Utilization of 3D imaging reconstructions and assessment of symptom-free survival after microvascular decompression of the facial nerve in hemifacial spasm

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OBJECTIVE

Hemifacial spasm (HFS), largely caused by neurovascular compression (NVC) of the facial nerve, is a rare condition characterized by paroxysmal, unilateral, involuntary contraction of facial muscles. It has long been suggested that these symptoms are due to compression at the transition zone of the facial nerve. The aim of this study was to examine symptom-free survival and long-term quality of life (QOL) in HFS patients who underwent microvascular decompression (MVD). A secondary aim was to examine the benefit of utilizing fused MRI and MRA post hoc 3D reconstructions to better characterize compression location at the facial nerve root exit zone (fREZ).

METHODS

The authors retrospectively analyzed patients with HFS who underwent MVD at a single institution, combined with a modified HFS-7 telephone questionnaire. Kaplan-Meier analysis was used to determine event-free survival, and the Wilcoxon signed-rank test was used to compare pre- and postoperative HFS-7 scores.

RESULTS

Thirty-five patients underwent MVD for HFS between 2002 and 2018 with subsequent 3D reconstructions of preoperative images. The telephone questionnaire response rate was 71% (25/35). If patients could not be reached by telephone, then the last clinic follow-up date was recorded and any recurrence noted. Twenty-four patients (69%) were symptom free at longest follow-up. The mean length of follow-up was 2.4 years (1 month to 8 years). The mean symptom-free survival time was 44.9 ± 5.8 months, and the average symptom-control survival was 69.1 ± 4.9 months. Four patients (11%) experienced full recurrence. Median HFS-7 scores were reduced by 18 points after surgery (Z = −4.013, p < 0.0001). Three-dimensional reconstructed images demonstrated that NVC most commonly occurred at the attached segment (74%, 26/35) of the facial nerve within the fREZ and least commonly occurred at the traditionally implicated transition zone (6%, 2/35).

CONCLUSIONS

MVD is a safe and effective treatment that significantly improves QOL measures for patients with HFS. The vast majority of patients (31/35, 89%) were symptom free or reported only mild symptoms at longest follow-up. Symptom recurrence, if it occurred, was within the first 2 years of surgery, which has important implications for patient expectations and informed consent. Three-dimensional image reconstruction analysis determined that culprit compression most commonly occurs proximally along the brainstem at the attached segment. The success of this procedure is dependent on recognizing this pattern and decompressing appropriately. Three-dimensional reconstructions were found to provide much clearer characterization of this area than traditional preoperative imaging. Therefore, the authors suggest that use of these reconstructions in the preoperative setting has the potential to help identify appropriate surgical candidates, guide operative planning, and thus improve outcome in patients with HFS.

ABBREVIATIONS AICA = anterior inferior cerebellar artery; fREZ = facial nerve root exit zone; HFS = hemifacial spasm; MVD = microvascular decompression; NVC = neurovascular compression; PICA = posterior inferior cerebellar artery; QOL = quality of life.

Article Information

Correspondence Kim J. Burchiel: Oregon Health & Science University, Portland, OR. burchiek@ohsu.edu.

INCLUDE WHEN CITING Published online July 12, 2019; DOI: 10.3171/2019.4.JNS183207.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Hemifacial spasm patient selection process.

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    Kaplan-Meier curve depicting cumulative (A) symptom-control survival and (B) symptom-free survival over time (months) for HFS patients following MVD (n = 35). Figure is available in color online only.

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    Three-dimensional reconstruction examples demonstrating the anterior superior (operative angle) view of cranial nerve (CN) VII with no evidence of compression visible (A), and inferolateral view obtained in the same patient, demonstrating brainstem compression along the attached segment by the AICA (B).

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    Anterolateral view of the fREZ, demonstrating the presence of a PICA vessel loop abutting the cisternal portion of cranial nerve VII.

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    A: Inferior view of the fREZ demonstrating PICA compression along the attached segment of cranial nerve VII. B: Close-up of panel A, demonstrating lack of compression along the cisternal portion of cranial nerve VII with actual compression occurring instead along the attached segment.

