged duration of HFS at least 3 years before MVD (p = 0.046, OR 3.75, 95% CI 1.03–13.76). Transient facial paresis was found in 11% of the patients. Of them, facial nerve function recovered completely in all cases.
Conclusions
A delayed complete remission of HFS could be expected in long-term follow-up after MVD and is probably related to a longer duration of HFS before surgery. Unnecessary reoperation should be avoided in the early years following the first surgery.
Similar content being viewed by others
.
References
Abbruzzese G, Berardelli A, Defazio G (2011) Hemifacial spasm. Handb Clin Neurol 100:675–680
Al Menabbawy A, Refaee EE, Elwy R, Salem AA, Lehmann S, Vollmer M, Matthes M, Fleck S, Baldauf J, Schroeder HWS (2022) A multivariable prediction model for recovery patterns and time course of symptoms improvement in hemifacial spasm following microvascular decompression. Acta Neurochir 164:833–844
Amano Y, Asayama B, Noro S, Abe T, Okuma M, Honjyo K, Seo Y, Nakamura H (2022) Significant correlation between delayed relief after microvascular decompression and morphology of the abnormal muscle response in patients with hemifacial spasm. Neurol Med Chir 62:513–520
Auger RG, Whisnant JP (1990) Hemifacial spasm in Rochester and Olmsted County, Minnesota, 1960 to 1984. Arch Neurol 47:1233–1234
Barker FG 2nd, Jannetta PJ, Bissonette DJ, Shields PT, Larkins MV, Jho HD (1995) Microvascular decompression for hemifacial spasm. J Neurosurg 82:201–210
Chang WS, Chung JC, Kim JP, Chung SS, Chang JW (2012) Delayed recurrence of hemifacial spasm after successful microvascular decompression: Follow-up results at least 5 years after surgery. Acta Neurochir 154:1613–1619
Dai Y, Ni H, Xu W, Lu T, Liang W (2016) Clinical analysis of hemifacial spasm patients with delay symptom relief after microvascular decompression of distinct offending vessels. Acta Neurol Belg 116:53–56
Goto Y, Matsushima T, Natori Y, Inamura T, Tobimatsu S (2002) Delayed effects of the microvascular decompression on hemifacial spasm: A retrospective study of 131 consecutive operated cases. Neurol Res 24:296–300
Han JS, Lee JA, Kong DS, Park K (2012) Delayed cranial nerve palsy after microvascular decompression for hemifacial spasm. J Korean Neurosurg Soc 52:288–292
Hatayama T, Kono T, Harada Y, Yamashita K, Utsunomiya T, Hayashi M, Nakajima H, Hatanaka R, Shimada D, Takemura A, Tabata H, Tobishima H (2015) Indications and timings of reoperation for residual or recurrent hemifacial spasm after microvascular decompression: Personal experience and literature review. Neurol Med Chir 55:663–668
Hatem J, 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 Neurosurg 15:496–499
Heuser K, Kerty E, Eide PK, Cvancarova M, Dietrichs E (2007) Microvascular decompression for hemifacial spasm: Postoperative neurologic follow-up and evaluation of life quality. Eur J Neurol 14:335–340
Hua Z, Da TY, Hui WX, Tingting Y, Jin Z, Yan Y, Shiting L (2016) Delayed facial palsy after microvascular decompression for hemifacial spasm. J Craniofac Surg 27:781–783
Hyun SJ, Kong DS, Park K (2010) Microvascular decompression for treating hemifacial spasm: Lessons learned from a prospective study of 1,174 operations. Neurosurg Rev 33:325–334
Illingworth RD, Porter DG, Jakubowski J (1996) Hemifacial spasm: A prospective long-term follow up of 83 cases treated by microvascular decompression at two neurosurgical centres in the United Kingdom. J Neurol Neurosurg Psychiatry 60:72–77
Ishikawa M, Nakanishi T, Takamiya Y, Namiki J (2001) Delayed resolution of residual hemifacial spasm after microvascular decompression operations. Neurosurgery 49:847–854
Jiang C, Xu W, Dai Y, Lu T, Jin W, Liang W (2017) Failed microvascular decompression surgery for hemifacial spasm: A retrospective clinical study of reoperations. Acta Neurochir 159:259–263
Jiang S, Lang L, Sun B, He J, Cai J, Chen L, Hu J, Mao Y (2022) Reoperation for residual or recurrent hemifacial spasm after microvascular decompression. Acta Neurochir 164:2963–2973
