Summary
Background. Microvascular decompression (MVD) for hemifacial spasm (HFS) provides a long-term cure rate. Delayed facial palsy (DFP) is not an unusual complication, but it has only been sporadically described in the literature. The purpose of this report is to evaluate the incidence of delayed facial palsy after MVD and its clinical course and final results.
Methods. From January, 1998 to April, 2004, 410 patients underwent microvascular decompression for hemifacial spasm at our Institute. During this time, 21 patients (5.4%) developed delayed facial weakness; eighteen of them were given steroid medication and they were followed up in the out-patient clinic.
Findings. Twenty-one patients developed DFP after microvascular decompression an incidence of 5.4%. There were seventeen women (81.0%) among the 21 patients with DFP who were included in this study. In twenty of them, the symptoms of HFS improved completely after the operation, but the spasm remained with one of them. The onset of palsy occurred between postoperative day 7 and 23 (average: 12.1 days). The palsy was at least Grade II or worse on the House-Brackmann (HB) scale. The time to recovery averaged 5.7 weeks (range: 25 days–17 weeks); 20 patients improved to complete recovery and 1 patient remained with minimal weakness, as Grade II on the HB scale, at the follow-up examination.
Conclusion. Our findings demonstrated that the incidence of DFP was not so low as has been reported the literature, and it did not have any striking predisposing factors. Even though the degree of facial palsy was variable, almost all patients exhibited a complete recovery without any further special treatment. The etiology of DFP and its association with herpes infection should be further clarified.
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References
RG Auger DG Piepgras ER Laws SuffixJr (1986) ArticleTitleHemifacial spasm: results of microvascular decompression of the facial nerve in 54 patients Mayo Clin Proc 61 640–644 Occurrence Handle3724243 Occurrence Handle1:STN:280:DyaL283lsFOhtQ%3D%3D
FG Barker Suffix2nd PJ Jannetta DJ Bissonette PT Shields MV Larkins HD Jho (1995) ArticleTitleMicrovascular decompression for hemifacial spasm J Neurosurg 82 201–210 Occurrence Handle7815147 Occurrence Handle10.3171/jns.1995.82.2.0201
K Furukawa M Sakoh Y Kumon M Teraoka S Ohta S Ohue N Hatoh T Ohnishi (2003) ArticleTitleDelayed facial palsy after microvascular decompression for hemifacial spasm due to reactivation of varicella-zoster virus No Shinkei Geka 31 899–902 Occurrence Handle12968493
K Hongo S Kobayashi T Takemae K Sugita (1985) ArticleTitlePosterior fossa microvascular decompression for hemifacial spasm and trigeminal neuralgia-some improvements on operative devices and technique No Shinkei Geka 13 1291–1296 Occurrence Handle4088451 Occurrence Handle1:STN:280:DyaL287hvFSmug%3D%3D
PJ Jannetta M Abbasy JC Maroon FM Ramos MS Albin (1977) ArticleTitleEtiology and definitive microsurgical treatment of hemifacial spasm. Operative techniques and results in 47 patients J Neurosurg 47 321–328 Occurrence Handle894338 Occurrence Handle1:STN:280:DyaE2s3ltFKgug%3D%3D Occurrence Handle10.3171/jns.1977.47.3.0321
BT Kim SC Hwang JC Chang WH Shin (1999) ArticleTitleDelayed facial palsy following microvascular decompression in hemifacial spasm J Korean Neurosurg Soc 28 1332–1336 Occurrence Handle1:CAS:528:DC%2BD3cXotlKhuw%3D%3D
