Treatment Of Hemifacial Spasm Research Articles

Clinical Research on Delayed Cure after Microvascular Decompression for Hemifacial Spasm.

The clinical data of patients with hemifacial spasm (HFS) were analyzed statistically to identify factors leading to delayed cure after microvascular decompression (MVD). A retrospective analysis of the clinical data of 600 patients with HFS subjected to MVD from March 2016 to May 2018 was performed. Student t test, chi-square test, logistic regression analysis, and multivariate analysis of variance were used to analyze the correlation between delayed cure and its related factors. Among the 600 patients enrolled, 117 had delayed cure after MVD. The shortest duration of delayed cure was 4 days, and the longest was 540 days, with an average of 108 days. The frequency of delayed improvement in these patients was not associated with sex, age, or offending vessel type (p > 0.05); however, delayed cure was positively correlated with the course of the disease, grade of HFS severity, and disappearance of abnormal muscle responses during the operation (p < 0.05). Moreover, a longer disease course was associated with more severe related symptoms and a longer duration of postoperative delayed cure. MVD is an effective treatment for HFS. Given that postoperative delayed cure was unavoidable, even with accurate identification of the offending vessel and sufficient decompression of the root exit zone, delayed cure should be considered in patients undergoing reoperation due to lack of remission or relapse after the operation. Additionally, the timing of efficacy assessments should be delayed.

Fully endoscopic microvascular decompression for hemifacial spasm.

Hemifacial spasm (HFS) is characterized by involuntary tonic and/or clonic contractions of facial nerve muscles. Fully endoscopic microvascular decompression (E-MVD) for HFS has not been widely adopted. This paper aims to illustrate the safety and efficacy of the fully endoscopic technique for HFS treatment. The authors conducted a single-center retrospective study of 27 patients (28 separate E-MVD cases; 1 patient had bilateral E-MVD) diagnosed with HFS who underwent fully E-MVD from January 2013 to October 2016. Intraoperative brainstem auditory evoked potentials and lateral spread resolution were reviewed. Outcome was based on the clinical status of the patient at the last contact point with the senior author. Complications were categorized as facial weakness, hearing loss, ataxia, dysphagia, or any adverse event able to be attributed to the surgical procedure. HFS was relieved either completely or partially in the majority of cases (24 of 28, 85.7%). Of the 28 separate procedures, 17 (60.7%) resulted in complete resolution of symptoms, 4 (14.3%) resulted in near-complete resolution, 2 (7.1%) resulted in 50% reduction of symptoms, 1 (3.6%) resulted in minimal reduction, and 4 (14.3%) resulted in no relief. Of the 27 patients, 26 (96%) had no permanent postoperative complications. In multivariate logistic regression, the best predictor of greater than 50% resolution of spasm was resolution of intraoperative lateral spread response. A fully E-MVD for HFS provides a safe and comprehensive view of the neurovascular conflict. Exclusive use of the endoscope in MVD is both safe and feasible in the treatment of HFS. Attention to lateral spread response monitoring remains an integral part of comprehensive neurosurgical management.

Intraoperative Neurophysiological Monitoring during Microvascular Decompression Surgery for Hemifacial Spasm.

Hemifacial spasm (HFS) is due to the vascular compression of the facial nerve at its root exit zone (REZ). Microvascular decompression (MVD) of the facial nerve near the REZ is an effective treatment for HFS. In MVD for HFS, intraoperative neurophysiological monitoring (INM) has two purposes. The first purpose is to prevent injury to neural structures such as the vestibulocochlear nerve and facial nerve during MVD surgery, which is possible through INM of brainstem auditory evoked potential and facial nerve electromyography (EMG). The second purpose is the unique feature of MVD for HFS, which is to assess and optimize the effectiveness of the vascular decompression. The purpose is achieved mainly through monitoring of abnormal facial nerve EMG that is called as lateral spread response (LSR) and is also partially possible through Z-L response, facial F-wave, and facial motor evoked potentials. Based on the information regarding INM mentioned above, MVD for HFS can be considered as a more safe and effective treatment.

