Facial Nerve Massage for the Treatment of Hemifacial Spasm Refractory to Microvascular Decompression: Outcomes and Complications

Patel, Kevin P.; Eubanks, Komal; Wecht, Daniel A.; Sekula, Raymond F.

doi:10.1227/neu.0000000000002075

Cited by 9 publications

(6 citation statements)

References 39 publications

(56 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…To mitigate the risk, we recommend using sling or bridge techniques to prevent direct Teflon-nerve contact. Although the facial nerve massage technique of Patel et al 16 was not implemented in our case series, we acknowledge its potential value and believe it merits consideration for improving revision management strategies.…”

Section: Techniques For Redo Mvd In Hfs: Insights and Recommendationsmentioning

confidence: 97%

Etiology and Management of Recurrent and Persistent Hemifacial Spasm—A Single-Center Experience

Al Mutawa,

Matthes,

Schroeder

et al. 2024

Neurosurgery

View full text Add to dashboard Cite

BACKGROUND AND OBJECTIVES: Despite a 90% success rate, microvascular decompression occasionally fails to resolve hemifacial spasm (HFS), necessitating revision surgery. We investigated recurrent cases to identify underlying causes. METHODS: We evaluated patients at our institution who underwent revision microvascular decompression because of recurrent or persistent HFS, assessing recurrence causes, decompression techniques, complications, and outcomes. Data considered included demographics, preoperative symptoms, disease duration, offending vessel, and magnetic resonance findings. Surgical notes and intraoperative videos were reviewed, and telephone interviews were conducted for recent outcomes. RESULTS: Out of our ongoing series of 493 patients, 43 patients (8.7%) required revision surgery with a patient cohort of 33 females and 10 males. The average symptom duration was 10 years. The median time between primary and revision surgery was 14 months. Thirteen patients (30.2%) underwent initial surgery elsewhere. Adhesions of Teflon pledgets to the facial nerve were the primary cause of nonresolution in 23 patients (53.5%), while in 13 (30.2%), a missed vascular compression was identified. Sixteen patients (37.2%) had sufficient decompression by removing the conflicting pledgets. During 10 revisions (23.3%), additional Teflon pledgets were necessary. After a median follow-up of 67 months after revision surgery, 27 patients (62.8%) reported complete spasm resolution. Six patients (14.0%) had a good outcome with over 90% reduction of their spasms, 3 patients (7.0%) stated a fair outcome (50% improvement), while 7 patients (16.3%) had no improvement. CONCLUSION: According to our results, adhesions of Teflon to the facial nerve may cause HFS recurrence. Therefore, whenever possible, Teflon should be placed without nerve contact between the brainstem and the offending vessel. Using a sling or bridge technique seems to be beneficial because it leaves the facial nerve completely free. Persistent symptoms often result from missed offending vessels in the pontomedullary sulcus indicating the benefit of endoscopic inspection of this area with an endoscope.

show abstract

Section: Techniques For Redo Mvd In Hfs: Insights and Recommendationsmentioning

confidence: 97%

Etiology and Management of Recurrent and Persistent Hemifacial Spasm—A Single-Center Experience

Al Mutawa,

Matthes,

Schroeder

et al. 2024

Neurosurgery

View full text Add to dashboard Cite

show abstract

“…The effect of traumatic facial nerve manipulation should also be acknowledged as a potential mechanism of early spasm relief. While intentional facial nerve trauma was utilized in the premicrosurgical era 1 and a potential alternative for rare cases of recalcitrant HFS, 46 therapeutic efforts should FIG. 5.…”

Section: Approach To Mvdmentioning

confidence: 99%

Hemifacial spasm: a neurosurgical perspective

Kaufmann

2024

Journal of Neurosurgery

View full text Add to dashboard Cite

Hemifacial spasm (HFS) causes both physical and psychological disabilities that significantly impact quality of life. Medical management with serial botulinum toxin injections provides transient spasm relief and is widely reported as highly effective, as compared to no treatment. While there is an excellent potential for disease cure with microvascular decompression (MVD) surgery, utilization rates remain very low in North America (approximately 10%) and many patients are not adequately informed of this surgical option. Although the majority of MVD neurosurgeons maintain a low annual case volume, excellent safety and success rates can be achieved with attention to technical nuances and anatomical appreciation of the target facial root exit zone. Attention to better informing patients and optimizing surgical outcomes should lead to a greater role for neurosurgery in the treatment and cure of HFS.

show abstract

“…I read with great interest the article by Kevin et al titled “Facial Nerve Massage for the Treatment of Hemifacial Spasm Refractory to Microvascular Decompression: Outcomes and Complications.” 1 I would like to address several comments to the authors.…”

mentioning

confidence: 99%

Letter: Facial Nerve Massage for the Treatment of Hemifacial Spasm Refractory to Microvascular Decompression: Outcomes and Complications

Amagasaki

2023

Neurosurgery

View full text Add to dashboard Cite

Facial Nerve Massage for the Treatment of Hemifacial Spasm Refractory to Microvascular Decompression: Outcomes and Complications

Cited by 9 publications

References 39 publications

Etiology and Management of Recurrent and Persistent Hemifacial Spasm—A Single-Center Experience

Etiology and Management of Recurrent and Persistent Hemifacial Spasm—A Single-Center Experience

Hemifacial spasm: a neurosurgical perspective

Letter: Facial Nerve Massage for the Treatment of Hemifacial Spasm Refractory to Microvascular Decompression: Outcomes and Complications

Contact Info

Product

Resources

About