The Efficacy and Safety of Microvascular Decompression for Hemifacial Spasm in Elderly Patients

Jeon, Chul Jin; Kong, Doo Sik; Lee, Jeong A; Park, Kwan

doi:10.3340/jkns.2010.47.6.442

Cited by 27 publications

(21 citation statements)

References 16 publications

(15 reference statements)

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“…However, in spite of the clinical importance, there was only one study on the efficacy and safety of MVD in elderly patients with HFS [13]. In this previous study, we reported a similar surgical outcome and complications in elderly patients compared with younger group.…”

Section: Discussionsupporting

confidence: 62%

“…In this previous study, we reported a similar surgical outcome and complications in elderly patients compared with younger group. However, this study had limitations such as the confounding effects from different characteristics of HFS between the groups [13]. Furthermore, the higher prevalence of comorbidities in the elderly group was not considered in this previous study.…”

Section: Discussionmentioning

confidence: 99%

“…Many neurosurgeons fear complications and concerns over fitness for surgery. Although there are some studies on the safety and efficacy of MVD in elderly patients with trigeminal neuralgia [10,11,12], little is known about the clinical value of MVD in elderly patients with HFS [13]. …”

Section: Introductionmentioning

confidence: 99%

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

Youn¹,

Kwon²,

Kim³

et al. 2013

Eur Neurol

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Background: Hemifacial spasm (HFS) is a common disorder and has a significant impact on the quality of life. Microvascular decompression (MVD) is an effective and safe treatment option for patients with HFS, however the effectiveness and safety of MVD in elderly patients with HFS is not clear. Methods: We enrolled 699 HFS patients who underwent MVD from February 2008 to December 2011 at the Samsung Medical Center in Seoul, Korea. Subjects were divided into two groups: an elderly group (patients who were 60 years old or older) and a younger group. We compared demographic and clinical data, surgical outcome and complications after MVD between the groups. Results: The elderly group had more severe spasms and higher grade indentation than the younger group. Multiple offending vessels were more commonly detected in the elderly group. Although the improvement was similar 6 months after MVD between the groups, complications were more common in the elderly group even after controlling for possible confounding factors. In particular, ear problems including hearing loss were more common in the elderly group. Conclusion: MVD is an effective treatment option in elderly patients with HFS. However, surgeons should be pay attention to potential complications in elderly patients with HFS.

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Section: Discussionsupporting

confidence: 62%

Section: Discussionmentioning

confidence: 99%

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

Youn¹,

Kwon²,

Kim³

et al. 2013

Eur Neurol

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“…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.…”

mentioning

confidence: 99%

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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“…Usually, these contractions start in the orbicularis oculi muscle, and over time progress to the lower facial muscles. HFS is thought to be caused by a combination of mechanisms: a hyperexcitable facial motor nucleus (central hypothesis), axono-axonal conduction due to demyelination or ephaptic transmission (which is the theory in favor of peripheral hypothesis responsible for hemifacial spasm), and vascular compression of the facial nerve at the site of demyelination [1][2][3][4][5]. Moller and Jannetta hypothesized that the activity at the facial nerve lesion, or site of demyelination at the root exit zone (REZ), may travel antidromically and cause abnormal functioning of the facial motor nucleus in a process similar to kindling [4].…”

Section: Introductionmentioning

confidence: 99%

Intra-operative monitoring of two facial muscles in hemifacial spasm surgery

2015

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The Efficacy and Safety of Microvascular Decompression for Hemifacial Spasm in Elderly Patients

Cited by 27 publications

References 16 publications

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

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

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

Intra-operative monitoring of two facial muscles in hemifacial spasm surgery

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