Jo KW, Kong DS, Park K (2013) Microvascular decompression for hemifacial spasm: long-term outcome and prognostic factors, with emphasis on delayed cure. Neurosurg Rev 36:297–301
Joo BE, Kim JS, Deletis V, Park KS (2022) Advances in intraoperative neurophysiology during microvascular decompression surgery for hemifacial spasm. J Clin Neurol 18:410–420
Kang MC, Choi YS, Choi HK, Lee SH, Ghang CG, Kim CH (2012) Efficacy of the disappearance of lateral spread response before and after microvascular decompression for predicting the long-term results of hemifacial spasm over two years. J Korean Neurosurg Soc 52:372–376
Kang YS, Lee HG, Ryu KY, Cho JH, Kang DG, Kim SC (2006) The efficacy of microvascular decompression in hemifacial spasm over the course of time. J Korean Neurosurg Soc 39:265–270
Kong CC, Guo ZL, Xu XL, Yu YB, Yang WQ, Wang Q, Zhang L (2020) Delayed facial palsy after microvascular decompression for hemifacial spasm. World Neurosurg 134:e12–e15
Kureshi SA, Wilkins RH (1998) Posterior fossa reexploration for persistent or recurrent trigeminal neuralgia or hemifacial spasm: Surgical findings and therapeutic implications. Neurosurgery 43:1111–1117
Lee JA, Jo KW, Kong DS, Park K (2012) Using the new clinical grading scale for quantification of the severity of hemifacial spasm: Correlations with a quality of life scale. Stereotact Funct Neurosurg 90:16–19
Lee JA, Kim KH, Kong DS, Lee S, Park SK, Park K (2019) Algorithm to predict the outcome of microvascular decompression for hemifacial spasm: A data-mining analysis using a decision tree. World Neurosurg 125:e797–e806
Lee JM, Park HR, Choi YD, Kim SM, Jeon B, Kim HJ, Kim DG, Paek SH (2018) Delayed facial palsy after microvascular decompression for hemifacial spasm: Friend or foe? J Neurosurg 129:299–307
Lee MH, Jee TK, Lee JA, Park K (2016) Postoperative complications of microvascular decompression for hemifacial spasm: Lessons from experience of 2040 cases. Neurosurg Rev 39:151–158
Li CS (2005) Varied patterns of postoperative course of disappearance of hemifacial spasm after microvascular decompression. Acta Neurochir 147:617–620
Li MW, Jiang XF, Wu M, He F, Niu C (2020) Clinical research on delayed cure after microvascular decompression for hemifacial spasm. J Neurol Surg A Cent Eur Neurosurg 81:195–199
Li S, Feng B, Xie C, You C, Wei X, Zheng X (2016) Good surgical outcomes of hemifacial spasm patients with obvious facial nerve indentation and color change. World Neurosurg 92:218–222
Liu MX, Xia L, Zhong J, Li B, Dou NN, Li ST (2018) What should we do for those hemifacial spasm patients without efficacy following microvascular decompression: Expectation of delayed relief or early reoperation? World Neurosurg 110:e897–e900
Lu AY, Yeung JT, Gerrard JL, Michaelides EM, Sekula RF Jr, Bulsara KR (2014) Hemifacial spasm and neurovascular compression. Sci World J 2014:349319
Lv MY, Deng SL, Long XF, Liu ZL (2017) Long-term outcome of microvascular decompression for hemifacial spasm. Br J Neurosurg 31:322–326
Montava M, Rossi V, CurtoFais CL, Mancini J, Lavieille JP (2016) Long-term surgical results in microvascular decompression for hemifacial spasm: Efficacy, morbidity and quality of life. Acta Otorhinolaryngol Ital 36:220–227
Marneffe V, Polo G, Fischer C, Sindou M (2003) Microsurgical vascular decompression for hemifacial spasm. Follow-up over one year, clinical results and prognostic factors. Study of a series of 100 cases. Neurochirurgie 49:527–535
Møller AR, Jannetta PJ (1985) Hemifacial spasm: Results of electrophysiologic recording during microvascular decompression operation. Neurology 35:969–974
Nielsen VK (1984) Pathophysiology of hemifacial spasm: I. Ephaptic transmission and ectopic excitation. Neurology 34:418–426
Nimmannitya P (2015) Hemifacial spasm and surgical treatment (microvascular decompression). Thammasat Med J 15:291–302
Oh ET, Kim E, Hyun DK, Yoon SH, Park H, Park HC (2008) Time course of symptom disappearance after microvascular decompression for hemifacial spasm. J Korean Neurosurg Soc 44:245–248
Poungvarin N, Devahastin V, Viriyavejakul A (1995) Treatment of various movement disorders with botulinum a toxin injection: An experience of 900 patients. J Med Assoc Thai 78:281–288
