Posterior Fossa Reexploration for Persistent or Recurrent Trigeminal Neuralgia or Hemifacial Spasm: Surgical Findings and Therapeutic Implications

Kureshi, Sohaib A.; Wilkins, Robert H.

doi:10.1097/00006123-199811000-00061

Cited by 112 publications

(97 citation statements)

References 19 publications

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“…At repeat surgery, the vessel may sometimes be better mobilized, although not at the expense of any perforators. As in prior reports, success rates have generally been lower than reported for initial surgery, 3,16,25 although we found that two-thirds of patients became spasm-free after our own repeat MVD. Similar to the results of our study, Barker and Jannetta did differentiate the results of surgery between patients treated initially by their own group versus other centers and found repeat MVD cure rates to be significantly higher in the latter.…”

Section: Repeat Mvd Techniquesupporting

confidence: 53%

Failed microvascular decompression surgery for hemifacial spasm due to persistent neurovascular compression: an analysis of reoperations

Bigder¹,

Kaufmann²

2016

JNS

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H emifacial spasm (HFS) is relatively rare, with an estimated incidence of 0.8 per 100,000 persons/year and an estimated prevalence of 7.4 per 100,000 men and 14.5 per 100,000 women. 2 The disease typically begins as infrequent twitches of an eyelid that progress over time in intensity, frequency, and extent of involvement of the ipsilateral facial muscles. HFS may cause significant disability due to annoying and distracting twitches and forceful spasms, and also by the loss of binocular vision associated with involuntary eye closure. The greatest impact on the quality of life for many patients is the psychological and social impact of the facial disfigurement caused by the disorder. 15,17 Surgical cure of HFS can be achieved with microvascular decompression (MVD) surgery, as pioneered by Jannetta in 1967, 12 and several series have demonstrated high rates of success and safety. 3,4,[6][7][8]10,11,13,20,21 The aim of this surgery is to alleviate culprit neurovascular compression (NVC) upon the facial nerve, most commonly at the facial root exit zone (fREZ). Only in rare cases is HFS caused by severe NVC of the cisternal portion of the facial nerve.4,5 The extent of the fREZ, however, has been variably defined and is often considered as only the Obersteiner-Redlich zone of transition between central oligodendrocytes and peripheral Schwann cell-derived myelin, just distal to the facial nerve detachment from the lateral pons. 19 We have previously em- OBJectiVe Microvascular decompression (MVD) surgery for hemifacial spasm (HFS) is potentially curative. The findings at repeat MVD in patients with persistent or recurrent HFS were analyzed with the aim to identify factors that may improve surgical outcomes. methOdS Intraoperative findings were determined from review of dictated operative reports and operative diagrams for patients who underwent repeat MVD after prior surgery elsewhere. Clinical follow-up was obtained from the hospital and clinic records, as well as telephone questionnaires. reSultS Among 845 patients who underwent MVD performed by the senior author, 12 had been referred after prior MVD for HFS performed elsewhere. Following repeat MVD, all patients improved and complete spasm resolution was described by 11 of 12 patients after a mean follow-up of 91 ± 55 months (range 28-193). Complications were limited to 1 patient with aggravation of preexisting hearing loss and mild facial weakness and 1 patient with aseptic meningitis without sequelae. Significant factors that may have contributed to the failure of the first surgery included retromastoid craniectomies that did not extend laterally to the sigmoid sinus or inferiorly to the posterior fossa floor in 11 of 12 patients and a prior surgical approach that focused on the cisternal portion of the facial nerve in 9 of 12 patients. In all cases, significant persistent neurovascular compression (NVC) was evident and alleviated more proximally on the facial root exit zone (fREZ). cONcluSiONS Most HFS patients will achieve spasm relief with thorough allevia...

