Long-Term Retrospective Analysis of Re-do Microvascular Decompression in Patients With Hemifacial Spasm

Abstract

Objective: To explore the clinical characteristics of patients with persistent or recurrent hemifacial spasm (HFS) and the experience of microvascular decompression (MVD) in the treatment of such patients to accumulate additional clinical evidence for optimal treatment protocols.Methods: We retrospectively analyzed the clinical data, surgical methods and treatment efficacies of 176 patients with persistent or recurrent HFS from January 2009 to January 2018.Results: Missing compression zones was the main reason for symptom persistence (87.50%) or recurrence (71.50%) after MVD treatment of HFS. We divided the surgical area into three zones. Most persistent or recurrent cases had decompression only in the root exit zone (REZ) (Zone 1) but missed the ventrolateral pons-involved area (Zone 2) or the bulbopontine sulcus-involved area (Zone 3) in the first MVD. Too much use of Teflon (12.50%), arachnoid adhesions (5.60%) and Teflon granulomas (10.40%) can also cause a recurrence. The difference between preoperative and postoperative Cohen scores was statistically significant in persistent or recurrent HFS patients (p<0.05). The postoperative follow-up time ranged from 36 to 108 months (71.75 ± 22.77).Conclusions: MVD should be performed in the compression site, which is mostly located at the brainstem/facial REZ. Intraoperative exploration should be conducted in accordance with the abovementioned zones to effectively avoid missing offending vessels. Re-do MVD is effective in patients with persistent or recurrent HFS.

Prediction of hemifacial spasm re-appearing phenomenon after microvascular decompression surgery in patients with hemifacial spasm using dynamic susceptibility contrast perfusion MRI

“…The recurrence of HFS after MVD surgery may be contributed by several factors, such as: The blood flow in their supply area may be reduced by the cumulative effect of compression by multiple perforator arterioles 38 . Reduced blood flow and recurrence may be led by the inappropriate insertion of Teflon, which may fail to absorb the pulse energy or induce local inflammation due to direct compression of the facial REZ 23 . The contact area and demyelination of the nerve may be increased by the ventrocaudal location of the offending vessel, resulting in a wider range of nerve dysfunction 28 .…”

“…The main causes of HFS persistence or recurrence are missed compression zones or improper use of Teflon 23,31 . Most missed compression zones are located in the ventrolateral pons area or bulbopontine sulcus, besides the REZ region.…”

Etiology and Management of Recurrent and Persistent Hemifacial Spasm—A Single-Center Experience

“…A multitude of studies have pinpointed missed vascular compression as the principal reason for surgical failure in MVD for treating HFS. [1][2][3][4][5]7,[9][10][11][12][13] Other well-documented factors contributing to the failure of MVD include Teflon overpacking, 2,4,6,7,13 inadequate use of Teflon material, 2,3,5,6,10,12 Teflon adhesion, 6,7,13 and Teflon slippage. 5,12,14,15 In addition, the formation of Teflon granuloma has been cited in recurrent cases.…”

“…5,12,14,15 In addition, the formation of Teflon granuloma has been cited in recurrent cases. 4,12 In rare instances, the reoccurrence of spasms has been attributed to the development of an aneurysm 9 or a new vascular issue. 6 To gain a more nuanced understanding of the causes behind primary MVD failure, we categorized them into 3 key groups: pledget adhesion, missed vascular compression, and insufficient decompression.…”

Brain White Matter Structural Alteration in Hemifacial Spasm: A Diffusion Tensor Imaging Study

“…All patients with HFS were assessed with the Cohen scale to quantify the hierarchy of facial spasms. 26 The scoring criteria are as follows: 0 point means normal; 1 point means external stimulation causes an increase in blepharospasm or slight facial spasm; 2 points were considered to be mild facial spasm and blepharospasm seem spontaneous, with no functional impairment; 3 points were considered to be moderate facial spasm and blepharospasm, mild functional impairment; 4 points were considered to be severe facial spasm, blepharospasm, and functional impairment. In addition, all the subjects underwent emotional assessment and selfscored through the selfrating anxiety scale (SAS) and the selfrating depression scale (SDS).…”