References

  • 1

    Barker FG IIJannetta PJBissonette DJShields PTLarkins MVJho HD: Microvascular decompression for hemifacial spasm. J Neurosurg 82:2012101995

  • 2

    Bigder MGKaufmann AM: Failed microvascular decompression surgery for hemifacial spasm due to persistent neurovascular compression: an analysis of reoperations. J Neurosurg 124:90952016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Campos-Benitez MKaufmann AM: Neurovascular compression findings in hemifacial spasm. J Neurosurg 109:4164202008

  • 4

    Cignoni PCallieri MCorsini MDellepiane MGanovelli GRanzuglia G: MeshLab: an open-source mesh processing tool in Proceedings of the 2008 Eurographics Italian Chapter Conference2016 (http://vcg.isti.cnr.it/Publications/2008/CCCDGR08/MeshLabEGIT.final.pdf) [Accessed May 22 2019]

    • Search Google Scholar
    • Export Citation
  • 5

    Cohen-Gadol AA: Microvascular decompression surgery for trigeminal neuralgia and hemifacial spasm: naunces of the technique based on experiences with 100 patients and review of the literature. Clin Neurol Neurosurg 113:8448532011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Doherty CMBriggs GQuigley DGMcCarron MO: An unusual cause of hemifacial spasm. Br J Neurosurg 29:1071092015

  • 7

    Flanders TMBlue RRoberts SMcShane BJWilent BTambi V: Fully endoscopic microvascular decompression for hemifacial spasm. J Neurosurg [epub ahead of print October 5 2018; DOI: 10.3171/2018.4.JNS172631]

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Gu YZhu WZhang XBHou YYXie T: Enterogenous cyst as a rare cause of hemifacial spasm. J Clin Neurosci 18:5745762011

  • 9

    Hughes MABranstetter BFTaylor CTFakhran SDelfyett WTFrederickson AM: MRI findings in patients with a history of failed prior microvascular decompression for hemifacial spasm: how to image and where to look. AJNR Am J Neuroradiol 36:7687732015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Jannetta PJAbbasy MMaroon JCRamos FMAlbin MS: Etiology and definitive microsurgical treatment of hemifacial spasm. Operative techniques and results in 47 patients. J Neurosurg 47:3213281977

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Jin YZhao CSu SZhang XQiu YJiang J: Residual hemifacial spasm after microvascular decompression: prognostic factors with emphasis on preoperative psychological state. Neurosurg Rev 38:5675722015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Lu AYYeung JTGerrard JLMichaelides EMSekula RF JrBulsara KR: Hemifacial spasm and neurovascular compression. ScientificWorldJournal 2014:3493192014

  • 13

    Naraghi RTanrikulu LTroescher-Weber RBischoff BHecht MBuchfelder M: Classification of neurovascular compression in typical hemifacial spasm: three-dimensional visualization of the facial and the vestibulocochlear nerves. J Neurosurg 107:115411632007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Nilsen BLe KDDietrichs E: Prevalence of hemifacial spasm in Oslo, Norway. Neurology 63:153215332004

  • 15

    Park JSKoh EJChoi HYLee JM: Characteristic anatomical conformation of the vertebral artery causing vascular compression against the root exit zone of the facial nerve in patients with hemifacial spasm. Acta Neurochir (Wien) 157:4494542015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Payner TDTew JM Jr: Recurrence of hemifacial spasm after microvascular decompression. Neurosurgery 38:6866911996

  • 17

    Sekula RF JrFrederickson AMBranstetter BF IVOskin JEStevens DRZwagerman NT: Thin-slice T2 MRI imaging predicts vascular pathology in hemifacial spasm: a case-control study. Mov Disord 29:129913032014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Sindou MMercier P: Microvascular decompression for hemifacial spasm: Outcome on spasm and complications. A review. Neurochirurgie 64:1061162018

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19

    Soriano-Baron HVales-Hidalgo OArvizu-Saldana EMoreno-Jimenez SRevuelta-Gutierrez R: Hemifacial spasm: 20-year surgical experience, lesson learned. Surg Neurol Int 6:832015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Tan EKFook-Chong SLum SYThumboo J: Validation of a short disease specific quality of life scale for hemifacial spasm: correlation with SF-36. J Neurol Neurosurg Psychiatry 76:170717102005

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21

    Tash RDeMerritt JSze GLeslie D: Hemifacial spasm: MR imaging features. AJNR Am J Neuroradiol 12:8398421991

  • 22

    Tomii MOnoue HYasue MTokudome SAbe T: Microscopic measurement of the facial nerve root exit zone from central glial myelin to peripheral Schwann cell myelin. J Neurosurg 99:1211242003

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

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