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Section: Repeat Mvd Techniquesupporting

confidence: 53%

Failed microvascular decompression surgery for hemifacial spasm due to persistent neurovascular compression: an analysis of reoperations

Bigder¹,

Kaufmann²

2016

JNS

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“…[8] Although some papers showed limited improvement with a high complication rate for preoperative MVD, [1,10] recent surgical results of late reoperation didn't show significant differences from those undergoing their initial MVDs. [16,21] Our results showed that cumulative spasm free rate at 3 months after operation was 97%.…”

Section: Assessment Of Persistent Spasm After Mvdmentioning

confidence: 99%

A significant correlation between delayed cure after microvascular decompression and positive response to preoperative anticonvulsant therapy in patients with hemifacial spasm

et al. 2016

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Delayed cure and anticonvulsant therapy 2 ABSTRACT (150-250 words) ObjectiveAlthough microvascular decompression (MVD) is a reliable treatment for hemifacial spasm (HFS), the postoperative course is varied. We retrospectively analyzed the resolution pattern of the spasm and specified predictors for delayed cure after MVD. MethodsThis study included 114 consecutive patients with typical HFS. All of them were followed-up for at least one year after operation. Patients were divided into three groups depending on the postoperative course:immediate cure, delayed cure, and failure. To identify the predictive factors for delayed cure after MVD, logistic regression analyses were applied using candidate clinical factors, such as duration of symptom, the tendency of the spasm, preoperative medical treatment and offending vessels. ResultsAmong the 114 patients, 107 patients were cured. For those cured, 65 patients were classified as immediate cure and 42 patients were classified as delayed cure. Cumulative spasm free rate after one week, one month, and 3 months after MVD were 70%, 88%, and 97%, respectively. No predictive factors between the cured and failure groups were observed. According to multivariate analysis, preoperative anticonvulsant therapy was found to be the sole significant predictive factor for delayed cure after MVD (p = 0.025). ConclusionsA significant correlation between delayed cure and preoperative anticonvulsant therapy was found in our study, which suggests that hyperexcitation of the facial nucleus plays an important role in pathogenesis of delayed cure. Therefore, if a patient demonstrating a positive response to preoperative anticonvulsant therapy showed a persistent spasm after MVD, reoperation should be delayed for at least 3 months after the initial operation.

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“…Patients who underwent a repeat MVD procedure for either trigeminal neuralgia or hemifacial spasm were excluded as reoperations may pose higher risks to cranial nerves than a first MVD. 17 During the study period, 3 patients were referred for treatment because of recurrent symptoms and underwent repeat MVD; they were excluded from this study. The patient population was divided into two groups.…”

Section: Patient Populationmentioning

confidence: 99%

Value-based neurosurgery: the example of microvascular decompression surgery

McLaughlin¹,

Buxey²,

Chaw³

et al. 2014

JNS

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Object Value of care is emerging as a promising framework to restructure health care, emphasizing the importance of reporting multiple outcomes that encompass the entire care episode instead of isolated outcomes specific to care points during a patient's care. The authors assessed the impact of coordinated implementation of processes across the episode of surgical care on value of neurosurgical care, using microvascular decompression (MVD) as an example. Methods This study is a retrospective review of consecutive cases involving patients with either trigeminal neuralgia or hemifacial spasm undergoing first-time MVD. Patients were divided into 2 groups: Group 1 included patients who underwent surgery between February 2008 and November 2009 and Group 2 included those who underwent surgery between January 2011 and October 2012. The authors collected data on outcome measures spanning the entire surgical episode of care according to the Outcome Measures Hierarchy. Results Forty-nine patients were included: 20 patients in Group 1 and 29 patients in Group 2. Thirty-one patients underwent MVD for trigeminal neuralgia and 18 for hemifacial spasm. A zero mortality rate and high degree of symptom resolution were achieved in both groups. Group 2 benefited from a reduction in the average total operating room time, a decrease in the mean and median postoperative length of hospital stay, a decrease in the mean length of stay on the floor, and a reduction in the rates of complications and readmissions. Conclusions Comprehensive implementation of improvement processes throughout the continuum of care resulted in improved global outcome and greater value of delivered care. Enhanced-recovery perioperative protocols and diagnosis-specific clinical pathways are two avenues built around global care delivery that can help achieve an “optimal episode of surgical care” in every case.

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Posterior Fossa Reexploration for Persistent or Recurrent Trigeminal Neuralgia or Hemifacial Spasm: Surgical Findings and Therapeutic Implications

Cited by 112 publications

References 19 publications

Failed microvascular decompression surgery for hemifacial spasm due to persistent neurovascular compression: an analysis of reoperations

Failed microvascular decompression surgery for hemifacial spasm due to persistent neurovascular compression: an analysis of reoperations

A significant correlation between delayed cure after microvascular decompression and positive response to preoperative anticonvulsant therapy in patients with hemifacial spasm

Value-based neurosurgery: the example of microvascular decompression surgery

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