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Microvascular decompression for hemifacial spasm: focus on late reoperation

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Abstract

The objective of this study is to investigate late repeat microvascular decompression (MVD) with persistent or recurrent hemifacial spasm (HFS) and to compare the clinical characteristics, intraoperative findings, complications, and outcomes with first MVD. We analyzed MVDs performed at the University of Pittsburgh Medical Center between January 1, 2000 and December 31, 2007. Thirty-three patients who underwent late redo MVDs were classified as group I and 243 patients who underwent their first MVD as group II. Clinical data were collected to analyze the difference between the two groups. The mean follow-up period was 54.48 months (range, 9–102 months). There is no significant difference in preoperative clinical characteristics (gender, age, side of MVD, botox usage, facial weakness) between the two groups. In present study, we found a vein as the offending vessel in significantly more number of patients who underwent repeat MVD as compared to first MVD (P = 0.02). The lateral spread response disappeared in 66 % of patients during repeat MVDs, which is not different from those undergoing their first MVD. No difference in the relief rate was found during the immediate postoperative, discharge, or follow-up stages between repeat and first MVD. Moreover, no difference was found in the incidence of complications between repeat MVD and first MVD. Late repeat MVD for HFS is an effective and safe procedure. No specific preoperative clinical characteristics were identified in patients with repeat MVD. Intraoperative monitoring with lateral spread response (LSR) is an effective tool to evaluate adequate decompression. In patients with persistent LSR at the end of the procedure, facial nerve compression from a vein should be examined. We believe that it is important to undergo a repeat MVD for failed HFS relief irrespective of the timing of the operation.

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References

  1. Acevedo JC, Sindou M, Fischer C, Vial C (1997) Microvascular decompression for the treatment of hemifacial spasm. Retrospective study of a consecutive series of 75 operated patients—electrophysiologic and anatomical surgical analysis. Stereotact Funct Neurosurg 68(1–4 Pt 1):260–265

    Article  PubMed  CAS  Google Scholar 

  2. Campos-Benitez M, Kaufmann AM (2008) Neurovascular compression findings in hemifacial spasm. J Neurosurg 109(3):416–420. doi:10.3171/jns/2008/109/9/0416

    Article  PubMed  Google Scholar 

  3. Chang JW, Chang JH, Park YG, Chung SS (2001) Microvascular decompression of the facial nerve for hemifacial spasm in youth. Childs Nerv Syst 17(6):309–312

    Article  PubMed  CAS  Google Scholar 

  4. Moller AR, Jannetta PJ (1985) Microvascular decompression in hemifacial spasm: intraoperative electrophysiological observations. Neurosurgery 16(5):612–618

    Article  PubMed  CAS  Google Scholar 

  5. Thirumala PD, Shah AC, Nikonow TN, Habeych ME, Balzer JR, Crammond DJ, Burkhart L, Chang YF, Gardner P, Kassam AB, Horowitz MB (2011) Microvascular decompression for hemifacial spasm: evaluating outcome prognosticators including the value of intraoperative lateral spread response monitoring and clinical characteristics in 293 patients. J Clin Neurophysiol 28(1):56–66. doi:10.1097/WNP.0b013e3182051300

    Article  PubMed  Google Scholar 

  6. Dannenbaum M, Lega BC, Suki D, Harper RL, Yoshor D (2008) Microvascular decompression for hemifacial spasm: long-term results from 114 operations performed without neurophysiological monitoring. J Neurosurg 109(3):410–415. doi:10.3171/jns/2008/109/9/0410

    Article  PubMed  Google Scholar 

  7. 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(5):527–535

    PubMed  CAS  Google Scholar 

  8. Sindou MP (2005) Microvascular decompression for primary hemifacial spasm. Importance of intraoperative neurophysiological monitoring. Acta Neurochir (Wien) 147(10):1019–1026. doi:10.1007/s00701-005-0583-6, discussion 1026

