Residual hemifacial spasm after microvascular decompression: prognostic factors with emphasis on preoperative psychological state

Jin, Yichao; Zhao, Changyi; Su, Shanshan; Zhang, Xiaohua; Qiu, Yongming; Jiang, Jiyao

doi:10.1007/s10143-015-0622-6

Cited by 18 publications

(6 citation statements)

References 24 publications

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“… 11 12 13 33 This discrepancy can be attributed to the effects of various factors including age, disease duration, comorbidities, and psychologic status on surgical outcomes and complications. 9 18 Although we observed that facial palsy was delayed in the severe-spasm group, the complication rate was still low and so MVD could be an effective treatment option for patients with HFS. Since treatment modalities are selected and complications are predicted based on clinical or laboratory findings, rather than on intraoperative findings, more studies focusing on the clinical features of HFS—like the present study—are important for providing doctors with the best information possible for making appropriate decisions.…”

Section: Discussionmentioning

confidence: 80%

“…Despite the wide-ranging impact of HFS, the significance of its clinical features has not been clearly demonstrated. Only a few clinical characteristics of HFS have been reported previously and no consensus has been reached, 9 10 11 while various surgical findings including intraoperative severity of indentation or resolution of the lateral spread response were suggested to be related to surgical outcome. 10 11 12 13 It is particularly notable that the severity of HFS is a clinical barometer that can be easily assessed in a clinic, but there is no consensus on how to evaluate spasm severity.…”

Section: Introductionmentioning

confidence: 99%

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Severe Hemifacial Spasm is a Predictor of Severe Indentation and Facial Palsy after Microdecompression Surgery

Cho

Park

et al. 2018

J Clin Neurol

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Background and PurposeHemifacial spasm (HFS) is mostly caused by the compression of the facial nerve by cerebral vessels, but the significance of spasm severity remains unclear. We investigated the clinical significance of spasm severity in patients with HFS who underwent microvascular decompression (MVD).MethodsWe enrolled 636 patients with HFS who underwent MVD between May 2010 and December 2013 at Samsung Medical Center (SMC), Seoul, Korea. Subjects were divided into two groups based on spasm severity: severe (SMC grade 3 or 4) and mild (SMC grade 1 or 2). We compared demographic, clinical, and surgical data between these two groups.ResultsThe severe-spasm group was older and had a longer disease duration at the time of MVD compared to the mild-spasm group. Additionally, hypertension and diabetes mellitus were more common in the severe-spasm group than in the mild-spasm group. Regarding surgical findings, there were more patients with multiple offending vessels and more-severe indentations in the severe-spasm group than in the mild-spasm group. Even though the surgical outcomes did not differ, the incidence of delayed facial palsy after MVD was higher in the severe-spasm group than in the mild-spasm group. Logistic regression analysis showed that severe-spasm was correlated with longer disease duration, hypertension, severe indentation, multiple offending vessels, and delayed facial palsy after MVD.ConclusionsSpasm severity does not predict surgical outcomes, but it can be used as a marker of pathologic compression in MVD for HFS, and be considered as a predictor of delayed facial palsy after MVD.

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Section: Discussionmentioning

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Severe Hemifacial Spasm is a Predictor of Severe Indentation and Facial Palsy after Microdecompression Surgery

Cho

Park

et al. 2018

J Clin Neurol

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“…Several studies investigated the predicting factors influencing the outcome following MVD in HFS patients [ 6 , 17 , 18 , 23 , 39 ]. Fewer studies analyzed the course of symptoms improvement and patterns of recovery following MVD attributing delayed resolution of the spasms to various predicting factors [ 18 , 24 , 27 , 32 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

