Effect of previous botulinum neurotoxin treatment on microvascular decompression for hemifacial spasm

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The objective of this study was to investigate the clinical characteristics, intraoperative findings, complications, and outcomes after the first microvascular decompression (MVD) in patients with and without previous botulinum neurotoxin treatment for hemifacial spasm (HFS).</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The authors analyzed 246 MVDs performed at the University of Pittsburgh Medical Center between January 1, 2000, and December 31, 2007. One hundred and seventy-six patients with HFS underwent botulinum neurotoxin injection treatment prior to first MVD (Group I), and 70 patients underwent their first MVD without previous botulinum neurotoxin treatment (Group II). Clinical outcome data were obtained immediately after the operation, at discharge, and at follow-up. Follow-up data were collected from 177 patients with a minimum follow-up period of 9 months (mean 54.48 ± 27.84 months).</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>In 246 patients, 89.4% experienced immediate postoperative relief of spasm, 91.1% experienced relief at discharge, and 92.7% experienced relief at follow-up. There was no significant difference in outcomes and complications between Group I and Group II (p &gt; 0.05). Preoperatively, patients in Group I had higher rates of facial weakness, tinnitus, tonus, and platysmal involvement as compared with Group II (p &lt; 0.05). The posterior inferior cerebellar artery and vertebral artery were intraoperatively identified as the offending vessels in cases of vasculature compression in a significantly greater number of patients in Group II compared with Group I (p = 0.008 and p = 0.005, respectively, for each vessel). The lateral spread response (LSR) disappeared in 60.48% of the patients in Group I as compared with 74.19% in Group II (p &gt; 0.05). No significant differences in complications were noted between the 2 groups.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Microvascular decompression is an effective and safe procedure for patients with HFS previously treated using botulinum neurotoxin. Intraoperative monitoring with LSR is an effective tool for evaluating adequate decompression.</jats:p></jats:sec>

Fully endoscopic microvascular decompression for hemifacial spasm

“…We report that the LSR was abolished in 61.5% of cases, which is consistent with the report of patients with prior Botox treatment. 40 The fully endoscopic approach is limited in that the scope itself is prone to blood soiling and requires irrigation or antifogging. The scope also lacks 3D information feedback.…”

Vestibulocochlear Symptoms Caused by Vertebrobasilar Dolichoectasia

“…Regular toxin injection can be extended to 20 years, but each treatment relieves symptoms for only several months. Therefore, MVD remains the definitive treatment, especially for patients previously treated with botulinum toxin [22]. However, several studies have reported symptom recurrence and serious complications (such as hearing loss and facial nerve palsy) after MVD [23].…”

Botulinum Toxin for the Treatment of Refractory Erythema and Flushing of Rosacea

“…The effects persisted for at least 7 months, with low to negligible recurrence rates [13]. The clinical results were substantiated with corresponding decreases in cutaneous blood flow, as measured using laser Doppler flowmetry [14]. Botulinum toxin works as a neuromodulator at the neuromuscular junction.…”