Study on the relationship between preoperative evaluation, operation and prognosis of microvascular decompression for the treatment of hemifacial spasm

Objective: To investigate the relationship between preoperative evaluation, surgery and prognosis of microvascular decompression (MVD) for the treatment of hemifacial spasm (HFS). Methods: The clinical data of 128 HFS patients treated with MVD in the department of neurosurgery of Taizhou Hospital of Zhejiang Province were retrospectively analyzed. According to the SMC grading system, the patients were divided into general spasm group and severe spasm group, and the clinical characteristics, offending vessel, prognosis and surgical complications of the two groups were compared. Results: In the general spasm group,the age at MVD was (48.6±10.6) years, the disease duration was (4.2±3.3) years;while in the severe spasm group,the age at MVD was (51.8±9.9) years, the disease duration was (8.1±4.5) years;the differences of age and disease duration between the two groups were statistically significant (P<0.05).In the general spasm group, there were 41 cases in which the offending vessel were AICA, 21 cases were PICA, 1 case was VA, 63 cases were single offending vessel, and 7 cases were multiple offending vessels. In the severe spasm group, there were 29 cases in which the offending vessel were AICA, 13 cases were PICA, 2 cases were VA, the total of 44 cases were single offending vessel and 14 cases were multiple offending vessels.There was a significant difference in the proportion of multiple offending vessels in the two groups, and the difference was statistically significant (P<0.05).Patients in the two groups were followed up for 12 to 32 months after surgery, and the difference in effective rate and recurrence rate was not statistically significant (P>0.05).Some kinds of postoperative complications were different between the two groups, the incidence of postoperative delayed facial paralysis was statistically significant (P<0.05), and the other complications were not statistically significant (P>0.05). Conclusion: Compared with the general spasm group, the patients in the severe spasm group were older, with longer disease duration, higher probability of multiple offending vessels and higher incidence of postoperative delayed facial paralysis. Therefore, preoperative SMC grading is helpful for the evaluation and prediction of intraoperative and postoperative conditions, which is worthy of wide clinical application.

Long-term Outcomes of Microvascular Decompression in the Treatment of Hemifacial Spasm Based on Different Offending Vessels.

To evaluate clinical features, outcomes, and complications in patients with hemifacial spasm (HFS) after microvascular decompression (MVD) of different offending vessels. Clinical data were collected from 362 patients with HFS treated with MVD between January 2013 and January 2014. Patients were divided into five groups based on the offending vessel: A (anterior inferior cerebellar artery [AICA] compression), B (posterior inferior cerebellar artery [PICA] compression), C (AICA plus PICA compression), D (vertebral artery [VA] compression), and E (VA plus small vessel compression). The most common offending vessel was the AICA (51.38%). The most common compression site was the root exit zone. During the follow-up period, the effective rate was 95.48% in group A, 92.15% in group B, 93.10% in group C, 90.14% in group D, and 91.45% in group E. Twenty-nine patients exhibited delayed facial palsy, the most common complication. No statistically significant differences were found in long-term outcomes or MVD-related complications among the study groups. The type of offending vessel was not a prognostic factor for MVD in patients with HFS.

The Cornerstone Technique of Microvascular Decompression for Hemifacial Spasm with Vertebral Artery Offender

Microvascular decompression surgery is the most effective treatment for hemifacial spasm (HFS). The vertebral artery (VA) is a larger and more elastic vessel, which makes surgical management moredifficult. We introduce a surgical technique of proximal Teflon transposition with interposition (PTTI) inthe vertebromedullary space for HFS with a VA offender. In 112 patients with HFS, 22 patients had a VA offender on the facial nerve exit zone. Six of 22 patients with a VA offender underwent surgery by traditional microvascular decompression at the facial nerve exit zone, and 16 patients underwent the PTTI technique. We compared surgical outcomes of the PTTI technique and the conventional technique for HFS associated withthe VA. We also compared surgical outcomes of the PTTI technique with outcomes of other alternative techniques. The PTTI technique was associated with a good operative prognosis and fewer complications. The PTTI technique is an easy, safe, and effective method for treatment of patients with HFS with a VA offender. The PTTI technique can be considered as another treatment option in addition to the transposition technique reported previously.

