Delayed Relief of Hemifacial Spasm After Microvascular Decompression

Abstract

Microvascular decompression (MVD) has been accepted worldwide as a reasonable treatment for hemifacial spasm (HFS); however, resolution of the HFS is often gradual. To conclude the delayed relief rate of the MVD for the treatment of HFS, we conducted a systematic review. Using the keywords delayed relief, hemifacial spasm, or microvascular decompression, articles published in English-language journals and indexed in PubMed between June 1, 1994 and June 1, 2014 on the treatment of HFS with emphasis on delayed relief were considered for this study. Twelve articles with 2727 patients with HFS were finally enrolled in this review. Among all the patients, the ratio of male versus female was 1:2.7, and left versus right was 1:1.6. The average age at surgery was 52.5 years (49.1-55.9 y), with HFS symptom duration of 68.4 months (38.4-98.4 mo) before the surgery. The average follow-up duration was 49 months (6.4-121.6 mo). After examining all the patients, we obtained a mean postoperative success rate of 85.1% (76.5%-93.5%), but the success rate after the MVD immediately is only 71.8% (59.5%-84%). The mean rate of delayed relief was 25.4% (18.8%-37.1%). Approximately 13.1% (5.9%-19.7%) of the patients with symptom recurrence resorted to repeated MVD during the follow-up period. Accordingly, MVD is the most effective treatment for patients with HFS, but some of the patients may experienced delayed relief, which could be avoided if a thorough decompression of the facial nerve root had been obtained.

Risultati chirurgici a lungo termine della decompressione microvascolare nell’emispasmo facciale: efficacia, morbilità e qualità di vita

“…Repeat MVD of the facial nerve may be sufficient to resolve symptoms in selected patients with persistent or recurrent HFS 25 . Hence, the benefit-risk ratio should be explained to the patient: in our study, most patients accepted second surgery (69% versus 13.1-50% in literature) 26 . No consensus has been reached on the timing of re-operation.…”

Hemifacial spasm secondary to middle ear cholesteatoma

“…Middle ear pathology in association with a dehiscent facial nerve can also cause hemifacial spasm. 3 This has been reported in the past regarding otitis media, but to the best of our knowledge, no case been reported as a consequence of cholesteatoma. Our patient's recurrent cholesteatoma was intimately associated with a dehiscent tympanic segment of the fallopian canal and an exposed facial nerve, which led to his progressive hemifacial spasm.…”

Retrospective clinical analysis of 320 cases of microvascular decompression for hemifacial spasm

“…After the operation, in most patients, the symptoms will disappear; while symptoms of a small group of patients will be relieved gradually until disappearing completely rather than disappear immediately after surgery—a phenomenon called “delayed resolution.” [ 31 ] It was reported that the rate of delayed resolution could be up to 36.3%. [ 31 ] The reason may be that the complete recovery of facial nerve root demyelination and the reactivation of the facial nerve motor nucleus needs months or even years. [ 31 , 32 ] Chang et al [ 33 ] considered that despite the full decompression, facial nerve root may still suffer from pulsatile impact from the cerebrospinal fluid pressure, resulting in extended length of recovery.…”