Microvascular decompression for hemifacial spasm in patients &gt;65 years of age: An analysis of outcomes and complications

Sekula, Raymond F.; Frederickson, Andrew M.; Arnone, Gregory D.; Quigley, Matthew R.; Hallett, Mark

doi:10.1002/mus.23800

Cited by 43 publications

(25 citation statements)

References 40 publications

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“…All medically stable patients, including patients of advanced age, those who had undergone prior MVD, or those with a history of facial botulinum toxin injections, were included in the study based on a positive abnormal motor response of the facial nerve and radiographically apparent neurovascular compression. 11,23,24 operative technique…”

Section: Methods Patient Selectionmentioning

confidence: 99%

Reduction in high-frequency hearing loss following technical modifications to microvascular decompression for hemifacial spasm

Frederickson

Balzer

Crammond

et al. 2015

JNS

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M icrovascular decompression (MVD) is a safe and efficacious procedure for the treatment of hemifacial spasm (HFS), a debilitating condition that reduces patients' quality of life. Severe sensorineural hearing loss (SNHL) across all frequencies is a known complication of the operation, with reported rates ranging from 1.4% to 20%. 4,12,[18][19][20][21]24 In addition to severe SNHL, however, a recent report has raised concern that as many as one-half of patients undergoing MVD for HFS may experience high-frequency (4-8 kHz) hearing loss.28 Although this type of hearing loss is not as obviously apparent upon clinical follow-up as severe SNHL, high-frequency hearing loss (HFHL) can profoundly reduce the quality of life of patients. 5,10 Although the prior report implicated noise from the high-speed surgical drill as the cause of HFHL following MVD, we conducted this study to examine the incidence of HFHL, with an emphasis on retractorless MVD for treatment of HFS.abbreviatioNs BAEP = brainstem auditory evoked potential; HFHL = high-frequency hearing loss; HFS = hemifacial spasm; MVD = microvascular decompression; SNHL = sensorineural hearing loss; SPL = sound pressure level. obJect Microvascular decompression is a safe and effective procedure to treat hemifacial spasm, but the operation poses some risk to the patient's hearing. While severe sensorineural hearing loss across all frequencies occurs at a low rate in experienced hands, a recent study suggests that as many as one-half of patients who undergo this procedure may experience ipsilateral high-frequency hearing loss (HFHL), and as many as one-quarter may experience contralateral HFHL. While it has been suggested that drill-related noise may account for this finding, this study was designed to examine the effect of a number of techniques designed to protect the vestibulocochlear nerve from operative manipulation on the incidence of HFHL. methods Pure-tone audiometry was performed both preoperatively and postoperatively on 67 patients who underwent microvascular decompression for hemifacial spasm during the study period. A change of greater than 10 dB at either 4 kHz or 8 kHz was considered to be HFHL. Additionally, the authors analyzed intraoperative brainstem auditory evoked potentials from this patient cohort. results The incidence of ipsilateral HFHL in this cohort was 7.4%, while the incidence of contralateral HFHL was 4.5%. One patient (1.5%; also included in the HFHL group) experienced an ipsilateral nonserviceable hearing loss. coNclusioNs The reduced incidence of HFHL in this study suggests that technical modifications including performing the procedure without the use of fixed retraction may greatly reduce, but not eliminate, the occurrence of HFHL following microvascular decompression for hemifacial spasm.

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Section: Methods Patient Selectionmentioning

confidence: 99%

Reduction in high-frequency hearing loss following technical modifications to microvascular decompression for hemifacial spasm

Frederickson

Balzer

Crammond

et al. 2015

JNS

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“…[26,27] the MVD success rate did not show any statistically significant between young and elderly patients that goes with statement of Sekula et al [25] The failed 4 cases had many characteristics: one of them was reoperated upon and HFS was improved post 2nd MVD operation. The reason of failure can be explained by in adequate facial nerve decompression, missed another offending vessel or not shredded Teflon sponge migration against the involved facial nerve as conducted by many studies.…”

Section: Discussionmentioning

confidence: 55%

Safety and effectiveness of microvascular decompression for treatment of hemifacial spasm through mini craniotomy

El‐Badry¹,

Mansour²,

Abdel‐Khalek³

2017

Romanian Neurosurgery

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Background:The hemifacial spasm (HFS) defined as involuntary intermittent twitching of the muscles of the face (usually unilateral). The spasms characteristically begin around the eye and then extend to affect other muscles of the ipsilateral face. It is caused by vascular element compressing the facial nerve that may be either the anterior or the posterior inferior cerebellar arteries in most cases. Objective of our work: to describe the operative technique (pearls and common mistakes), the efficacy and morbidity of microvascular decompression technique for hemifacial spasm through mini craniotomy, determine the prognostic factors affecting success rate of the surgery. Material & method:A retrospective study of 23 cases of hemifacial spasm treated by mini craniotomy retro sigmoid approach and microvascular decompression at neurosurgery dept., Mansoura University Hospital in last 10 years was investigated. This include Epidemiological, clinical and imaging details, selected treatment options and patients' outcome. Results: complete resolving of symptoms was conducted in 19 cases 82.6% while reoperated in 2 cases with improvement in one case. Facial palsy appeared postoperative in 6 cases 4 of them improved in 3 months, transient hearing loss in 4 cases17.4% which improved later, cerebrospinal fluid leak appeared in 3 cases 13% which managed conservatively. Conclusions: MVD relieves symptoms of HFS in about 80% of patients while recurrence still in low percentage. The study reported low permanent Complications and generally transient.

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“…5,[13][14][15] Reasons for an unsuccessful MVD include not identifying the true culprit vessels and incomplete vascular decompression. 16 Additionally, a subpopulation of Ͻ10% of patients do not improve despite undergoing a technically successfully procedure, possibly due to a central mechanism.…”

Section: Discussionmentioning

confidence: 99%

“…16 Additionally, a subpopulation of Ͻ10% of patients do not improve despite undergoing a technically successfully procedure, possibly due to a central mechanism. 5,[13][14][15][16] The existing literature regarding surgical success rates for repeat MVD in the setting of persistent HFS is less extensive. The anatomic location along the facial nerve where persistent vascular compression was identified in repeat MVD surgeries has not been well-described in the existing literature.…”

Section: Discussionmentioning

confidence: 99%

“…However, many patients with unabated HFS despite prior MVD can and do benefit from repeat operations. 5,6 Failure to identify persistent vascular compression of the facial nerve can discourage reoperation and potential cure. The purpose of this article was to determine whether MR imaging could identify unaddressed neurovascular contact in patients with ongoing HFS despite prior MVD and to report the frequency and most common locations of this residual neurovascular contact.…”

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confidence: 99%

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MRI Findings in Patients with a History of Failed Prior Microvascular Decompression for Hemifacial Spasm: How to Image and Where to Look

Hughes

Branstetter

Taylor

et al. 2014

AJNR Am J Neuroradiol

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Microvascular decompression for hemifacial spasm in patients >65 years of age: An analysis of outcomes and complications

Cited by 43 publications

References 40 publications

Reduction in high-frequency hearing loss following technical modifications to microvascular decompression for hemifacial spasm

Reduction in high-frequency hearing loss following technical modifications to microvascular decompression for hemifacial spasm

Safety and effectiveness of microvascular decompression for treatment of hemifacial spasm through mini craniotomy

MRI Findings in Patients with a History of Failed Prior Microvascular Decompression for Hemifacial Spasm: How to Image and Where to Look

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