Severe Hemifacial Spasm is a Predictor of Severe Indentation and Facial Palsy after Microdecompression Surgery

Abstract

Background and PurposeHemifacial spasm (HFS) is mostly caused by the compression of the facial nerve by cerebral vessels, but the significance of spasm severity remains unclear. We investigated the clinical significance of spasm severity in patients with HFS who underwent microvascular decompression (MVD).MethodsWe enrolled 636 patients with HFS who underwent MVD between May 2010 and December 2013 at Samsung Medical Center (SMC), Seoul, Korea. Subjects were divided into two groups based on spasm severity: severe (SMC grade 3 or 4) and mild (SMC grade 1 or 2). We compared demographic, clinical, and surgical data between these two groups.ResultsThe severe-spasm group was older and had a longer disease duration at the time of MVD compared to the mild-spasm group. Additionally, hypertension and diabetes mellitus were more common in the severe-spasm group than in the mild-spasm group. Regarding surgical findings, there were more patients with multiple offending vessels and more-severe indentations in the severe-spasm group than in the mild-spasm group. Even though the surgical outcomes did not differ, the incidence of delayed facial palsy after MVD was higher in the severe-spasm group than in the mild-spasm group. Logistic regression analysis showed that severe-spasm was correlated with longer disease duration, hypertension, severe indentation, multiple offending vessels, and delayed facial palsy after MVD.ConclusionsSpasm severity does not predict surgical outcomes, but it can be used as a marker of pathologic compression in MVD for HFS, and be considered as a predictor of delayed facial palsy after MVD.

Microvascular decompression for abducens nerve palsy due to neurovascular compression from both the vertebral artery and anterior inferior cerebellar artery: A case report

“…Notably, multiple offending vessels, including those that create sandwich-type compression, are related to severe compression and severe symptoms in cases of hemifacial spasm, suggesting a close relationship between multiple offending vessels and pathogenesis. [ 11 ] Taken together with the characteristics of the offending vessels in these three successfully treated cases, MVD is the preferred treatment option for cases of isolated abducens nerve palsy with severe compression by the dolichoectatic BA or elongated VA, particularly in cases with sandwich-type compression including the BA or VA. On the other hand, whether to recommend MVD in cases in which the AICA is suspected to be the offending vessel, that is, still a matter of debate.…”