Prognostic Factors of Hemifacial Spasm after Microvascular Decompression

Abstract

Objective : The factors that influence the prognosis of patients with hemifacial spasm (HFS) treated by microvascular decompression (MVD) have not been definitely established. We report a prospective study evaluating the prognostic factors in patients undergoing MVD for HFS. Methods : From January 2004 to September 2006, the authors prospectively studied a series of 293 patients who underwent MVD for HFS. We prospectively analyzed a number of variables in order to evaluate the predictive value of independent variables for the prognosis of patients undergoing MVD. The patients were followed-up at regular intervals and divided into as cured and unsatisfactory groups based on symptom relief. Uni-and multivariate analyses were performed using logistic regression models. Results : A total 273 of 293 (94.2%) patients achieved symptom relief within one year after the operation. Intraoperatively, the indentation of the root exit zone was observed in 259 (88.5%) patients. Uni-and multivariate analyses revealed that the symptoms at postoperative 3 months (p<0.001) and indentation of the root exit zone (p=0.036) were associated with good outcomes. Conclusion :The intraoperative finding of root exit zone indentation will help physicians determine the prognosis in patients with HFS. To predict the prognosis of HFS, a regular follow-up period of at least 3 months following MVD should be required.

A significant correlation between delayed cure after microvascular decompression and positive response to preoperative anticonvulsant therapy in patients with hemifacial spasm

“…[8,9,17] But none was previously found to be significantly different between immediate cure and delayed cure groups. [5,6] In this extensive investigation, multivariate analysis revealed a significant correlation between preoperative anticonvulsant therapy and delayed cure after MVD.…”

“…[8] Although some papers showed limited improvement with a high complication rate for preoperative MVD, [1,10] recent surgical results of late reoperation didn't show significant differences from those undergoing their initial MVDs. [16,21] Our results showed that cumulative spasm free rate at 3 months after operation was 97%.…”

“…[5,7,8,12,17] Interestingly, the postoperative course of MVD is variable even though the same surgical procedure is applied. Although the majority of patients become spasm-free immediately, others require a longer period of time after MVD surgery to become spasm-free.…”

Safety and Effectiveness of Microvascular Decompression for the Treatment of Hemifacial Spasm in the Elderly

“…First, immediate spasm after MVD was the predictor for the unsuccessful surgical outcome in both the younger and elderly group. Immediate spasm after MVD was not assessed as a predictor for surgical outcome in previous studies, and only spasm at 3 months after MVD was evaluated as a risk factor and associated with a long-term outcome in our previous study [26]. Additionally, in our study, severe indentation grade reduced the risk of unsuccessful outcome in the younger group.…”

“…Only a few studies utilized clinical data as prognostic factors of surgical outcome and complications, but often with diverse results [23,26]. We assessed the risk factors for the unsuccessful outcome and complications using multivariate logistic regression analysis.…”