    Article  CAS  Google Scholar 

  9. Engh JA, Horowitz M, Burkhart L, Chang YF, Kassam A (2005) Repeat microvascular decompression for hemifacial spasm. J Neurol Neurosurg Psychiatry 76(11):1574–1580. doi:10.1136/jnnp.2004.056861

    Article  PubMed  CAS  Google Scholar 

  10. Li S, Hong W, Tang Y, Ying T, Zhang W, Li X, Zhu J, Zhong J, Hua X, Xu S, Wan L, Wang X, Yang M, Li Y, Zheng X (2010) Re-operation for persistent hemifacial spasm after microvascular decompression with the aid of intraoperative monitoring of abnormal muscle response. Acta Neurochir (Wien) 152(12):2113–2118. doi:10.1007/s00701-010-0837-9

    Article  Google Scholar 

  11. 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(6):1162–1167. doi:10.1227/01.neu.0000215954.97948.b3, discussion 1162–1167

    Article  PubMed  Google Scholar 

  12. Moller AR (1998) Vascular compression of cranial nerves. I. History of the microvascular decompression operation. Neurol Res 20(8):727–731

    PubMed  CAS  Google Scholar 

  13. Moller AR, Moller MB (2007) Microvascular decompression operations. Prog Brain Res 166:397–400. doi:10.1016/s0079-6123(07)66038-5

    Article  PubMed  Google Scholar 

  14. Shah A, Nikonow T, Thirumala P, Hirsch B, Chang Y, Gardner P, Balzer J, Habeych M, Crammond D, Burkhart L, Horowitz M (2012) Hearing outcomes following microvascular decompression for hemifacial spasm. Clin Neurol Neurosurg 114(6):673–677. doi:10.1016/j.clineuro.2012.01.016

    Article  PubMed  Google Scholar 

  15. Thirumala PD, Kassasm AB, Habeych M, Wichman K, Chang YF, Gardner P, Prevedello D, Snyderman C, Carrau R, Crammond DJ, Balzer J (2011) Somatosensory evoked potential monitoring during endoscopic endonasal approach to skull base surgery: analysis of observed changes. Neurosurgery 69 (1 Suppl Operative):ons64-76; discussion ons76. doi:10.1227/NEU.0b013e31821606e4

  16. Chung SS, Chang JH, Choi JY, Chang JW, Park YG (2001) Microvascular decompression for hemifacial spasm: a long-term follow-up of 1,169 consecutive cases. Stereotact Funct Neurosurg 77(1–4):190–193

    Article  PubMed  CAS  Google Scholar 

  17. Moussa R, Harfouche D, Samaha E, Rizk T, Nohra G, Okais N (2006) Microsurgical facial nerve decompression for hemifacial spasm. J Med Liban 54(3):146–151

    PubMed  Google Scholar 

  18. Park JS, Kong DS, Lee JA, Park K (2008) Hemifacial spasm: neurovascular compressive patterns and surgical significance. Acta Neurochir (Wien) 150(3):235–241. doi:10.1007/s00701-007-1457-x, discussion 241

    Article  CAS  Google Scholar 

  19. 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(4):712–718, discussion 718–719

    Article  PubMed  Google Scholar 

  20. 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(3):335–340. doi:10.1111/j.1468-1331.2006.01670.x

    Article  PubMed  CAS  Google Scholar 

  21. 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(3):325–334. doi:10.1007/s10143-010-0254-9, discussion 334

    Article  PubMed  Google Scholar 

  22. Zhong J, Zhu J, Li ST, Li XY, Wang XH, Yang M, Wan L, Guan HX (2010) An analysis of failed microvascular decompression in patients with hemifacial spasm: focused on the early reoperative findings. Acta Neurochir (Wien) 152(12):2119–2123. doi:10.1007/s00701-010-0794-3