Pumseenil S, Sitthinamsuwan B (2017) Hemifacial spasm and microvascular decompression: The treatment of neurovascular conflict. J Med Assoc Thai 100:S214–S223
Ravina K, Strickland BA, Rennert RC, Bakhsheshian J, Russin JJ, Giannotta SL (2019) Revision microvascular decompression for trigeminal neuralgia and hemifacial spasm: Factors associated with surgical failure. J Neurol Surg B Skull Base 80:31–39
Samii M, Günther T, Iaconetta G, Muehling M, Vorkapic P, Samii A (2002) Microvascular decompression to treat hemifacial spasm: Long-term results for a consecutive series of 143 patients. Neurosurgery 50:712–718
Sato Y, Shimizu K, Iizuka K, Irie R, Matsumoto M, Mizutani T (2022) Factors related to the delayed cure of hemifacial spasm after microvascular decompression: An analysis of 175 consecutive patients. J Neurol Surg B Skull Base 83:548–553
Shibahashi K, Morita A, Kimura T (2013) Surgical results of microvascular decompression procedures and patient’s postoperative quality of life: Review of 139 cases. Neurol Med Chir 53:360–364
Shin JC, Chung UH, Kim YC, Park CI (1997) Prospective study of microvascular decompression in hemifacial spasm. Neurosurgery 40:730–734
Sindou M, Keravel Y (2009) Neurosurgical treatment of primary hemifacial spasm with microvascular decompression. Neurochirurgie 55:236–247
Sindou M, Mercier P (2018) Microvascular decompression for hemifacial spasm: Outcome on spasm and complications. A review. Neurochirurgie 64:106–116
Sindou MP (2005) Microvascular decompression for primary hemifacial spasm. Importance of intraoperative neurophysiological monitoring. Acta Neurochir 147:1019–1026
Soriano-Baron H, Vales-Hidalgo O, Arvizu-Saldana E, Moreno-Jimenez S, Revuelta-Gutierrez R (2015) Hemifacial spasm: 20-year surgical experience, lesson learned. Surg Neurol Int 6:83
Terasaka S, Asaoka K, Yamaguchi S, Kobayashi H, Motegi H, Houkin K (2016) 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
Wang A, Jankovic J (1998) Hemifacial spasm: Clinical findings and treatment. Muscle Nerve 21:1740–1747
Wang X, Thirumala PD, Shah A, Gardner P, Habeych M, Crammond D, Balzer J, Burkhart L, Horowitz M (2013) Microvascular decompression for hemifacial spasm: focus on late reoperation. Neurosurg Rev 36:637–643
Xia L, Zhong J, Zhu J, Dou NN, Liu MX, Li ST (2015) Delayed relief of hemifacial spasm after microvascular decompression. J Craniofac Surg 26:408–410
Zhang P, Selim MH, Wang H, Kuang W, Wu M, Ji C, Hu G, Wu L, Zhu X, Guo H (2019) Intraoperative measuring of the offending vessel’s pressure on the facial nerve at root exit zone in patients with hemifacial spasm during microvascular decompression: A prospective study. World Neurosurg 122:e89–e95
Zhong J, Zhu J, Sun H, Dou NN, Wang YN, Ying TT, Xia L, Liu MX, Tao BB, Li ST (2014) Microvascular decompression surgery: Surgical principles and technical nuances based on 4000 cases. Neurol Res 36:882–893
Acknowledgements
The authors gratefully acknowledge Saowalak Hunnangkul, Clinical Epidemiology Unit, Office of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, for assistance with statistical analysis.
Funding
No funding was received for this research.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethical approval
The protocol for this study was approved by the Siriraj Institutional Review Board (SIRB), Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. This study complied with the principles set forth in the 1964 Declaration of Helsinki and all of its later amendments or with comparable ethical standards. Written informed consent was not required for this study.
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Nunta-aree, S., Kateyoi, T. & Sitthinamsuwan, B. Delayed complete remission of hemifacial spasms following microvascular decompression and the implications for optimal time of revision surgery. Acta Neurochir 166, 12 (2024). https://doi.org/10.1007/s00701-024-05891-9
Received:
Accepted:
Published:
DOI: https://doi.org/10.1007/s00701-024-05891-9