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Potential reasons for failure and recurrence in microvascular decompression for hemifacial spasm

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Abstract

Background

To examine the factors contributing to persistent and recurrent hemifacial spasms (HFS) following a microvascular decompression (MVD) procedure and to suggest technical improvements to prevent such failures.

Methods

A retrospective review was conducted on fifty-two cases of repeat surgery. The extent of the previous craniotomy and the location of neurovascular compression (NVC) were investigated. The operative findings were categorized into two groups: “Missing Compression” and “Teflon Contact”. The analysis included long-term outcomes and operative complications after repeat MVD procedures.

Results

Missing compression was identified in 29 patients (56%), while Teflon contact was observed in 23 patients (44%). Patients with missing compression were more likely to experience improper craniotomy (66%) compared to those with Teflon contact (48%). Medially located NVC was a frequent finding in both groups, mainly due to compression by the anterior inferior cerebellar artery. In the missing compression group, during the repeat MVD, Teflon sling retraction was utilized in 79% of cases, while in the Teflon contact group, the most common procedure involved removing the Teflon in contact (65%). After the repeat MVD procedure, immediate spasm relief was achieved in 42 patients (81%), with six (12%) experiencing delayed relief. After a median follow-up of 54 months, 96% of patients were free from spasms. Delayed facial palsy, facial weakness, and hearing impairment were more frequently observed in the Teflon contact group.

Conclusions

A proper craniotomy that provides adequate exposure around the REZ is crucial to prevent missing the culprit vessel during the initial MVD procedure. Teflon contact on the REZ should be avoided, as it poses a potential risk of procedure failure and recurrence.

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Data availability

Data is available upon reasonable request.

Code availability

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Authors and Affiliations

  1. Department of Neurosurgery, Koto Memorial Hospital, Higashiomi, Shiga, Japan

    Takuro Inoue & Yukihiro Goto

  2. Department of Neurosurgery, National Brain Center Hospital, Jakarta, Indonesia

    Takuro Inoue, Peter Adidharma & Mustaqim Prasetya

  3. Department of Neurosurgery, Nadogaya Hospital, Chiba, Japan

    Yasuaki Inoue

  4. Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA

    Takanori Fukushima

Authors
  1. Takuro Inoue
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  2. Yukihiro Goto
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  3. Yasuaki Inoue
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  4. Peter Adidharma
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  5. Mustaqim Prasetya
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  6. Takanori Fukushima
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Contributions

Study concept and design: Takuro Inoue. Data collection and analysis: Takuro Inoue, Yukihiro Goto, Yasuaki Inoue, Mustaqim Prasetya, and Takanori Fukushima. Data interpretation: Peter Adidharma. Writing the manuscript: Takuro Inoue. Reviewing and editing: Yukihiro Goto, Yasuaki Inoue, and Mustaqim Prasetya. Supervision: Takanori Fukushima. All authors approved the final version of the submitted manuscript.

Corresponding author

Correspondence to Takuro Inoue.

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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.

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Inoue, T., Goto, Y., Inoue, Y. et al. Potential reasons for failure and recurrence in microvascular decompression for hemifacial spasm. Acta Neurochir 165, 3845–3852 (2023). https://doi.org/10.1007/s00701-023-05861-7

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  • DOI: https://doi.org/10.1007/s00701-023-05861-7

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