Repeat microvascular decompression for hemifacial spasm. Issue 11 (14th October 2005)

• Record Type: Journal Article
• Authors: Engh, J A; Horowitz, M; Burkhart, L; Chang, Y-F; Kassam, A
• Is Part Of: Journal of neurology, neurosurgery and psychiatry. Volume 76:Issue 11(2005)
• Page Start: 1574
• Page End: 1580
• Publication Date: 2005-10-14
• Subjects: AICA, anterior inferior cerebellar artery -- EMG, electromyography -- HBS, House-Brackmann score -- HFS, hemifacial spasm -- MVD, microvascular decompression -- PICA, posterior inferior cerebellar artery -- SAT, speech awareness threshold -- UPMC, University of Pittsburgh Medical Center; decompression -- hemifacial -- microvascular -- spasm; Neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; Psychiatry -- Periodicals; 616.8
• DOI: 10.1136/jnnp.2004.056861
• Languages: English
• ISSNs: 0022-3050

Abstract

Abstract : Objective: To report our experience with repeat microvascular decompression (MVD) for hemifacial spasm (HFS) in patients who have failed their first operation. Methods: The authors describe 41 redo MVDs for HFS in 36 patients performed over a 3 year period. Seven patients underwent early re-operation after an aborted seventh nerve decompression. Eight patients underwent early re-operation for clinical failure. Eighteen patients underwent late re-operation for spasm recurrence long after their original MVD. Eight MVDs were performed on patients who had already undergone at least two prior operations. Results: Twenty four patients experienced complete spasm resolution (70.6%), eight patients had near total resolution (23.5%), and two patients failed re-operation (5.9%). Two patients were lost to follow up (5.6%). A favourable outcome was reported by 82.4% of patients at a mean follow up interval of 18 months. A total of 91.7% of patients 50 years of age or younger were cured at follow up versus 59.1% of patients older than 50 (p = 0.04). Patients undergoing early re-operation were significantly more likely to be cured or improved than patients undergoing late re-operation (p = 0.03). Conclusions: Repeat MVD for HFS is effective in experienced hands. Younger patients respond better to repeat MVD. Late repeat MVD for HFS is a reasonable treatment option, although results are less favourable than for early re-operation.