Safety and Effectiveness of Microvascular Decompression for the Treatment of Hemifacial Spasm in the Elderly

Youn, Jinyoung; Kwon, Soonwook; Kim, Ji Sun; Jeong, Heejeong; Park, Kwan; Cho, Jin Whan

doi:10.1159/000351266

Cited by 16 publications

(8 citation statements)

References 26 publications

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“…Tinnitus tends to correlate with HL, and patients will often complain of the ringing more than their HL. 21,22 Since tinnitus often resolves in conjunction with HL, it is also appropriate to wait at least 2 months postoperatively before any intervention is pursued.…”

Section: Discussionmentioning

confidence: 99%

Neurotologic Complications Following Microvascular Decompression: A Retrospective Study

et al. 2019

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Objective The main purpose of this article is to determine the frequency of neurotologic complications after posterior fossa microvascular decompression (MVD) surgery. Design Retrospective case review. Setting Tertiary care referral center. Participants A total of 215 consecutive MVD operations by a single surgeon between March 1996 and May 2016 were reviewed with 192 surgeries on 183 patients meeting inclusion criteria. Main Outcome Measures Neurotologic complications secondary to MVD. Results The 52 males and 131 females had a mean age of 58.52 years (range, 28–92 years). Indications for MVD were trigeminal neuralgia (n = 162), hemifacial spasm (n = 23), glossopharyngeal neuralgia (n = 13), vagal palsy (n = 1), and tinnitus (n = 1). The outcomes examined were postoperative hearing loss, tinnitus, vertigo, and hemifacial paresis. At least one of these complications was present in 17.7% of patients. There were 4.17% with permanent hearing loss, 6.77% with transient hearing loss, 5.21% with tinnitus, 5.73% with vertigo, and 0.52% with hemifacial paresis. There was no significant difference in complication rates based on surgical indication. Conclusions Neurotologic complications are a significant risk when performing MVD. It is important for otolaryngologists as well as neurosurgeons to be aware of such complications. We recommend perioperative audiometry in all patients undergoing MVD and believe there is utility in routine otolaryngologist involvement.

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Section: Discussionmentioning

confidence: 99%

Neurotologic Complications Following Microvascular Decompression: A Retrospective Study

et al. 2019

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“…Similarly, when we compared clinical features between elderly patients with HFS and younger patients in a previous study, the elderly patients with HFS showed more severe-spasms and were more likely to have HTN and DM. 18 Considering that the age at MVD was not associated with spasm severity in the multivariate analysis performed in the present study, the severity of HFS might not be directly related to age, but rather to other conditions such as HTN or disease duration. Previous studies have also focused on the association between vascular dolichoectasia and HFS, concluding that dolichoectasia is usually associated with HTN.…”

Section: Discussionmentioning

confidence: 49%

“… 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: 87%

“…The clinical course of HFS was classified into three types: periocular onset (spasm presenting first in the periocular area), perioral onset (perioral involvement at symptom onset), and hemi onset (hemifacial area at onset). 18 We also assessed the presence of HFS-related tinnitus resulting from spasm of the stapedius muscle, which is innervated by facial nerves.…”

Section: Methodsmentioning

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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“…Injuries to the vestibulocochlear nerve or inner ear vasculature can also result in potentially disabling postoperative tinnitus. Tinnitus tends to correlate with hearing loss, and patients will often complain of the ringing more than their hearing loss [21,22]. Since tinnitus often resolves in conjunction with hearing loss, it is also appropriate to wait at least two months postoperatively before any intervention is pursued.…”

Section: Discussionmentioning

confidence: 99%

Neurotologic Complications Following Microvascular Decompression: A Retrospective Study

Leonetti¹

2017

OHNS

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Microvascular Decompression (MVD) offers effective, long-term symptom relief for patients with pathologies related to neurovascular conflicts of cranial nerves in the posterior fossa. We aimed to determine the frequency of neurotologic complications following this surgery. This is a retrospective case review in a tertiary care referral center. A total of 215 consecutive MVD operations by a single surgeon between March 1996 and May 2016 were reviewed with 192 surgeries on 183 patients meeting inclusion criteria. The 52 males and 131 females had a mean age of 58.52 years (range 28-92 years). Indications for MVD were trigeminal neuralgia (n=162), hemifacial spasm (n=23), glossopharyngeal neuralgia (n=13), vagal palsy (n=1), and tinnitus (n=1). The outcomes examined were postoperative hearing loss, tinnitus, vertigo, and hemifacial paresis. At least one of these complications was present in 17.7% of patients. There were 4.17% with permanent hearing loss, 6.77% with transient hearing loss, 5.21% with tinnitus, 5.73% with vertigo, and 0.52% with hemifacial paresis. There was no significant difference in complication rates based on surgical indication. Complication rates in this study are consistent with those in the literature. We recommend perioperative audiometry in all patients undergoing MVD. It is important for otolaryngologists as well as neurosurgeons to be aware of neurotologic complications in order to adequately counsel patients preoperatively and identify them postoperatively.

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Safety and Effectiveness of Microvascular Decompression for the Treatment of Hemifacial Spasm in the Elderly

Cited by 16 publications

References 26 publications

Neurotologic Complications Following Microvascular Decompression: A Retrospective Study

Neurotologic Complications Following Microvascular Decompression: A Retrospective Study

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

Neurotologic Complications Following Microvascular Decompression: A Retrospective Study

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