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Microvascular decompression to treat hemifacial spasm: long-term results for a consecutive series of 755 patients

Kwan Park, Jeong A Lee, Kwang Wook Jo

INTRODUCTION The purpose of this study is to determine the optimal time for physicians to predict and judge the results of surgery and to make a decision for the next treatment if this was needed.

METHODS Between April 1997 and June 2007 MVD for hemifascial spasm (HFS) was performed in 755. In this study, 551 (73.0%) patients were women and 204 (27.0%) were men with a mean age of 48.3 years (range 19-75 years). The preoperative symptom duration was 65.8 month (ranging from 1 month to 30 years). After the 3-year follow-up examination, eight (1.19%) patients improved completely. Medical record data of 8patients were analyzed retrospectively.

RESULTS In our series, 721 (95.5%) patients of total 755 patients exhibited the curable state. In this group, spasm was resolved completely until a week in 468 (66.2%) patients, until 3month in 130 (17.2%) patients, until 1year in 105 (14.0%) patients. 52 (6.9%) patients showed residual spasms including recurrence after 1year. 10 (1.3%) patients among 52 patients showed gradually improving spasm until 2years. 8 (1.1%) patients exhibited the delayed improved hemifascial spasm after 3years. 34 (4.5%) patients showed residual spasms including recurrences after 3 years. In our series, 8 patients exhibited the delayed improved hemifascial spasm. In this group, 5 patients were women and 3 were men with a mean age of 45.3years (range 23-60 years). The preoperative symptom duration was 58.5 month (ranging from 12 month to 10 years). Mean duration until improved hemifascial spasm was 55.5 months. Offending vessles are AICA (5), PICA (2), and AICA+PICA (1). Intraopreative lateral spread of all patients was disappeared immediately. Neurovascular compressive pattern and indentation of root exit zone in delayed improved group were not different compared with that of improved group. The major postoperative complications included permanent hearing loss in 4 (0.5%), permanent facial palsy in 5 (0.6%), cerebrospinal fluid leak in two (0.24%), and cerebellar infarction or hemorrhage in two (0.24%). There were no operative deaths.

CONCLUSION The possibility of cure after 12 months is not low. In our series, 52 patients showed residual spasm including recurrence after 1 year. And 8 (15.4%) among 52 patients were improved gradually after 3 years. Those patients who have significant residual symptoms for 12 months should be considered about a possible second operation or they should think about other treatment options carefully because some patients is cured after 3years postoperatively.