Abstract
Purpose
To study the clinical features and outcomes of pediatric primary hemifacial spasm patients who underwent microvascular decompression procedures.
Methods
In this retrospective study, five pediatric (<18 years old) primary hemifacial spasm patients underwent microvascular decompression. After surgery, resolution of spasms and surgical complications were observed. Their social adaptability was evaluated using a social adaptation scale, which was designed specially for Chinese middle-school students.
Results
Four typical hemifacial spasm patients had immediate excellent or good relief. However, the microvascular decompression procedure did not help the atypical patient much (50% relief of spasm). The score of social adaptation of the pediatric hemifacial spasm patients was 111.6 ± 8.2. Compared with the ordinary healthy Chinese middle-school students, whose score is 170.8 ± 25.4, the patients experienced great difficulty in social adaptation (P < 0.01). After surgery, the scores of two patients increased to a normal level; however, the other three patients remained unchanged.
Conclusions
Microvascular decompression is effective and safe to typical primary hemifacial spasm patients younger than 18 years old. Hemifacial spasm is harmful to the children’s social adaptation. However, only some of the patients recovered to the normal social adaptation level even when the spasms were cured.
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Acknowledgements
This study was supported by a grant from the National Science Foundation of China (NSFC, No. 30800316), and by the New Hundred Talents Program of Shanghai JiaoTong University School of Medicine (to Xuesheng Zheng).
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Comment
Owing to the huge number of hemifacial spasms (HFSs) treated in a very short period of time (2 years), Feng et al. were able to isolate five paediatric cases (<18 years old) out of a total of 1,304 patients who underwent a microvascular decompression (MVD) of the seventh nerve. As in the adult population, the typical cases greatly surpassed the atypical cases, and a general overview on this series shows that there are few clinical, radiological and surgical differences between children and adults, except their rarity at a young age, which was already known from previous individual case reports, and other particularities described in this paper, such as the AICA as the sole culprit for the compression and the “plump” aspect of the cerebellar hemisphere due to the younger age.
One of the interesting points is the appreciation of the result using a Chinese score of social adaptation for middle-school children, showing that, even if the surgery was uneventful and cured the HFS, only two patients improved to a normal score, the other three (two typical and one atypical HFS) had still some problem of social adaptation.
B. Rilliet
Geneva, Switzerland
Baohui Feng and Xuesheng Zheng contributed equally to this study.
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Feng, B., Zheng, X., Zhang, W. et al. Surgical treatment of pediatric hemifacial spasm patients. Acta Neurochir 153, 1031–1035 (2011). https://doi.org/10.1007/s00701-011-0956-y
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DOI: https://doi.org/10.1007/s00701-011-0956-y