Hemifacial spasm: 20-year surgical experience, lesson learned.

Abstract

Background:Hemifacial spasm is characterized by unilateral, paroxysmal, and involuntary contractions. It is more common in women on the left side. Its evolution is progressive, and it rarely improves without treatment.Methods:Microvascular decompressions (N = 226) were performed in 194 Hispanic patients (May 1992–May 2011). Outcomes were evaluated on a 4-point scale: Excellent (complete remission); good (1–2 spasms/day); bad (>2 spasms/day); and recurrence (relapse after initial excellent/good response).Results:Most patients were female (n = 123); 71 were male. Mean (±SD) age was 49.4 (±11.7) years; age at onset, 43.9 (±11.9) years; time to surgery, 5.7 (±4.7) years. The left side was affected in 114 patients. Typical syndrome occurred in 177 (91.2%); atypical in 17 (8.8%). Findings were primarily vascular compression (n = 185 patients): Anterior inferior cerebellar artery (n = 147), posterior inferior cerebellar artery (n = 12), basilar artery (n = 10), superior cerebellar artery (n = 8), and 2 vessels (n = 8); 9 had no compression. Postsurgical results were primarily excellent (79.9% [n = 155]; good, 4.6% [n = 9]; bad, 15.5% [n = 30]), with recurrence in 21 (10.8%) at mean 51-month (range, 1–133 months) follow-up. Complications included transient hearing loss and facial palsy.Conclusions:The anterior inferior cerebellar artery is involved in most cases of hemifacial spasm. Failure to improve postsurgically after 1 week warrants reoperation. Sex, side, and onset are unrelated to treatment response. Microvascular decompression is the preferred treatment. It is minimally invasive, nondestructive, and achieves the best long-term results, with minor morbidity. To our knowledge, this series is the largest to date on a Hispanic population.