An investigation into quality of life improvement in patients undergoing microvascular decompression for hemifacial spasm

Lawrence, Jeffrey G.; Frederickson, Andrew M.; Chang, Yue‐Fang; Weiss, Patricia M; Gerszten, Peter C.; Sekula, Raymond F.

doi:10.3171/2016.9.jns161022

Cited by 27 publications

(22 citation statements)

References 79 publications

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“…Despite a lack of pain, hemifacial spasm symptoms can be both physically and emotionally debilitating. 1 , 2 Vascular compression along the centrally myelinated portion of the facial nerve attached to the pons and just beyond is responsible for hemifacial spasm in the majority of patients. 3–6 Anticonvulsant medication is typically ineffective for hemifacial spasm.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and severity of neurovascular compression in hemifacial spasm patients

Traylor

Sekula

Eubanks

et al. 2021

Brain

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Hemifacial spasm is typically caused by vascular compression of the proximal intracranial facial nerve. Although the prevalence of neurovascular compression has been investigated in a cohort of patients with classical trigeminal neuralgia, the prevalence and severity of neurovascular compression has not been well characterized in patients with hemifacial spasm. We aimed to investigate whether presence and severity of neurovascular compression are correlated to the symptomatic side in patients with hemifacial spasm. All patients in our study were evaluated by a physician who specializes in the management of cranial nerve disorders. Once hemifacial spasm was diagnosed on physical exam, the patient underwent a dedicated cranial nerve protocol magnetic resonance imaging study on a 3 T scanner. Exams were retrospectively reviewed by a neuroradiologist blinded to the symptomatic side. The presence, severity, vessel type, and location of neurovascular compression along the facial nerve was recorded. Neurovascular compression was graded as contact alone (vessel touching the facial nerve) versus deformity (indentation or deviation of the nerve by the culprit vessel). A total of 330 patients with hemifacial spasm were included. The majority (232) were female while the minority (98) were male. The average age was 55.7 years. Neurovascular compression (arterial) was identified on both the symptomatic (97.88%) and asymptomatic sides (38.79%) frequently. Neurovascular compression from an artery along the susceptible/proximal portion of the nerve was much more common on the symptomatic side (96.36%) than on the asymptomatic side (12.73%), odds ratio = 93.00, P < 0.0001. When we assessed severity of arterial compression, the more severe form of neurovascular compression, deformity, was noted on the symptomatic side (70.3%) much more frequently than on the asymptomatic side (1.82%) (odds ratio = 114.00 P < 0.0001). We conclude that neurovascular compression that results in deformity of the susceptible portion of the facial nerve is highly associated with the symptomatic side in hemifacial spasm.

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Section: Introductionmentioning

confidence: 99%

Prevalence and severity of neurovascular compression in hemifacial spasm patients

Traylor

Sekula

Eubanks

et al. 2021

Brain

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“…Proponents of botulinum toxin as primary treatment for HFS point to high rates of patient satisfaction and low complication rates, 5 while others have found improved quality of life scores achieved with MVD surgery. 6 Thus, the observed disparity may be attributable to variations in practice patterns and healthcare provider beliefs regarding the relative efficacy, functional outcomes, and costeffectiveness of interventional therapies such as botulinum toxin relative to MVD. Finally, easy accessibility to alternative treatment options such as botulinum toxin as well as surgical therapy may be speculated to vary from province to province.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, there are no well-known guidelines to direct primary care or surgical providers on when to seek surgical management for HFS. Proponents of botulinum toxin as primary treatment for HFS point to high rates of patient satisfaction and low complication rates, 5 while others have found improved quality of life scores achieved with MVD surgery 6 . Thus, the observed disparity may be attributable to variations in practice patterns and healthcare provider beliefs regarding the relative efficacy, functional outcomes, and cost-effectiveness of interventional therapies such as botulinum toxin relative to MVD.…”

Section: Discussionmentioning

confidence: 99%

Geographic Disparities in the Surgical Management of Hemifacial Spasm in Canada

Somji

Kaufmann

2018

Can. J. Neurol. Sci.

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BackgroundWe aimed to interrogate the Canadian Institute for Health Information (CIHI) database in order to determine the geographic distribution and outcomes of microvascular decompression (MVD) for the treatment of hemifacial spasm (HFS).MethodsThe CIHI database was searched from 2004 to 2017 for relevant diagnostic and procedure codes. A new database was populated with the following categories: year, institution, province, number of interventions per year, and mean length of stay. Descriptive statistics were generated. Provincial utilization rates of MVD for HFS were calculated.ResultsDuring the period 2004-17, we identified 671 MVDs performed for HFS at 20 centers across Canada. During the study period, 286 MVDs (42.6%) were performed at one center in Manitoba. Another 131 (19.5%) and 72 (10.7%) were performed at one center in British Columbia and Ontario, respectively. The remaining 182 (27.1%) MVDs for HFS were performed at 17 centers across the rest of Canada where the mean number of cases performed per year was 1.1 (SD=0.9, range 0.2-2.9). When out-of-province cases were re-allocated to place of residence, the adjusted provincial utilization of MVD for HFS ranged between 0.5 and 6.1 patients per million per year.ConclusionsMicrovascular decompression for HFS is performed relatively rarely and there is a tremendous geographic variation in utilization across Canada. Although most of these surgeries are performed by a few surgeons, more than half of Canadian centers perform an average of less than 1 case per year. Further examination of the impact of these discrepancies appears warranted.

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“…Patients complain, however, less of the physical problems than of social issues, both personal and occupational, which may lead to anxiety and depression [4]. Microvascular decompression is presently the sole curative treatment, definitively resolving spasm with a low risk of complications [2,3,[5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Quality of life after hemifacial spasm surgery: French versions of the HFS-8 and HFS-30 questionnaires

Alciato¹,

Simon

Hervochon³

et al. 2021

European Annals of Otorhinolaryngology, Head and Neck Diseases

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Objectives. The aim of the present study was to assess quality of life before and after surgery for hemifacial spasm, in order to validate two specific quality of life scales translated in French. Surgical results and complications were reported.Material and methods. Twenty-three patients with hemifacial spasm treated by microvascular decompression were retrospectively included. The HFS-8 and HFS-30 quality of life scales were translated from English into French using a forwardbackward method and implemented on patients at least 1 year after surgery.Results. Median HFS-8 and HFS-30 values were respectively 16 ± 12.5 (range, 8 -20.5) and 38 ± 38.5 (range, 23 -61.5) before surgery and 0.5 ± 4.5 (range, 0 -4.5) and 5 ± 17.5 (range, 1 -18.5) after surgery, showing significant improvement in quality of life (p < 0.001). The internal consistency of both scales was excellent (Cronbach's alpha > 0.9), and they were significantly correlated (Pearson coefficient = 0.95; 95% CI [0.91; 0.98]; p < 0.0001). Success rates were respectively 83% and 91% after primary and revision surgeries. Complications were transient with minor consequences in 80% of cases, but could impact quality of life when lasting. Conclusions. These results support the validity of the French versions of HFS-8 and HFS-30. Microvascular decompression is a safe and effective treatment for hemifacial spasm, and these scales are reliable tools to assess postoperative quality of life.

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An investigation into quality of life improvement in patients undergoing microvascular decompression for hemifacial spasm

Cited by 27 publications

References 79 publications

Prevalence and severity of neurovascular compression in hemifacial spasm patients

Prevalence and severity of neurovascular compression in hemifacial spasm patients

Geographic Disparities in the Surgical Management of Hemifacial Spasm in Canada

Quality of life after hemifacial spasm surgery: French versions of the HFS-8 and HFS-30 questionnaires

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