Algorithm to Predict the Outcome of Microvascular Decompression for Hemifacial Spasm: A Data-Mining Analysis Using a Decision Tree

Although microvascular decompression (MVD) is the primary treatment for hemifacial spasm (HFS), the postoperative course is variable. This study aimed to develop a prediction model of the outcome of MVD in patients with HFS by investigating influential factors. Electronic medical records of 1624 patients with HFS who underwent MVD from July 2004 to January 2015 were reviewed. The relationships between patient-related, disease-related, and surgery-related factors and postoperative outcome were analyzed using multinomial logistic regression. A predictive model for MVD outcome was developed using decision tree analysis. The mean follow-up duration after surgery was 30.2 months (median, 23.5 months; range, 6.0-133.3 months). For the 1624 patients, the overall improvement rate was 90.5%. Overall, 984 patients (60.6%) showed improvement of spasm immediately after surgery, 486 (29.9%) experienced delayed improvement, and 154 (9.5%) showed persistence of spasm. Outcome of patients with HFS after MVD was predicted by 4 items: postoperative delayed facial palsy, degree of preoperative spasm, intraoperative indentation on the facial nerve, and sex. The patients were classified into 6 categories and improvement of spasm immediately after surgery showed 35%-91%, delayed improvement 6%-46%, and persistence of spasm 0%-59%. The accuracy of the developed prediction model was 0.608. Male sex, mild degree of preoperative spasm, intraoperative indentation on the facial nerve, and postoperative delayed facial palsy were better favorable prognostic factors of MVD in patients with HFS. This novel algorithm may be useful to predict the outcome of MVD in these patients.

Different Roles of Microvascular Decompression in Hemifacial Spasm and Trigeminal Neuralgia.

Objectives Microvascular decompression (MVD) involves the same procedure for both hemifacial spasm (HFS) and trigeminal neuralgia (TN), the resulting clinical courses are different. The aim of this study was to compare differences in MVD operations for HFS and TN and to determine the consequences of these differences on the clinical courses of the two diseases. Methods The medical records of patients who underwent an MVD operation between January 1998 and March 2013 were reviewed. Results A total of 2,263 patients were enrolled, 222 had TN and 2,040 had HFS. In the HFS group, the estimated cure rates at postoperative years 1, 2, and 3 were 92.0, 93.4, and 93.6%. In the TN group, the estimated cure rates at postoperative years 1, 2, and 3 were 88.4, 89.4, and 91.4%. Comparison of the initial treatment response between the HFS and TN groups did not reveal any statistically significant difference ( p = 0.338). Among the 1,749 HFS patients initially cured by MVD, 57 were worsened. Among the 181 TN patients treated by MVD, 43 were worsened, with ≥ BNI III (Barrow Neurological Institute pain intensity score III) 12 worsened to a BNI score of IV. Comparing the recurrence rate between the HFS and TN groups, there was a statistically significant difference for cases with ≥ BNI III ( p < 0.001), but not in cases with ≥ BNI IV ( p = 0.498). Conclusion MVD is a promising treatment for HFS. In contrast, MVD-treated TN had a risk of recurrence. The MVD operation should be carefully considered when applied as a treatment for TN patients.

Prevalence of side effects in treatment of hemifacial spasm with botulinum toxin

Prevalence of side effects in treatment of hemifacial spasm with botulinum toxin

Variables that influence duration of treatment of hemifacial spasm controlled with botulinum toxin

Variables that influence duration of treatment of hemifacial spasm controlled with botulinum toxin

Variables that influence the latency of treatment of hemifacial spasm controlled with botulinum toxin

Variables that influence the latency of treatment of hemifacial spasm controlled with botulinum toxin

Geographic Disparities in the Surgical Management of Hemifacial Spasm in Canada.

