Microvascular decompression for hemifacial spasm: Outcome on spasm and complications. A review

Sindou, Marc; Mercier, Philippe

doi:10.1016/j.neuchi.2018.01.001

Cited by 105 publications

(95 citation statements)

References 71 publications

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“…The recovery time for facial paralysis reportedly overlapped the time of delayed healing; however, facial paralysis had no effect on the patient's overall prognosis. 11 The present study also revealed that although the complete disappearance of intraoperative AMR waves indicates successful decompression and immediate alleviation of symptoms, lack of AMRs is not related to patient prognosis. In this study, electrophysiologic monitoring of AMRs was performed in 600 patients who underwent MVD.…”

Section: Discussionsupporting

confidence: 55%

Clinical Research on Delayed Cure after Microvascular Decompression for Hemifacial Spasm

Jiang

et al. 2019

J Neurol Surg A Cent Eur Neurosurg

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Objective The clinical data of patients with hemifacial spasm (HFS) were analyzed statistically to identify factors leading to delayed cure after microvascular decompression (MVD). Methods A retrospective analysis of the clinical data of 600 patients with HFS subjected to MVD from March 2016 to May 2018 was performed. Student t test, chi-square test, logistic regression analysis, and multivariate analysis of variance were used to analyze the correlation between delayed cure and its related factors. Results Among the 600 patients enrolled, 117 had delayed cure after MVD. The shortest duration of delayed cure was 4 days, and the longest was 540 days, with an average of 108 days. The frequency of delayed improvement in these patients was not associated with sex, age, or offending vessel type (p > 0.05); however, delayed cure was positively correlated with the course of the disease, grade of HFS severity, and disappearance of abnormal muscle responses during the operation (p < 0.05). Moreover, a longer disease course was associated with more severe related symptoms and a longer duration of postoperative delayed cure. Conclusion MVD is an effective treatment for HFS. Given that postoperative delayed cure was unavoidable, even with accurate identification of the offending vessel and sufficient decompression of the root exit zone, delayed cure should be considered in patients undergoing reoperation due to lack of remission or relapse after the operation. Additionally, the timing of efficacy assessments should be delayed.

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Section: Discussionsupporting

confidence: 55%

Clinical Research on Delayed Cure after Microvascular Decompression for Hemifacial Spasm

Jiang

et al. 2019

J Neurol Surg A Cent Eur Neurosurg

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“…Hemifacial spasm (HFS) is a common cranial nerve disease characterized by irregular, involuntary, and recurring spasms of the facial muscles innervated by the ipsilateral seventh cranial nerve. [1][2][3] It is generally believed that HFS is caused by cross-compression of the facial nerve by the offending vessel at the root exit zone (REZ). 4 Accordingly, microvascular decompression (MVD) has become widely accepted as the first-line therapeutic option for HFS, with reports of immediate cure rates ranging from 50% to 98%.…”

Section: Introductionmentioning

confidence: 99%

Long-term Outcomes of Microvascular Decompression in the Treatment of Hemifacial Spasm Based on Different Offending Vessels

Zhao

Tang

Zhang

et al. 2019

J Neurol Surg A Cent Eur Neurosurg

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Objective To evaluate clinical features, outcomes, and complications in patients with hemifacial spasm (HFS) after microvascular decompression (MVD) of different offending vessels. Methods Clinical data were collected from 362 patients with HFS treated with MVD between January 2013 and January 2014. Patients were divided into five groups based on the offending vessel: A (anterior inferior cerebellar artery [AICA] compression), B (posterior inferior cerebellar artery [PICA] compression), C (AICA plus PICA compression), D (vertebral artery [VA] compression), and E (VA plus small vessel compression). Results The most common offending vessel was the AICA (51.38%). The most common compression site was the root exit zone. During the follow-up period, the effective rate was 95.48% in group A, 92.15% in group B, 93.10% in group C, 90.14% in group D, and 91.45% in group E. Twenty-nine patients exhibited delayed facial palsy, the most common complication. Conclusion No statistically significant differences were found in long-term outcomes or MVD-related complications among the study groups. The type of offending vessel was not a prognostic factor for MVD in patients with HFS.

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“…According to Sindou et al, delayed effect ranged from 5% to 50% in literature. Jo et al who studied a delayed cure among surgically treated patients stated that not all of the patients are cured immediately [20][21][22]. All our patients enjoyed either excellent or good cure rate with no recurrence during follow up.…”

Section: Discussionmentioning

confidence: 56%

“…Excellent result occurred in 84% with recurrence rate 1.5%. Sindou et al reviewed 5.935 patients and found that excellent results obtained in a range from 68% to 94.1%, recurrence rate was low 1%, incomplete resolution (more than or equal to 50% relief) ranged from 4.6% to 19% and failure (effect less than 50%) from 3.6% to 15.5% [20,[23][24][25].…”

Section: Discussionmentioning

confidence: 99%

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Endoscopic assisted microvascular decompression versus new antiepileptics and BOTOX in treatment of hemifacial spasm: a clinical trial

et al. 2020

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Introduction: Hemifacial spasm (HFS) is a chronic movement disorder characterized by twitching of muscles of facial expression which is innervated by the facial nerve. The condition is unilaterally, beginning in the orbicularis occuli, and later on progress to involve the perioral, platysma, and other muscles of facial expression. Endoscopic assisted microvascular decompression is considered the state of the art in hemi-facial spasm surgery. New antiepileptic have emerged with a new hope for good control with few side effects. Botulinum toxin is still a good option for some patients. Methods: This study is a prospective study that was conducted on 30 patients with primary hemifacial spasm. Bilateral and secondary cases where excluded. All patients were subjected to proper pre-treatment assessment including; proper history taking, clinical examination, and proper radiological investigations (MRI, FISTA) when needed. They were divided into three groups according to treatment modality: group A where patient's general condition was unfit for surgical intervention, received oral medications (gabapentin or levetiracetam); group B included those patients unfit for surgical intervention and did not respond to oral therapy, received Botox injection; and group C underwent endoscopic assisted microvascular decompression. Follow-up period ranged from 6 to 24 months. Outcome of different treatment modalities were compared among different groups. Results: Among group A patients, one patient showed excellent response to treatment (Gabapentin 1200 mg), three patients had good response, four patients had fair response, and three patients had poor response to treatment (one used levetiracetam, two used gabapentin). Overall success rate is 72.7%. Among group B patients, four patients enjoyed excellent response. Another four patients had good response, while three patients had fair response. Only one patient had poor response. Overall success rate was 83.3%. Among group C patients, five cases had excellent outcome and two cases had good outcome. Overall success rate is 100%. Conclusion: Endoscopic assisted microvascular decompression offers the best chance to permanent cure with low complication rate. New antiepileptics (levetiracetam, gabapentin) provide a safe therapy for patients refusing surgical intervention. Botox is an attractive local therapy with reversible complications but with non-sustainable effect. From our results, we conclude that endoscopic assisted microvascular decompression is superior to either BOTOX or antiepiletics for the permanent cure of hemifacial spasm.

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Microvascular decompression for hemifacial spasm: Outcome on spasm and complications. A review

Cited by 105 publications

References 71 publications

Clinical Research on Delayed Cure after Microvascular Decompression for Hemifacial Spasm

Clinical Research on Delayed Cure after Microvascular Decompression for Hemifacial Spasm

Long-term Outcomes of Microvascular Decompression in the Treatment of Hemifacial Spasm Based on Different Offending Vessels

Endoscopic assisted microvascular decompression versus new antiepileptics and BOTOX in treatment of hemifacial spasm: a clinical trial

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