Microvascular decompression for hemifacial spasm: long-term outcome and prognostic factors, with emphasis on delayed cure

Abstract

The postoperative course of microvascular decompression (MVD) for hemifacial spasm (HFS) is variable, and the optimal time for assessing the results is unclear. From April 1997 to October 2007, MVD for HFS was performed in 801 patients. Patients were divided into two groups (cured or failed) according to subjective patient assessments over a 3-year period. We analyzed patient characteristics and surgical findings to determine prognostic factors. Medical records were analyzed retrospectively over the 3-year follow-up period. Of the 801 patients who underwent surgery, 743 (92.8%) appeared to be cured, 70 (8.7%) had residual or recurrent spasms more than 1year after surgery, 11 (1.3%) had gradual improvement over 3years, and 1 (0.1%) had delayed improvement more than 3years after surgery. Fifty-eight patients (7.2%) had residual or recurrent spasms more than 3years after surgery, of which 19 (2.4%) had recurrence after initial relief. The mean time to spasm recurrence was 18.9months. Intraoperative resolution of the lateral spread response (LSR) after decompression (p = 0.048) and severe indentation (p = 0.038) were significant predictors of good long-term outcome after MVD for HFS. In our series, 70 patients (8.7%) had residual or recurrent spasms more than 1year after surgery, of which 12 (17.1%) improved gradually after 1year. If the surgeon can confirm intraoperative resolution of the LSR and severe indentation, reoperation can be delayed until 3years after MVD.