Treatment of Hemifacial Spasm: The authors reply

Abstract

Our results and those of other investigators1Jannetta PJ Hemifacial spasm.in: Samii M Jannetta PJ The Cranial Nerves: Anatomy, Pathology, Pathophysiology, Diagnosis, Treatment. Springer-Verlag, New York1981: 484-493Google Scholar, 2Neagoy DR Dohn DF Hemifacial spasm secondary to vascular compression of the facial nerve.Cleve Clin Q. 1974; 41: 205-214Crossref PubMed Scopus (39) Google Scholar, 3Wilson CB Yorke C Prioleau G Microsurgical vascular decompression for trigeminal neuralgia and hemifacial spasm.West J Med. 1980; 132: 481-484PubMed Google Scholar, 4Loeser JD Chen J Hemifacial spasm: treatment by microsurgical facial nerve decompression.Neurosurgery. 1983; 13: 141-146Crossref PubMed Scopus (104) Google Scholar, 5Fairholm D Wu J-M Liu K-N Hemifacial spasm: results of microvascular relocation.Can J Neurol Sci. 1983; 10: 187-191PubMed Google Scholar, 6Kim P Fukushima T Observations on synkinesis in patients with hemifacial spasm: effect of microvascular decompression and etiological considerations.J Neurosurg. 1984; 60: 821-827Crossref PubMed Scopus (66) Google Scholar, 7Piatt Jr, JH Wilkins RH Treatment of tic douloureux and hemifacial spasm by posterior fossa exploration: therapeutic implications of various neurovascular relationships.Neurosurgery. 1984; 14: 462-471Crossref PubMed Scopus (139) Google Scholar demonstrate unequivocally that microsurgical decompression of the facial nerve effectively alleviates hemifacial spasm in most patients, and this was the conclusion of our study. In the United States, microsurgical decompression is the standard treatment for patients who have severe, disabling facial spasm and is the standard terminology in the field, even though Dr. Lyons has a contrary view. Objective electrophysiologic abnormalities also resolve after microsurgical decompression.8Auger RG Piepgras DG Laws Jr, ER Miller RH Microvascular decompression of the facial nerve for hemifacial spasm: clinical and electrophysiologic observations.Neurology. 1981; 31: 346-350Crossref PubMed Google Scholar, 9Nielsen VK Jannetta PJ Pathophysiology of hemifacial spasm. III. Effects of facial nerve decompression.Neurology. 1984; 34: 891-897Crossref PubMed Google Scholar, 10Moller AR Jannetta PJ Blink reflex in patients with hemifacial spasm: observations during microvascular decompression operations.J Neurol Sci. 1986; 72: 171-182Abstract Full Text PDF PubMed Scopus (61) Google Scholar Dr. Lyons seems to agree that the operation yields beneficial effects inasmuch as he states in his letter that the procedure is “undoubtedly effective.” In view of these facts, there is no basis for Dr. Lyons' statement that our conclusion is erroneous. Whether the beneficial results obtained from microvascular decompression are due to the actual mobilization of the vessels per se or to other factors such as mild trauma of the nerve during the surgical procedure or subsequent fibrosis is unknown. In fact, we emphasized this specific point in a previously published article on this subject.8Auger RG Piepgras DG Laws Jr, ER Miller RH Microvascular decompression of the facial nerve for hemifacial spasm: clinical and electrophysiologic observations.Neurology. 1981; 31: 346-350Crossref PubMed Google Scholar Others have also commented on this issue.7Piatt Jr, JH Wilkins RH Treatment of tic douloureux and hemifacial spasm by posterior fossa exploration: therapeutic implications of various neurovascular relationships.Neurosurgery. 1984; 14: 462-471Crossref PubMed Scopus (139) Google Scholar, 11Kaye AH Adams CBT Hemifacial spasm: a long term follow-up of patients treated by posterior fossa surgery and facial nerve wrapping.J Neurol Neurosurg Psychiatry. 1981; 44: 1100-1103Crossref PubMed Scopus (43) Google Scholar Nevertheless, even though no one is certain about the mechanism of action, the fact remains that microvascular decompression is highly effective in the treatment of hemifacial spasm. Treatment of Hemifacial SpasmMayo Clinic ProceedingsVol. 61Issue 12PreviewIn reference to the article on hemifacial spasm by Auger, Piepgras, and Laws in the August 1986 issue of the Proceedings (pages 640 through 644), the conclusion of the article seems in gross error. Although the treatment apparently was effective, it should not be called a “decompression” of the facial nerve. With all due respect to the authors, the success of this operation and of similar operations on the root of the trigeminal nerve for tic douloureux depends on the placement of foreign material (the more permanent the material the better) against the nerve. Full-Text PDF