We aimed to interrogate the Canadian Institute for Health Information (CIHI) database in order to determine the geographic distribution and outcomes of microvascular decompression (MVD) for the treatment of hemifacial spasm (HFS). The CIHI database was searched from 2004 to 2017 for relevant diagnostic and procedure codes. A new database was populated with the following categories: year, institution, province, number of interventions per year, and mean length of stay. Descriptive statistics were generated. Provincial utilization rates of MVD for HFS were calculated. During the period 2004-17, we identified 671 MVDs performed for HFS at 20 centers across Canada. During the study period, 286 MVDs (42.6%) were performed at one center in Manitoba. Another 131 (19.5%) and 72 (10.7%) were performed at one center in British Columbia and Ontario, respectively. The remaining 182 (27.1%) MVDs for HFS were performed at 17 centers across the rest of Canada where the mean number of cases performed per year was 1.1 (SD=0.9, range 0.2-2.9). When out-of-province cases were re-allocated to place of residence, the adjusted provincial utilization of MVD for HFS ranged between 0.5 and 6.1 patients per million per year. Microvascular decompression for HFS is performed relatively rarely and there is a tremendous geographic variation in utilization across Canada. Although most of these surgeries are performed by a few surgeons, more than half of Canadian centers perform an average of less than 1 case per year. Further examination of the impact of these discrepancies appears warranted.

Microvascular Decompression for Hemifacial Spasm Associated with Vertebral Artery: Biomedical Glue−Coated Teflon Sling Transposition Technique

Microvascular decompression is the most effective treatment for hemifacial spasm. However, when encountering hemifacial spasm associated with vertebral artery (VA), the procedure is more challenging and requires complicated operation techniques. The authors retrospectively analyzed the clinical characteristics of this group of cases and investigated reasonable transposition procedures for different anatomic classifications. We retrospectively analyzed 117 cases that underwent their first microvascular decompression for hemifacial spasm between June 2010 and December 2016, which had all associated with vertebral artery compression diagnosed by preoperational radiology examination. The study first classified offending vessels into 3 types according to operative anatomy and designed personalized decompression management according to different forms of neurovascular conflict. Curative effects and complications were assessed. The offending vessels were artificially divided into 3 types according to both arterial pattern and compression direction: 1) ipsilateral VA plus anterior inferior cerebellar artery compressing the facial nerve from the ventrolateral direction in 72 (61.5%) cases; 2) ipsilateral VA plus posterior inferior cerebellar artery compressing the facial nerve from the caudal-medial direction in 31 (26.5%) cases; 3) bilateral VA compressing the facial nerve in 14 (12.0%) cases. We selected corridors to expose the neurovascular conflict site between the suprafloccular-transhorizontal fissure approach and subtonsillar-transcerebellomedullary fissure approach. The methods of decompression consist of anteromedial and posterolateral transposition by using biomedical glue-coated Teflon sling. Sufficient decompression of the offending vessels was safely performed in all cases. All cases had total relief of symptoms immediately after their operations. Follow-up periods ranged from 16-90 months, and total recovery occurred in 110 cases (94.0%). In 7 cases (6.0%), 90% recovery occurred. Accuracy and comprehensive recognition of anatomic features of the offending vessels are crucial for the management of hemifacial spasm associated with vertebral artery compression. Appropriate approaches combined with the biomedical glue-coated Teflon sling transposition technique can allow adequate mobilization of the vertebral artery and bring complete postoperative symptom relief for most cases.

Endoscope-assisted retrosigmoid approach in hemifacial spasm: our experience

IntroductionThe use of surgical decompression of facial hemispasm due to the loop in the internal auditory canal is not always accepted due to the risk related to the surgical procedure. Currently a new surgical technique allows surgeons to work in safer conditions. ObjectiveTo report the results with endoscope-assisted retrosigmoid approach for facial nerve microvascular decompression in hemifacial spasm due to neurovascular conflict. The surgical technique is described. MethodsWe carried out a prospective study in a tertiary referral center observing 12 (5 male, 7 female) patients, mean age 57.5 years (range 49–71) affected by hemifacial spasm, that underwent to an endoscope assisted retrosigmoid approach for microvascular decompression. We evaluated intra-operative findings, postoperative HFS resolution and complication rates. ResultsHemifacial spasm resolution was noticed in 9/12 (75%) cases within 24h after surgery and in 12/12 (100%) subjects within 45 days. A significant (p<0.001) correlation between preoperative historical duration of hemifacial spasm and postoperative recovery timing was recorded. Only 1 patient had a complication (meningitis), which resolved after intravenous antibiotics with no sequelae. No cases of cerebrospinal fluid leak, facial palsy or hearing impairment were recorded. Hemifacial spasm recurrence was noticed in the only subject where the neurovascular conflict was due to a vein within the internal auditory canal. ConclusionsThe endoscope assisted retrosigmoid approach technique offers an optimal visualization of the neurovascular conflict thorough a minimally invasive approach, thus allowing an accurate decompression of the facial nerve with low complication rates. Due to the less invasive nature, the procedure should be considered in functional surgery of the cerebellar pontine angle as hemifacial spasm treatment, specially when the procedure is performed by an otolaryngologist.

