Abstract
Background
Although microvascular decompression (MVD) surgery has been widely accepted as an effective treatment for hemifacial spasm (HFS), delayed facial palsy (DFP) is not an unusual complication, but it has only been sporadically described in the literature. The purpose of this study was to examine the probability of occurrence, the risk/predisposing factors, and the prognosis and timing of DFP.
Methods
A prospective cohort study was conducted that included patients diagnosed with HFS and treated by MVD at our institution. All patients were followed up at the outpatient department or by telephone from December 2009 to December 2014. Categorical variables were analyzed using the Pearson’s Chi-square test or Fisher’s exact test. Continuous variables were compared using the independent Student’s t test. The Spearman rank test was used to determine the correlation between the time of onset and the duration of DFP. The risk/predisposing factors were analyzed by the logistic regression method.
Results
We enrolled 248 patients who were treated by MVD for HFS. During the follow-up period, 16 patients (6.5 %) developed DFP. Fifteen of those patients had a complete recovery, and in one patient the facial palsy did not resolve. The average onset time was 10.2 days (range, 2–30 days) after surgery, and the mean duration of DFP after MVD, with exclusion of the permanent facial palsy patient, was 59.7 days (range, 7–220 days). The time of onset was correlated with the duration of DFP after MVD (p = 0.036). Furthermore, hypertension contributed to DFP (odds ratio [OR] 4.226, 95 % confidence interval [CI] 1.089–16.401, p = 0.037).
Conclusions
Although the degree of facial palsy was variable, most patients experienced a complete recovery without requiring any special treatment. DFP may be a self-healing disease that resolves spontaneously without any treatment. The time of onset was correlated with the duration of DFP; i.e., an earlier development of DFP corresponded with a shorter duration, whereas a later development of DFP corresponded with a longer duration. Our results also suggest that hypertension contributes to DFP.
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References
Bademosi O, Ogunlesi TO, Osuntokun BO (1987) Clinical study of unilateral peripheral facial nerve paralysis in Nigerians. Af J Med Sci 16:197–201
Barker FGJP, Bissonette DJ (1995) Microvascular decompression for hemifacial spasm. J Neurosurg J Neurosurg 82:201–210
Franco-Vidal V, Nguyen DQ, Guerin J, Darrouzet V (2004) Delayed facial paralysis after vestibular schwannoma surgery: role of herpes viruses reactivation—our experience in eight cases. Otol Neurotol 25:805–810
Franco-Vidal VN, Guerin J, Darrouzet V (2004) Delayed facial paralysis after vestibular schwannoma surgery: role of herpes virus reactivation-our experience in eight cases. Otol Neurotol: Off Publ Am Otol Soc Am Neurotol Soc Eur Acad Otol Neurotol 25:805–810
Furukawa K, Sakoh M, Kumon Y, Teraoka M, Ohta S, Ohue S, Hatoh N, Ohnishi T (2003) Delayed facial palsy after microvascular decompression for hemifacial spasm due to reactivation of Varicella zoster virus. Neurol Surg 31:899–902
Gianoli GJ, Kartush JM (1996) Delayed facial palsy after acoustic neuroma resection: the role of viral reactivation. Am J Otol 17:625–629
Hengstman GJ, Gons RA, Menovsky T, Lunel FV, van de Vlasakker CJ, de Vries J (2005) Delayed cranial neuropathy after neurosurgery caused by herpes simplex virus reactivation: report of three cases. Surg Neurol 64:67–69, discussion 69–70
Huh R, Han IB, Moon JY, Chang JW, Chung SS (2008) Microvascular decompression for hemifacial spasm: analyses of operative complications in 1582 consecutive patients. Surg Neurol 69:153–157
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
Han J-S, Lee J-A, Kong D-S, Park K (2012) Delayed cranial nerve palsy after microvascular decompression for hemifacial spasm. J Korean Neurosurg Soc 52:288–292s. doi:10.3340/jkns.2012.52.4.288
Jannette P (1998) Typical or atypical hemifacial spasm. J Neurosurg 89:346–347
Kim BTHS, Chang JC, Shin WH (1999) Delayed facial palsy following microvascular decompression in hemifacial spasm. J Korean Neurosurg Soc 28:1332–1336
Kumar S, Jain S, Diwan SK, Mahajan SN (2011) Severe systemic hypertension presenting with infranuclear facial palsy. Int J Nutr Pharmacol Neurol Dis 1:83. doi:10.4103/2231-0738.77540
Kuroki A, Itagaki S, Nagai O (1991) Delayed facial palsy after microvascular decompression for hemifacial spasm. Facial Nerve Res 11:147–150
Lovely TJ, Getch CC, Jannetta PJ (1998) Delayed facial weakness after microvascular decompression of cranial nerve VII. Surg Neurol 50:449–452
Menovsky TVOJ, Graham MD (1999) On the mechanism of transient postoperative deficit of cranial nerve. Surg Neurol 51:223–226
Rhee DJ, Kong DS, Park K, Lee JA (2006) Frequency and prognosis of delayed facial palsy after microvascular decompression for hemifacial spasm. Acta Neurochir (Wien) 148:839–843, discussion 843
Samii M, Gunther 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, discussion 718–719
Savadi-Oskouei D, Abedi A, Sadeghi-Bazargani H (2008) Independent role of hypertension in Bell’s palsy: a case–control study. Eur Neurol 60:253–257
Wang A, Jankovic J (1998) Hemifacial spasm: clinical findings and treatment. Muscle Nerve 21:1740–1747
Wilkins RH (1991) Hemifacial spasm: a review. Surg Neurol 36:251–277
Zhang H, Lei D, You C, Mao BY, Wu B, Fang Y (2013) The long-term outcome predictors of pure microvascular decompression for primary trigeminal neuralgia. World Neurosurg 79:756–762
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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Lun-Xin Liu and Chang-Wei Zhang contributed equally to this work.
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Liu, LX., Zhang, CW., Ren, PW. et al. Prognosis research of delayed facial palsy after microvascular decompression for hemifacial spasm. Acta Neurochir 158, 379–385 (2016). https://doi.org/10.1007/s00701-015-2652-9
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DOI: https://doi.org/10.1007/s00701-015-2652-9