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J Neurol Surg B Skull Base 2019; 80(05): 511-517
DOI: 10.1055/s-0038-1676377
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Different Roles of Microvascular Decompression in Hemifacial Spasm and Trigeminal Neuralgia

Min Ho Lee
1   Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea
,
Jeong-A Lee
1   Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea
,
Kwan Park
1   Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea
› Author Affiliations
Further Information

Publication History

30 July 2018

25 October 2018

Publication Date:
07 December 2018 (online)

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Abstract

Objectives Microvascular decompression (MVD) involves the same procedure for both hemifacial spasm (HFS) and trigeminal neuralgia (TN), the resulting clinical courses are different. The aim of this study was to compare differences in MVD operations for HFS and TN and to determine the consequences of these differences on the clinical courses of the two diseases.

Methods The medical records of patients who underwent an MVD operation between January 1998 and March 2013 were reviewed.

Results A total of 2,263 patients were enrolled, 222 had TN and 2,040 had HFS. In the HFS group, the estimated cure rates at postoperative years 1, 2, and 3 were 92.0, 93.4, and 93.6%. In the TN group, the estimated cure rates at postoperative years 1, 2, and 3 were 88.4, 89.4, and 91.4%. Comparison of the initial treatment response between the HFS and TN groups did not reveal any statistically significant difference (p = 0.338). Among the 1,749 HFS patients initially cured by MVD, 57 were worsened. Among the 181 TN patients treated by MVD, 43 were worsened, with ≥ BNI III (Barrow Neurological Institute pain intensity score III) 12 worsened to a BNI score of IV. Comparing the recurrence rate between the HFS and TN groups, there was a statistically significant difference for cases with ≥ BNI III (p < 0.001), but not in cases with ≥ BNI IV (p = 0.498).

Conclusion MVD is a promising treatment for HFS. In contrast, MVD-treated TN had a risk of recurrence. The MVD operation should be carefully considered when applied as a treatment for TN patients.

Keywords

microvascular decompression - hemifacial spasm - trigeminal neuralgia - complication

Ethical Approval

The study protocol was reviewed and approved by the institutional review board of Samsung Medical Center (SMC 2014–04–028–001).


Informed Consent

As this is a retrospective study, the IRB approved a waiver of the requirement for informed consent to the study.


 

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