Hemifacial Spasm: Comparison of Results between Patients Older and Younger than 70 Years Operated on with Microvascular Decompression

Abstract

Objective The aim of the present study was to evaluate the efficacy and safety of microvascular decompression (MVD) for primary hemifacial spasm (HFS) in patients aged ≥70 years and to compare the outcome with a control cohort of younger patients(<70 years).

Methods In this retrospective study, subjects were divided into two groups: an elderly group (patients who were ≥70 years) and a younger group. We compared demographic and clinical data, surgical outcome, MVD-related complications, and duration of operation and hospitalization after MVD between the two groups.

Results At a mean follow-up of 32 ± 4.2 months, 188 elderly patients (90.4%) reported an effective outcome without need for any medication versus 379 (91.1%) of the younger cohort. There was no mortality in both cohorts. The prevalence of delayed facial palsy was 4.8% in the elderly group and 4.1% in the younger group. One (0.5%) patient in the elderly group and 3 (0.7%) patients in the younger group suffered cerebrospinal fluid (CSF) leakage. There was no significant difference between the two groups in terms of MVD-related complications, such as delayed facial palsy, hearing impairment, CSF leakage, and hematoma.

Conclusions MVD is an effective treatment option in elderly patients with HFS as well as in younger patients. Age itself seems to be no relevant contraindication or, alternatively, risk factor regarding MVD.

Keywords

efficacy - elderly - hemifacial spasm - microvascular decompression - safety

Statement of Human and Animal Rights

The present study involved human participants and all the procedures were in accordance with the ethical standards of the institutional and/or national research committee (Xinhua hospital affiliated to Shanghai Jiao Tong University School of Medicine) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Publikationsverlauf

Eingereicht: 03. Dezember 2019

Angenommen: 07. April 2020

Artikel online veröffentlicht:
08. Juli 2021

• References

• 1 Zhu J, Li ST, Zhong J. et al. Role of arterioles in management of microvascular decompression in patients with hemifacial spasm. J Clin Neurosci 2012; 19 (03) 375-379
• 2 Miller LE, Miller VM. Safety and effectiveness of microvascular decompression for treatment of hemifacial spasm: a systematic review. Br J Neurosurg 2012; 26 (04) 438-444
• 3 Zhao H, Zhang X, Tang YD. et al. Factors promoting a good outcome in a second microvascular decompression operation when hemifacial spasm is not relieved after the initial operation. World Neurosurg 2017; 98: 872.e811-872.e819
• 4 Jannetta PJ, Abbasy M, Maroon JC, Ramos FM, Albin MS. Etiology and definitive microsurgical treatment of hemifacial spasm. Operative techniques and results in 47 patients. J Neurosurg 1977; 47 (03) 321-328
• 5 Zhang WB, Min LZ, Zhong WX. et al. Surgical effect and electrophysiological study of patients with hemifacial spasm treated with botulinum toxin or acupuncture before microvascular decompression. Clin Neurol Neurosurg 2019; 184: 105417
• 6 Jung NY, Lee SW, Park CK, Chang WS, Jung HH, Chang JW. Hearing outcome following microvascular decompression for hemifacial spasm: series of 1434 cases. World Neurosurg 2017; 108: 566-571
• 7 Teton ZE, Blatt D, Holste K, Raslan AM, Burchiel KJ. Utilization of 3D imaging reconstructions and assessment of symptom-free survival after microvascular decompression of the facial nerve in hemifacial spasm. J Neurosurg 2019; 12: 1-8
• 8 Sacramento DRC, Lima A, Maia DP. et al. Comparison of techniques of botulinum toxin injections for blepharospasm and hemifacial spasm. Mov Disord 2019; 34 (09) 1401-1403
• 9 Bhattacharjee S. Treatment of hemifacial spasm: Botulinum toxin versus microvascular decompression. Neurol India 2018; 66 (04) 1043-1044
• 10 Elston JS. Botulinum toxin treatment of hemifacial spasm. J Neurol Neurosurg Psychiatry 1986; 49 (07) 827-829
• 11 Xiao L, Pan L, Li B. et al. Botulinum toxin therapy of hemifacial spasm: bilateral injections can reduce facial asymmetry. J Neurol 2018; 265 (09) 2097-2105
• 12 Pandey S, Jain S. Clinical features and response to botulinum toxin in primary and secondary hemifacial spasm. Neurol India 2018; 66 (04) 1036-1042
• 13 Thussu A, Barman CR, Prabhakar S. Botulinum toxin treatment of hemifacial spasm and blepharospasm: objective response evaluation. Neurol India 1999; 47 (03) 206-209
• 14 Lolekha P, Choolam A, Kulkantrakorn K. A comparative crossover study on the treatment of hemifacial spasm and blepharospasm: preseptal and pretarsal botulinum toxin injection techniques. Neurol Sci 2017; 38 (11) 2031-2036
• 15 Kwon S, Kim G. Gold thread acupuncture for hemifacial spasm. Neurology 2018; 91 (04) 185-186
• 16 Zhao H, Tang Y, Zhang X, Li S. Microvascular decompression for idiopathic primary trigeminal neuralgia in patients over 75 years of age. J Craniofac Surg 2016; 27 (05) 1295-1297
• 17 Jeon CJ, Kong DS, Lee JA, Park K. The efficacy and safety of microvascular decompression for hemifacial spasm in elderly patients. J Korean Neurosurg Soc 2010; 47 (06) 442-445