Postoperative complications of microvascular decompression for hemifacial spasm: lessons from experience of 2040 cases

Abstract

Microvascular decompression (MVD) is an effective and safe treatment option that offers the prospect of definitive cure for hemifacial spasm (HFS). However, there are potential risks of complications for MVD associated with retromastoid suboccipital craniectomy (RmSOC) and cranial nerves in particular. The purpose of this study was to identify clinical characteristics of possible complications after MVD for HFS and to establish appropriate management concept of these complications. We retrospectively reviewed medical records of 2040 patients who underwent RmSOC with MVD for HFS at Samsung medical center between January 1998 and March 2013. Of 2040 patients, 2027 were followed (99.4%). Of the 2027 patients, 1841 (90.8%) exhibited complete relief or minimal symptoms, and 113 (5.6%) reported improved spasm but had mild remnant symptoms. After operation, the most frequently developed complications were facial nerve palsy (8.19%), followed by middle ear effusion (4.90%) and hearing loss (3.63%). There were two cases of supratentorial subdural hemorrhage, three cases of infarction. MVD was found to be safe and effective treatment for HFS, in consistent with previous reports. Some of the complications such as facial nerve palsy, middle ear effusion, and hearing loss are relatively common. However, they have mild clinical courses that are usually transient.

Comparison of Cardiovascular, Analgesic and Sedative Effects of Different Doses of Dezocine

“…MVD surgery has been identified as a well-accepted and positive effective treatment method for medicationintractable HFS and has proved to be valuable to cure this disease [8,[24][25][26][27][28]. However, MVD does have potential risks of complications, such as postoperative headache and hemorrhage [29][30][31].…”

“…Because of above-mentioned reasons, although no longer used clinically in Western countries, Dezocine has been used widely in China as an alternative medication for postoperative pain management [3]. Micro vascular decompression (MVD) surgery has been regarded widely as a positive effective treatment method for hemi facial spasm (HFS) [6][7][8]. However, MVD does have potential risks of complications resulting from retromastoidsuboccipital craniectomysuch as postoperative headache and hemorrhage [8,9].…”

“…Micro vascular decompression (MVD) surgery has been regarded widely as a positive effective treatment method for hemi facial spasm (HFS) [6][7][8]. However, MVD does have potential risks of complications resulting from retromastoidsuboccipital craniectomysuch as postoperative headache and hemorrhage [8,9]. Acute pain, due to surgical tissue and nerve trauma, can lead to significant hemodynamic changes and even serious complications during anesthesia recovery period, which needs to be paid close attention to.…”

Fleece-bound tissue sealing in microvascular decompression

“…High-resolution magnetic resonance imaging and intraoperative application optimizes the anatomical information obtained during surgery (10). Complications such as postoperative CSF leaks, even from clinically undetectable defects, can lead to infection, meningitis, abscess formation, and pneumocephalus (6)(7)(8).…”

Bone Cement Cranioplasty Reduces Cerebrospinal Fluid Leak Rate after Microvascular Decompression: A Single-Institutional Experience

“…[1][2][3][4][5] While the retrosigmoid approach provides an ideal operative corridor for the treatment of these conditions, cerebrospinal fluid (CSF) leak is a known complication of this technique. [6][7][8][9][10][11] The rate of CSF leak after retrosigmoid craniectomy for the treatment of TN and HS at experienced centers has been previously reported to range from 0 to 9.5%. 2,3,[12][13][14][15] Several factors can predispose patients to postoperative CSF leak, none more important than the method of dural and bony closure.…”