BT Kim SB Im JC Chang WH Shin SK Choi (1998) ArticleTitleCerebellar cortical artery technique for the preservation of operative field during microvascular decompression for hemifacial spasm J Korean Neurosurg Soc 27 1533–1536
A Kuroki S Itagaki O Nagai (1991) ArticleTitleDelayed facial palsy after microvascular decompression for hemifacial spasm Facial Nerve Res 11 147–150
TJ Lovely CC Getch PJ Jannetta (1998) ArticleTitleDelayed facial weakness after microvascular decompression of cranial nerve VII Surg Neurol 50 449–452 Occurrence Handle9842870 Occurrence Handle1:STN:280:DyaK1M%2FlslSjtg%3D%3D Occurrence Handle10.1016/S0090-3019(97)00314-5
AR Moller PJ Jannetta (1986) ArticleTitlePhysiological abnormalities in hemifacial spasm studied during microvascular decompression operations Exp Neurol 93 584–600 Occurrence Handle3743704 Occurrence Handle1:STN:280:DyaL28zgtFSitw%3D%3D Occurrence Handle10.1016/0014-4886(86)90178-0
JJA Mooij MK Mustafa TW van Weerden (2001) ArticleTitleHemifacial spasm: intraoperative electromyographic monitoring as a guide for microvascular decompression Neurosurgery 49 1365–1371 Occurrence Handle11846935 Occurrence Handle1:STN:280:DC%2BD387ht12hsQ%3D%3D Occurrence Handle10.1097/00006123-200112000-00012
TD Payner JM Tew SuffixJr (1996) ArticleTitleRecurrence of hemifacial spasm after microvascular decompression Neurosurgery 38 686–691 Occurrence Handle8692385 Occurrence Handle1:STN:280:DyaK283kslyitQ%3D%3D Occurrence Handle10.1097/00006123-199604000-00009
A Wang J Jankovic (1998) ArticleTitleHemifacial spasm: clinical findings and treatment Muscle Nerve 21 1740–1747 Occurrence Handle9843077 Occurrence Handle1:STN:280:DyaK1M%2Flslaisw%3D%3D Occurrence Handle10.1002/(SICI)1097-4598(199812)21:12<1740::AID-MUS17>3.0.CO;2-V
S Santos-Lasaosa LF Pascual-Millan C Tejero-Juste F Morales-Asin (2000) ArticleTitlePeripheral facial paralysis: etiology, diagnosis and treatment Rev Neurol 30 IssueID11 1048–1053 Occurrence Handle10904952 Occurrence Handle1:STN:280:DC%2BD3cvgt1Wrtw%3D%3D
V Franco-Vidal DQ Naguyen J Guerin V Darrouzet (2004) ArticleTitleDelayed facial paralysis after vestibular schwannoma surgery: role of herpes virus reactivation-our experience in eight cases Otology & Neurotology 25 805–810 Occurrence Handle10.1097/00129492-200409000-00026
T Menovsky JM Van Overbeeke MD Graham (1999) ArticleTitleOn the mechanism of transient postoperative deficit of cranial nerve Surg Neurol 51 223–226 Occurrence Handle10029432 Occurrence Handle1:STN:280:DyaK1M7ltFyqsg%3D%3D Occurrence Handle10.1016/S0090-3019(97)00510-7
GJ Gianoli JM Kartush (1996) ArticleTitleDelayed facial palsy after acoustic neuroma resection: the role of viral reactivation Am J Otol 17 625–629 Occurrence Handle8841711 Occurrence Handle1:STN:280:DyaK28vjvFersg%3D%3D
C Scheller C Staruss R Fahlbusch J Romstök (2004) ArticleTitleDelayed facial nerve paresis following acoustic neuroma resection and postoperative vasoactive treatment Zentralbl Neurochir 65 103–107 Occurrence Handle15306972 Occurrence Handle1:STN:280:DC%2BD2cvgtlWmtw%3D%3D Occurrence Handle10.1055/s-2004-816268
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Rhee, D., Kong, D., Park, K. et al. Frequency and prognosis of delayed facial palsy after microvascular decompression for hemifacial spasm. Acta Neurochir (Wien) 148, 839–843 (2006). https://doi.org/10.1007/s00701-006-0847-9
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DOI: https://doi.org/10.1007/s00701-006-0847-9