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Delayed relief of hemifacial spasm after microvascular decompression: can it be avoided?

  • Clinical Article - Vascular
  • Published:
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Abstract

Background

Although microvascular decompression (MVD) surgery has been widely accepted as an effective treatment for hemifacial spasm (HFS), delayed relief cases have been frequently reported. Therefore, the value of an immediate redo MVD should be discussed.

Methods

This study included 1,435 HFS patients who underwent MVD with intraoperative abnormal muscle response (AMR) monitoring from 2011 through 2013 at XinHua Hospital. These cases were analyzed retrospectively with emphasis on the postoperative outcomes and introaperative findings.

Results

After MVD, 1,384 HFS patients obtained relief immediately. The 51 unrelieved patients underwent AMR monitoring again the next day; this was positive in 48 and negative in 3 patients. These three patients with negative AMR obtained relief spontaneously within a week. Among the 48 positive patients, 31 and 11 were underwent redo MVD within a week and 5–22 months, respectively, and all achieved relief after the second operation. Of the six remainig patients, two obtained relief within 2 months and 4 remained unchanged in the up-to-3-year’s follow-up period. In redo MVDs, insufficient decompression of the facial nerve accounted for the failure. Finally, in this database, the immediate postoperative cure rate was 96.4 %; with earlier redo MVD, the final cure rate could be increased to 99.9 %.

Conclusions

Despite being a reasonable remedy for HFS in the hands of an experienced neurosurgeon, sometimes small vessels can be missed while managing the main offending arteries during MVDs, which might account for the delayed relief. Therefore, reexamination of the AMR is necessary for unimproved patients; if a positive result is recorded, an immediate redo MVD is suggested.

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Acknowledgments

This study was supported by the National Natural Science Foundation of China (#81471317) and Science & Technology Committee of Shanghai Municipal (#124119a0800).

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, XinHua Hospital (The Cranial Nerve Disease Center of Shanghai), Shanghai JiaoTong University School of Medicine, Shanghai, 200092, China

    Jun Zhong, Lei Xia, Ning-Ning Dou, Ting-Ting Ying, Jin Zhu, Ming-Xing Liu & Shi-Ting Li

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  1. Jun Zhong
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  2. Lei Xia
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  3. Ning-Ning Dou
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  4. Ting-Ting Ying
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  5. Jin Zhu
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  7. Shi-Ting Li
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Corresponding author

Correspondence to Shi-Ting Li.

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Comment

This is an extremely interesting study on microvascular decompression (MVD) in hemifacial spasm (HFS). In this study, the authors were able to include 1,435 HFS patients who were surgically treated in 31 months. This is a large number of patients treated in a very short time period. The results reported here are even more astonishing, with 96.5 % of patients immediately relieved and an overall cure rate of more than 99 %. These are all very convincing arguments, and the recommendations made by the authors are supported by solid evidence. The authors demonstrated that immediate reoperation might resolve the HFS in almost all patients who do not have symptom relief after the first surgery. They clearly showed that an electrophysiological test, the abnormal muscle response, has very strong predictive value; therefore, we all should consider adopting this intraoperative test as a standard for HFS surgery. The authors also convincingly used their electrophysiological findings to infer the pathophysiology of HFS. The hypothesis that HFS is generated by an ectopic impulse emerging from the compressed facial nerve, which might be triggered by sympathetic endings in the offending artery wall, appears intriguing and could explain why the spasm attacks often occur when the patient is nervous or excited.

Alfredo Conti

Messina, Italy

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Zhong, J., Xia, L., Dou, NN. et al. Delayed relief of hemifacial spasm after microvascular decompression: can it be avoided?. Acta Neurochir 157, 93–99 (2015). https://doi.org/10.1007/s00701-014-2247-x

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  • DOI: https://doi.org/10.1007/s00701-014-2247-x

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