Endoscope-assisted decompression of facial nerve for treatment of hemifacial spasm

Microvascular decompression has become the sole method for a curative treatment of primary hemifacial spasm. Finding the responsible conflicting artery is not always easy as its location can be deeply situated within the cerebellopontine/medullary fissure at the facial root exit zone. Sole or additional offending vessel(s) may be at the meatus of the internal auditory canal (5% of the cases). Identifying the compressive vessel(s) and performing decompression is in most cases possible without cerebellar retraction by classical microsurgical techniques. However, in a number of patients the neurovascular conflict may be hidden in spite of the direct illumination of the operative microscope. Therefore, assistance by endoscopy can be useful and contribute as a minimally invasive approach. The author reports his own experience in a series of 553 patients operated on over the past three decades. A total of 93.6% had complete relief of their spasm (11% after repeated surgery). Relief was delayed in 20.8% of these patients. Recurrence was rare (0.3%). There was no mortality and morbidity was low: deafness occurred in 0.6%. There was no permanent postoperative facial palsy. CSF leakage amounted to 1% in the last period of surgery. In conclusion, the author advocates combining the use of both the endoscopy for exploration and the microscope for decompression.

Successful treatment of hemifacial spasm accompanying neck and shoulder pain: a case report

Successful treatment of hemifacial spasm accompanying neck and shoulder pain: a case report

Safety and effectiveness of microvascular decompression for treatment of hemifacial spasm through mini craniotomy

Abstract Background: The hemifacial spasm (HFS) defined as involuntary intermittent twitching of the muscles of the face (usually unilateral). The spasms characteristically begin around the eye and then extend to affect other muscles of the ipsilateral face. It is caused by vascular element compressing the facial nerve that may be either the anterior or the posterior inferior cerebellar arteries in most cases. Objective of our work: to describe the operative technique (pearls and common mistakes), the efficacy and morbidity of microvascular decompression technique for hemifacial spasm through mini craniotomy, determine the prognostic factors affecting success rate of the surgery. Material &amp; method: A retrospective study of 23 cases of hemifacial spasm treated by mini craniotomy retro sigmoid approach and microvascular decompression at neurosurgery dept., Mansoura University Hospital in last 10 years was investigated. This include Epidemiological, clinical and imaging details, selected treatment options and patients’ outcome. Results: complete resolving of symptoms was conducted in 19 cases 82.6% while reoperated in 2 cases with improvement in one case. Facial palsy appeared postoperative in 6 cases 4 of them improved in 3 months, transient hearing loss in 4 cases17.4% which improved later, cerebrospinal fluid leak appeared in 3 cases 13% which managed conservatively. Conclusions: MVD relieves symptoms of HFS in about 80% of patients while recurrence still in low percentage. The study reported low permanent Complications and generally transient.

What Should We Do for Those Hemifacial Spasm Patients Without Efficacy Following Microvascular Decompression: Expectation of Delayed Relief or Early Reoperation?