    Article  Google Scholar 

  23. 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(3):296–300

    Article  PubMed  Google Scholar 

  24. Zhong J, Li ST, Zhu J, Guan HX, Zhou QM, Jiao W, Ying TT, Yang XS, Zhan WC, Hua XM (2012) A clinical analysis on microvascular decompression surgery in a series of 3000 cases. Clin Neurol Neurosurg 114(7):846–851. doi:10.1016/j.clineuro.2012.01.021

    Article  PubMed  Google Scholar 

  25. Lovely TJ, Getch CC, Jannetta PJ (1998) Delayed facial weakness after microvascular decompression of cranial nerve VII. Surg Neurol 50(5):449–452

    Article  PubMed  CAS  Google Scholar 

  26. Yoshida A, SY Y, Kaibara M, Taniyama K, Tanaka N (2002) 5-Hydroxytryptamine receptors, especially the 5-HT4 receptor, in guinea pig urinary bladder. Jpn J Pharmacol 89(4):349–355

    Article  PubMed  CAS  Google Scholar 

  27. Moller AR (1999) Vascular compression of cranial nerves: II: pathophysiology. Neurol Res 21(5):439–443

    PubMed  CAS  Google Scholar 

  28. Zheng X, Hong W, Tang Y, Ying T, Wu Z, Shang M, Feng B, Zhang W, Hua X, Zhong J, Li S (2012) Discovery of a new waveform for intraoperative monitoring of hemifacial spasms. Acta Neurochir (Wien) 154(5):799–805. doi:10.1007/s00701-012-1304-6

    Article  Google Scholar 

  29. Kalkanis SN, Eskandar EN, Carter BS, Barker FG 2nd (2003) Microvascular decompression surgery in the United States, 1996 to 2000: mortality rates, morbidity rates, and the effects of hospital and surgeon volumes. Neurosurgery 52(6):1251–1261, discussion 1261–1252

    Article  PubMed  Google Scholar 

  30. Joo WI, Lee KJ, Park HK, Chough CK, Rha HK (2008) Prognostic value of intra-operative lateral spread response monitoring during microvascular decompression in patients with hemifacial spasm. J Clin Neurosci 15(12):1335–1339. doi:10.1016/j.jocn.2007.08.008

    Article  PubMed  Google Scholar 

  31. Sekula RF Jr, 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(4):E10. doi:10.3171/2009.8.FOCUS09142

    Article  Google Scholar 

  32. Kong DS, Park K, Shin BG, Lee JA, Eum DO (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(3):384–387. doi:10.3171/jns.2007.106.3.384

    Article  PubMed  Google Scholar 

  33. Moller AR, Jannetta PJ (1987) Monitoring facial EMG responses during microvascular decompression operations for hemifacial spasm. J Neurosurg 66(5):681–685. doi:10.3171/jns.1987.66.5.0681

    Article  PubMed  CAS  Google Scholar 

  34. 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 (Wien) 147(9):933–937. doi:10.1007/s00701-005-0571-x, discussion 937–938

    Article  CAS  Google Scholar 

  35. Fernandez-Conejero I, Ulkatan S, Sen C, Deletis V (2012) Intra-operative neurophysiology during microvascular decompression for hemifacial spasm. Clin Neurophysiol 123(1):78–83. doi:10.1016/j.clinph.2011.10.007

    Article  PubMed  CAS  Google Scholar 

  36. Jannetta PJ (1997) Outcome after microvascular decompression for typical trigeminal neuralgia, hemifacial spasm, tinnitus, disabling positional vertigo, and glossopharyngeal neuralgia (honored guest lecture). Clin Neurosurg 44:331–383

    PubMed  CAS  Google Scholar 

  37. Miller LE, Miller VM (2011) Safety and effectiveness of microvascular decompression for treatment of hemifacial spasm: a systematic review. Br J Neurosurg. doi:10.3109/02688697.2011.641613

    PubMed  Google Scholar 

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Acknowledgments

The authors acknowledge the collaboration of all of the staff and technical members at the Center for Clinical Neurophysiology, Department of Neurological Surgery, University of Pittsburgh Medical Center.

