Subscribe to RSS
How to Improve the Effect of Microvascular Decompression for Hemifacial Spasm: A Retrospective Study of 32 Cases with Unsuccessful First Time MVDFunding None.
Background Microvascular decompression (MVD) has become accepted as an effective therapeutic option for hemifacial spasm (HFS); however, the curative rate of MVD for HFS varies widely (50–98%) in different medical centers. This study could contribute to the improvement of the MVD procedure.
Methods We retrospectively analyzed 32 patients in whom initial MVD failed in other hospitals and who underwent a second MVD at our center. The clinical characteristics, operative findings, outcome of the second MVD, and complications were recorded.
Results There were 18 women and 14 men (56.3 and 43.7%, respectively). The left-to-right ratio was 19:13. The mean age of the patients was 59.8 years. We found an undiscovered conflict site located in zone 4 in 10 patients and in the root entry zone in 8 patients. The initial MVD failed in nine patients because of ignorance of the arterioles that originate from the anterior inferior cerebellar artery. There were no special findings in four patients. No Teflon felts were found in the whole surgical field in one patient.
Conclusion Omission of the offending vessel is the most common cause of an unsuccessful MVD. Intraoperative abnormal muscle response associated with the Z-L response is a good measure to correctly identify the involved arterioles.
# Yun-fei Xia, Wei-ping Zhou, Ying Zhang and Yan-zhen Li are first co-authors.
Received: 14 December 2020
Accepted: 12 February 2021
Article published online:
15 November 2021
© 2021. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
- 1 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
- 2 Ko HC, Lee SH, Shin HS. Facial nerve indentation in hemifacial spasm: an analysis of factors contributing to the formation of and consequent effects associated with indentation. World Neurosurg 2020;S1878-8750(20)32461-X
- 3 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
- 4 El Refaee E, Langner S, Marx S, Rosenstengel C, Baldauf J, Schroeder HWS. Endoscope assisted microvascular decompression for the management of hemifacial spasm caused by vertebrobasilar dolichoectasia. World Neurosurg 2019; 121: e566-e575
- 5 Zhao H, Zhu J, Zhang X. et al. Involved small arteries in patients who underwent microvascular decompression for hemifacial spasm. World Neurosurg 2018; 118: e646-e650
- 6 Barker II FG, Jannetta PJ, Bissonette DJ, Shields PT, Larkins MV, Jho HD. Microvascular decompression for hemifacial spasm. J Neurosurg 1995; 82 (02) 201-210
- 7 Ryu H, Yamamoto S, Sugiyama K, Uemura K, Miyamoto T. Hemifacial spasm caused by vascular compression of the distal portion of the facial nerve. Report of seven cases. J Neurosurg 1998; 88 (03) 605-609
- 8 Campos-Benitez M, Kaufmann AM. Neurovascular compression findings in hemifacial spasm. J Neurosurg 2008; 109 (03) 416-420
- 9 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.e11-872.e19
- 10 Li J, Zhang Y, Zhu H, Li Y. Prognostic value of intra-operative abnormal muscle response monitoring during microvascular decompression for long-term outcome of hemifacial spasm. J Clin Neurosci 2012; 19 (01) 44-48
- 11 Sekula Jr RF, Bhatia S, Frederickson AM. et al. Utility of intraoperative electromyography in microvascular decompression for hemifacial spasm: a meta-analysis. Neurosurg Focus 2009; 27 (04) E10
- 12 Zhang X, Zhao H, Ying TT, Tang YD, Zhu J, Li ST. The effects of dual abnormal muscle response monitoring on microvascular decompression in patients with hemifacial spasm. World Neurosurg 2017; 101: 93-98
- 13 Huang C, Miao S, Chu H. et al. An optimized abnormal muscle response recording method for intraoperative monitoring of hemifacial spasm and its long-term prognostic value. Int J Surg 2017; 38: 67-73
- 14 Zheng X, Hong W, Tang Y. et al. Discovery of a new waveform for intraoperative monitoring of hemifacial spasms. Acta Neurochir (Wien) 2012; 154 (05) 799-805
- 15 Son BC, Ko HC, Choi JG. Intraoperative monitoring of Z-L response (ZLR) and abnormal muscle response (AMR) during microvascular decompression for hemifacial spasm. Interpreting the role of ZLR. Acta Neurochir (Wien) 2018; 160 (05) 963-970
- 16 Zhang X, Zhao H, Tang YD. et al. The effects of combined intraoperative monitoring of abnormal muscle response and z-l response for hemifacial spasm. World Neurosurg 2017; 108: 367-373
- 17 Jin Y, Zhao C, Su S, Zhang X, Qiu Y, Jiang J. Residual hemifacial spasm after microvascular decompression: prognostic factors with emphasis on preoperative psychological state. Neurosurg Rev 2015; 38 (03) 567-572 , discussion 572
- 18 Kim HR, Rhee DJ, Kong DS, Park K. Prognostic factors of hemifacial spasm after microvascular decompression. J Korean Neurosurg Soc 2009; 45 (06) 336-340
- 19 Marneffe V, Polo G, Fischer C, Sindou M. Microsurgical vascular decompression for hemifacial spasm. Follow-up over one year, clinical results and prognostic factors. Study of a series of 100 cases. Neurochirurgie 2003; 49 (05) 527-535
- 20 Park JS, Kong DS, Lee JA, Park K. Chronologic analysis of symptomatic change following microvascular decompression for hemifacial spasm: value for predicting midterm outcome. Neurosurg Rev 2008; 31 (04) 413-418 , discussion 418–419
- 21 Jo KW, Kong DS, Park K. Microvascular decompression for hemifacial spasm: long-term outcome and prognostic factors, with emphasis on delayed cure. Neurosurg Rev 2013; 36 (02) 297-301 , discussion 301–302