Although microvascular decompression (MVD) has been widely accepted as an effective treatment for hemifacial spasm (HFS), some patients may experience delayed relief instead of immediate improvement after the surgery. The need for and timing of repeat MVD has been controversial to date; thus, we conducted the present study with emphasis on those unrelieved patients. Between January 2010 and December 2014, 3095 patients with idiopathic HFS were treated with MVD at XinHua Hospital, Shanghai Jiaotong University School of Medicine. Among these patients, 174 (5.6%) reported no symptom relief. Those patients without immediate relief were the focus of this study, and all were reevaluated at 2 years after MVD surgery. Among these 174 patients, 96 underwent redo MVD within 1 week of the first procedure (early MVD redo group), 19 underwent redo between 3 and 12 months after the first procedure (late MVD redo group), and 59 were observed (observation group). In the early redo MVD group, immediate improvement was reported by all patients except 1, who did not experience symptom relief until 3 months later. In the later redo MVD group, immediate symptom improvement was reported by 14 of 19 patients. By the end of the 2-year follow-up period, 1 recurrence occurred in the early redo MVD group, no changes occurred in the later MVD group, and 9 patients improved in the observation group. Ultimately, the final rates of symptom relief were 99.0% in the early redo MVD group, 73.7% in the later redo MVD group, and 15.3% in the observation group (P < 0.01). In the early redo MVD group, postoperative courses showed no significant differences between the first and the second operations. In the later redo MVD group, 1 patient developed a mild facial palsy and 1 had a cerebrospinal fluid leak. Our findings demonstrate that MVD is the most effective treatment for patients with HFS. An early reoperation is easier and safer than a later reoperation and may improve the likelihood of immediate relief.

Long-Term Efficacy of Initial Microvascular Decompression Versus Subsequent Microvascular Decompression for Idiopathic Hemifacial Spasm

Hemifacial spasm (HFS) is a disorder characterized by intermittent, involuntary facial muscle contractions. Microvascular decompression (MVD) is the gold treatment for HFS. The aim of this research was to discuss whether patients undergoing MVD as their initial surgical intervention experience greater spasm control than patients experiencing an MVD performed as a subsequent surgical intervention. The study included 976 patients with HFS, 452 of whom (group A) underwent MVD as their initial surgical intervention and 524 of whom (group B) underwent subsequent MVD. Relevant clinical data including outcome of MVD, operative findings, complications, and so on were collected immediately after MVD operation and at follow-up. The follow-up period was 7-9 years (mean, 7.96 ± 0.87 years). The mean age at intervention was 53.14 years and 55.43 years in the 2 groups, respectively. The long-term postoperative relief rate of patients in the 2 groups was 98.23% and 87.21%, respectively. There was a significant difference in long-term postoperative relief rate of patients between the 2 groups (P < 0.05). Patients undergoing MVD for HFS as the primary treatment experience better long-term efficacy than patients first treated with botulinum neurotoxin typeA.

Microvascular decompression for treatment of hemifacial spasm

Objective To discuss the surgical techniques, outcomes and complications of microvascular decompression (MVD) for treatment of hemifacial spasm (HFS) with offending vessels including the vertebral artery (VA). Methods A total of 783 patients with HFS undergoing MVD at Department of Neurosurgery, China-Japan Friendship Hospital from January 2010 and February 2012 were retrospectively enrolled into this study. Among them, 125 cases (16.0%) were found to have offending vessels including VA and were classified into VA group. The other 685 cases (84.0%) did not have VA as the offending vessel and belonged to non-VA (NVA) group. The clinical characteristics, surgical techniques, efficacies and complications were analyzed for the two groups. Results In the VA group, 120 cases (96.0%) had offending vessels including VA and other arteries. Out of the 120 cases, VA acted as the only main offending vessel or one of the main offending vessels in 11 cases, and as the secondary offending vessel in 109 cases. VA was identified as the only offending vessel in 5 cases (4.0%). Compared with the NVA group, the symptoms in VA group seemed to affect more commonly the left side and male patients (all P 0.05). Conclusions It seems uncommon that VA acts as the only major offending vessel, which tends to be the secondary offending vessel and results in compression together with other arteries. The efficacy of MVD in HFS involving offending vessels including VA is suggested to be certain. Compared with the NVA patients, delayed curing is more likely to occur with later remission and higher rate of recurrence in VA patients. Postoperative complications post MVD are more commonly observed in VA patients than in NVA patients. Key words: Hemifacial spasm; Microvascular decompression; Vertebral artery; Treatment outcome; Postoperative complications