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Authors and Affiliations

  1. Department of Neurological Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China

    Xuhui Wang

  2. Department of Neurological Surgery, Center for Clinical Neurophysiology, UPMC Presbyterian, Suite B-400 200 Lothrop Street, Pittsburgh, PA, 15213, USA

    Parthasarathy D. Thirumala, Paul Gardner, Miguel Habeych, Donald Crammond, Jeffrey Balzer, Lois Burkhart & Michael Horowitz

  3. Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA

    Michael Horowitz

  4. Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA

    Parthasarathy D. Thirumala

  5. Department of Anesthesiology, University of Washington Medical Center, Washington, USA

    Aalap Shah

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  1. Xuhui Wang
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Correspondence to Parthasarathy D. Thirumala.

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Comments

Marc Sindou, Lyon, France

The authors should be acknowledged for their encouraging advice to redo MVD in patients with persistent HFS after a first MVD was considered as failed, irrespective of the timing of the operation.

Our personal policy is to propose reoperation in “resisting cases,” but only under very restrictive conditions:

-A delay of at least 1 year: As a matter of fact, in approximately one third of our patients, HFS necessitated several months up to 1 year to be completely relieved, including disappearance of EMG signs. Delayed relief was particularly observed in the patients in whom MVD was little atraumatic for the nerve and with the interposed prosthesis (Teflon) not touching the facial nerve, i.e., not being neo-compressive.

-On MRI, a possible still-compressive loop at brainstem or a deliberately left loop at the porus of internal auditory meatus: In the later, eventuality, hearing function could be at risk due to manipulation of the eighth nerve and/or the labyrinthine artery.

-Acceptance from the patient of occurrence of facial weakness or hearing disturbances, as reoperations entail higher risk of such side effects

As regard to usefulness of intraoperative monitoring of the lateral spread responses, although we think it interesting, we observed some deficiency in reliability [1].

Whatever these reserves, we agree that a patient without satisfactory effect after a first MVD may benefit from reoperation, especially when botulinum toxin injections have consumed their therapeutic effects.

References

1. 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 33 patient series. Br J Neurosurg 15:496–499

Jun Zhong, Shanghai, China

Dr. Wang et al. did a retrospective investigation concerning redo MVD operations on those with persistent or recurrent HFS in the University of Pittsburgh and concluded that late repeat MVD is an effective and safe procedure. Their works once again confirmed Jannetta and his team’s contribution that MVD is a reasonable as well as an effective treatment for HFS.

In the paper, they recognized that veins could be the offending vessel. We also noticed that arterioles could be the offending vessel [12], and the REZ is not the only area where the neurovascular confliction occurs [7]. Accordingly, I believe that, for a HFS patient, his or her ipsilateral facial nerve root should be compressed (though a compression of VII nerve is not always developing to a HFS). The culprit could be any vessel(s) anywhere along the nerve root [8]. The reason for a so-called negative finding of the offending vessel was nothing but (1) the culprit had been transposed while retracting the cerebellum, dissecting the arachnoids, or even suctioning the CSF, and (2) the culprit was not discovered, especially when it is located very caudomedially. Theoretically, for a properly diagnosed HFS, with an appropriate manipulation by a sophisticated neurosurgeon, MVD should lead to a total relief of the symptom immediately after the operation. Nevertheless, a failure of MVD may arise in case of difficult approach to the neurovascular conflict site due to individual anatomical feature [6, 13].

However, there are some reports regarding delayed relief in the literature [1, 2]. I think this may happen when the facial nerve root was not sufficiently decompressed. Our primary study on the mechanism of HFS implied that the emersion of ectopic action potentials in the VII nerve fibers might be triggered by neurotransmitters released from sympathetic endings in the offending artery wall, and the attrition of neurovascular interface was the essence of the etiology [11]. This new hypothesis gave a good explanation for the fact that the episode of spasm is often associated with moods (sympathetic excitement) [5]. It could also explain the partial or delayed relief. It may happen when multiple vessels are involved. Once the larger one is moved away, the symptom may marginally improve as the main problem has been solved. For the smaller vessel, a little movement may allow the lesions at the interfaces to repair over time. With restoring of both the epineurium and adventitia, the nerve may finally be isolated from the vessel [10].

