Chronological Patterns of Long-Term Outcomes After Microvascular Decompression for Hemifacial Spasm Over 5 Years

Abstract

The postoperative course of hemifacial spasm (HFS) varies. We analyzed the clinical outcomes from 1 to ≥5years after microvascular decompression (MVD) in patients with HFS. Between July 2004 and January 2015, 528 patients who were followed up for ≥5years after MVD for HFS were included. We evaluated chronological patterns of clinical outcomes from 1 to ≥5years. The outcomes at 2, 3, 4, and ≥5years postoperatively were individually compared with those at 1year postoperatively, and the relationships between clinical features, surgical findings, and outcomes over time were analyzed. Eight groups were created according to the similarity in the pattern of clinical outcomes from 1 to ≥5years postoperatively. Individual postoperative outcomes at 2-4years were consistent with those at 1year postoperatively, whereas postoperative outcomes at ≥5years were not (P=0.020). There was substantial to moderate agreement between the outcomes at 1year and at 2-4years postoperatively, but the agreement decreased over time. Patients without diabetes (P=0.015), an intraoperative offending vessel without a vein (P=0.005), and intraoperative discoloration of the facial nerve (P=0.036) showed better outcomes at ≥5years postoperatively. Long-term outcomes from 1 to ≥5years after MVD in patients with HFS were diverse. Nondiabetes, intraoperative offending vessel without a vein, and intraoperative discoloration of the facial nerve were better prognostic factors for outcomes at ≥5years postoperatively. It is advisable to consider these results when evaluating the long-term outcomes of this surgery.