<Japan - Asia Friendship Conference>

Microvascular decompression for hemifacial spasm and trigeminal neuralgia: Lessons learned from 1500 operations

Kwan Park, Kwang Wook, Sehwan Kim

INTRODUCTION The purpose of this study is to verify the efficacy and safety of microvascular decompression (MVD) for hemifacial spasm (HFS) and trigeminal neuralgia (TN) based on our experiences and discuss the related issues.

METHODS Between April 1997 and January 2010, MVD for HFS and TN was performed in 1,500 consecutive patients. This series include 1355 (90.3%) HFS and 145 (9.7%) TN. In this study, 1061 (70.7%) patients were women and 439 (29.2%) were men with a mean age of 52.6 years (range 19-77 years). The preoperative symptom duration was 5.47 years (ranging from 1 month to 35 years) and the mean post-operative follow up duration was 1.22 year (ranging from 6 month to 9.3 years). Preoperative imaging studies including magnetic resonance images were performed. Electromyography and brain stem evoked potential were monitored intraoperatively and audiologic studies were conducted in every cases pre- and post-operatively. The Kaplan–Meier method was used to estimate the overall cure rate by SPSS software.

RESULTS In HFS group, 1105 (94.1%) patients of total 1,174 patients exhibited the curable state, and 69 (5.9%) patients showed remained spasms including recurrences. In TN group, 140 (90.5%) patients showed curable state and 12(9.5%) patients complained facial pain.  In HFS group, 13 (1.1%) patients showed recurrence and in TN group, 7 (5%) patients showed recurrence.The major postoperative complications included permanent hearing loss in 13 (1.1%), permanent facial palsy in 9 (0.7%), cerebrospinal fluid leak in three (0.25%), and cerebellar infarction or hemorrhage in two (0.17%). There were no operative deaths.  

CONCLUSION MVD is a very effective and safe modality of treatment for HFS and TN. Some questions of MVD were answered by previous reports, but still many issues are remained for the perfect surgery of MVD.