Therefore, we agree on a redo MVD, even an early reoperation if the patient does hope for an immediate cure instead of anxiously expecting of a possible relief. To ensure the curative effect, we had suggested separating all the vessels from the VII nerve including the AICA between the VII and VIII nerves near the internal acoustic meatus [3], but it may raise the complication for a young neurosurgeon. To balance cure with safety [9], I recommend terminating the operation once an apparent offending artery was found in the axil of the VII nerve (especially when a dent was also visualized in the nerve) and the LSR or AMR vanished as the culprit was moved away [4]. Postoperatively, if the symptom does not improve at all, an immediate reoperation with exploration of the entire intracranial segment of the facial nerve is recommended; if the symptom improves a bit, then an alternative is to observe.

References

1. Ishikawa M, Nakanishi T, Takamiya Y, Namiki J (2001) Delayed resolution of residual hemifacial spasm after microvascular decompression operations. Neurosurgery 49:847–854; discussion 854–856

2. Jo KW, Kong DS, Park K (2013) Microvascular decompression for hemifacial spasm: long-term outcome and prognostic factors, with emphasis on delayed cure. Neurosurg Rev36:297–302

3. Li Y, Zheng X, Hua X, Ying T, Zhong J, Zhang W, Li S (2013) Surgical treatment of hemifacial spasm with zone-4 offending vessel. Acta Neurochir (Wien) 155(5):849–853. doi:110.1007/s00701-013-1623-2

4. Ying T, Li S, Zhong J, Li X, Wang X, Zhu J (2011) The value of abnormal muscle response monitoring during microvascular decompression surgery for hemifacial spasm. Int J Surg 9:347–351

5. Zheng X, Hong W, Tang Y, Ying T, Wu Z, Shang M, Feng B, Zhang W, Hua X, Zhong J, Li S (2012) Discovery of a new waveform for intraoperative monitoring of hemifacial spasms. Acta Neurochir (Wien) 154:799–805

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

7. Zhong J, Li S, Zhu J, Guan H (2011) Is entire nerve root decompression necessary for hemifacial spasm? Int J Surg 9:254–257

8. Zhong J, Zhu J, Li S, Guan H (2011) Microvascular decompressions in patients with coexistent hemifacial spasm and trigeminal neuralgia. Neurosurgery 68:916–920; discussion 920

9. Zhong J (2012) An ideal microvascular decompression technique should be simple and safe. Neurosurg Rev 35:137–140; author reply 140

10. Zhong J, Li ST, Zhu J, Guan HX, Zhou QM, Jiao W, Ying TT, Yang XS, Zhan WC, Hua XM (2012) A clinical analysis on microvascular decompression surgery in a series of 3000 cases. Clin Neurol Neurosurg 114:846–851

11. Zhou QM, Zhong J, Jiao W, Zhu J, Yang XS, Ying TT, Zheng XS, Dou NN, Wang YN, Li ST (2012) The role of autonomic nervous system in the pathophysiology of hemifacial spasm. Neurol Res 34:643–648

12. Zhu J, Li S, Zhong J, Guan H, Ying T, Yang M, Yang X, Zhou Q, Jiao W (2012) Role of arterioles in management of microvascular decompression in patients with hemifacial spasm. J Clin Neurosci1 9:375–379

13. Zhu J, Li ST, Zhong J, Ying TT, Guan HX, Yang XS, Zhou QM, Jiao W (2012) Microvascular decompression for hemifacial spasm. J Craniofac Surg 23:1385–1387

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Wang, X., Thirumala, P.D., Shah, A. et al. Microvascular decompression for hemifacial spasm: focus on late reoperation. Neurosurg Rev 36, 637–644 (2013). https://doi.org/10.1007/s10143-013-0480-z

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