A multivariable prediction model for recovery patterns and time course of symptoms improvement in hemifacial spasm following microvascular decompression

et al. 2022

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Background Microvascular decompression (MVD) success rates exceed 90% in hemifacial spasm (HFS). However, postoperative recovery patterns and durations are variable. Objective We aim to study factors that might influence the postoperative patterns and duration needed until final recovery. Method Only patients following de-novo MVD with a minimum follow-up of 6 months were included. Overall trend of recovery was modeled. Patients were grouped according to recognizable clinical recovery patterns. Uni- and multivariable analyses were used to identify the factors affecting allocation to the identified patterns and time needed to final recovery. Results A total of 323 (92.6%) patients had > 90% symptom improvement, and 269 (77.1%) patients had complete resolution at the last follow-up. The overall trend of recovery showed steep remission within the first 6 months, followed by relapse peaking around 8 months with a second remission ~ 16 months. Five main recovery patterns were identified. Pattern analysis showed that evident proximal indentation of the facial nerve at root exit zone (REZ), males and facial palsy are associated with earlier recovery at multivariable and univariable levels. anterior inferior cerebellar artery (AICA), AICA/vertebral artery compressions and shorter disease durations are related to immediate resolution of the symptoms only on the univariable level. Time analysis showed that proximal indentation (vs. distal indentation), males and facial palsy witnessed significantly earlier recoveries. Conclusion Our main finding is that in contrast to peripheral indentation, proximal indentation of the facial nerve at REZ is associated with earlier recovery. Postoperative facial palsy and AICA compressions are associated with earlier recoveries. We recommend a minimum of 1 year before evaluating the final outcome of MVD for HFS.

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“…A small Teflon felt may drift away, and a large Teflon felt may cause a new compression; in addition, the oversized Teflon may block the surgeon's vision and the offending vessel may be overlooked. Some experts [17][18][19][20][21] have reported that a few patients with poor postoperative outcome after the initial MVD are likely to be cured in 1 to 3 years without additional operations. It is worth re-exploring if delayed resolution after 2 to 3 years could not be observed.…”

Section: Teflon Felts Affect the Outcomes Of Mvdmentioning

confidence: 99%

How to Improve the Effect of Microvascular Decompression for Hemifacial Spasm: A Retrospective Study of 32 Cases with Unsuccessful First Time MVD

Xia

Zhou

Zhang

et al. 2021

J Neurol Surg A Cent Eur Neurosurg

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Background Microvascular decompression (MVD) has become accepted as an effective therapeutic option for hemifacial spasm (HFS); however, the curative rate of MVD for HFS varies widely (50–98%) in different medical centers. This study could contribute to the improvement of the MVD procedure. Methods We retrospectively analyzed 32 patients in whom initial MVD failed in other hospitals and who underwent a second MVD at our center. The clinical characteristics, operative findings, outcome of the second MVD, and complications were recorded. Results There were 18 women and 14 men (56.3 and 43.7%, respectively). The left-to-right ratio was 19:13. The mean age of the patients was 59.8 years. We found an undiscovered conflict site located in zone 4 in 10 patients and in the root entry zone in 8 patients. The initial MVD failed in nine patients because of ignorance of the arterioles that originate from the anterior inferior cerebellar artery. There were no special findings in four patients. No Teflon felts were found in the whole surgical field in one patient. Conclusion Omission of the offending vessel is the most common cause of an unsuccessful MVD. Intraoperative abnormal muscle response associated with the Z-L response is a good measure to correctly identify the involved arterioles.

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Residual hemifacial spasm after microvascular decompression: prognostic factors with emphasis on preoperative psychological state

Cited by 18 publications

References 24 publications

Severe Hemifacial Spasm is a Predictor of Severe Indentation and Facial Palsy after Microdecompression Surgery

Severe Hemifacial Spasm is a Predictor of Severe Indentation and Facial Palsy after Microdecompression Surgery

A multivariable prediction model for recovery patterns and time course of symptoms improvement in hemifacial spasm following microvascular decompression

How to Improve the Effect of Microvascular Decompression for Hemifacial Spasm: A Retrospective Study of 32 Cases with Unsuccessful First Time MVD

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