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Chronologic analysis of symptomatic change following microvascular decompression for hemifacial spasm: value for predicting midterm outcome

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Abstract

The objectives of this study are to categorize the patterns of symptomatic change and to chronologically analyze them. From January 2004 to February 2006, microvascular decompression was performed on 236 consecutive patients. Follow-up time was at least over 1 year (mean, 17.1 months). We categorized the postoperative courses into five different groups according to the similarity of the temporal changes of the residual symptoms. The symptomatic change during each follow-up interval was chronologically analyzed among five different groups. The five improvement patterns included group A (immediate recovery without relapse), group B (temporary relapse followed by cure), group C (slow but steady improvement that leads to cure after one or more months), group D (recurrence with sustained symptoms), and group E (no improvement or improvement to some extent that does not lead to cure). The symptomatic change in the successful groups (groups A, B, and C) differed from that in the unsatisfactory groups (groups D and E), especially during the follow-up interval between postoperative 3 weeks and 3 months (p = 0.014). This finding was true with (p = 0.029) or without (p = 0.015) the relapse curve. Therefore, we can predict the postoperative result as early as 3 months after the surgery. Overall cure rate in this series (93.2%) was nearly correspondent to the estimated cure rate at the first postoperative year (93.4%). Postoperative 3 months can be the most efficient and earliest time to predict the postoperative result.

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Authors and Affiliations

  1. Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul, 135-710, Korea

    Jae Sung Park, Doo-Sik Kong, Jeong-A Lee & Kwan Park

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  1. Jae Sung Park
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  2. Doo-Sik Kong
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  3. Jeong-A Lee
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  4. Kwan Park
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Correspondence to Kwan Park.

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Comments

Tomokatsu Hori, Tokyo, Japan

The surgical technique adopted by these authors is different from our technique. They put several (5–10) pieces of Teflon sponge between the compressing vessel and the REZ. They use two different sponges 5 × 15 mm sized bigger one and 2 × 10 mm sized smaller one. Instead of inserting Teflon sponge, the reviewer wrapped the offending vessel with Teflon fibers and the Teflon fibers will be glued to the periosteum around the jugular foramen.

Namely, the offending artery should be completely moved away from the offending place, and the aberrant reflex will disappear or will not appear again after complete decompression. Recently, the reviewer experienced a recurrent case who has been operated at another institute several years ago.

At the time of reoperation, we have found large “Teflon granuloma” compressing the exit zone of the facial nerve; after removal of such granuloma and use of wrap and transfer technique, the patient’s facial spasm disappear completely when recovered from anesthesia. In my beginner’s experience, the time course of postoperative facial spasm was almost the same as described in this paper. But in recent 5 years, the facial spasm will disappear completely immediately after operation if the offending artery was detected and wrapped and transferred from the direct compressing site.

William T. Couldwell, Salt Lake City, USA

The authors review a remarkably large series of patients who underwent microvascular decompression (MVD) for hemifacial spasm at their institution over a 2-year period. This is an interesting study, in which the authors have explored the pattern of response (or lack thereof) of hemifacial spasm following MVD surgery. They categorized the response among five different patterns and found that they could predict the outcome at 3 months based on the postoperative pattern of response. Earlier time periods were unable to differentiate the outcome, as there was significant overlap in patterns of improvement following MVD. The authors are to be commended for their careful analysis of the response patterns in this group of patients; this information will be very helpful for all surgeons performing microvascular decompression for hemifacial spasm. The information that waiting for 3 months is especially helpful in the group B patients (temporary relapse followed by long-term improvement), in which the surgeon is posed with the dilemma of considering retreatment for the patient who does not start to improve after surgery.

Jae Sung Park and Doo-Sik Kong equally contributed to this work

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Park, J.S., Kong, DS., Lee, JA. et al. Chronologic analysis of symptomatic change following microvascular decompression for hemifacial spasm: value for predicting midterm outcome. Neurosurg Rev 31, 413–419 (2008). https://doi.org/10.1007/s10143-008-0150-8

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  • DOI: https://doi.org/10.1007/s10143-008-0150-8

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