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Zoe E. Teton, Daniel Blatt, Katherine Holste, Ahmed M. Raslan and Kim J. Burchiel

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.

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Takamitsu Fujimaki, Takanori Fukushima and Shinichiro Miyazaki

; poor: persistent pain. Fig. 2. Kaplan-Meier analysis of the probability of pain-free ratio in 108 patients. Rates of pain-free patients at 12, 24, 36, 48, and 54 months were 0.71, 0.55, 0.48, 0.35, and 0.28, respectively. Complications relating to percutaneous retrogasserian glycerol injection were unexpectedly frequent. Of 80 patients followed for 38 to 54 months, 50 patients (63%) had definite hypesthesia and 23 (29%) suffered from unpleasant paresthesia or dysesthesia, including two cases of anesthesia dolorosa. Of the 36 patients who had

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Ari J. Kane, Michael E. Sughrue, Martin J. Rutkowski, Derick Aranda, Steve A. Mills, Raphael Buencamino, Shanna Fang, Igor J. Barani and Andrew T. Parsa

these patients who underwent resection alone, and in those who had low-grade Hyams, there were no deaths during the 9 months of total follow-up. Because we found that radiotherapy provided no survival benefit or disadvantage, and to include all patients who had received surgery as part of their management, we performed Kaplan-Meier analysis on patients who underwent surgery or surgery plus radiotherapy. Similar results were obtained for this group of patients as well. In univariate analysis, Kadish stage continued to predict prognosis in 574 patients receiving

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Alessa Schütz, Michael Murek, Lennart Henning Stieglitz, Corrado Bernasconi, Sonja Vulcu, Jürgen Beck, Andreas Raabe and Philippe Schucht

as determined by the treating neurosurgeon were included in the study and categorized as patients with BFR. Statistical Analysis Baseline characteristics of patients with and without BFR were analyzed descriptively and compared using the 2-sample t-test with pooled variances for continuous variables and Fisher’s exact test for categorical variables. A Kaplan-Meier analysis of time from AC to diagnosis of BFR was performed and putative predictors associated with BFR were investigated using the log-rank test. A multivariable Cox proportional hazards model was fitted

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Jamal M. Taha, John M. Tew Jr. and C. Ralph Buncher

%), pain persisted after surgery. Rate and Timing of Pain Recurrence A 25% pain recurrence rate was estimated by Kaplan—Meier analysis for the 154 patients at 14 years ( Fig. 1 ); 15% within 5 years; 7% within 5 to 10 years; and 3% within 10 to 15 years. The rates and timing of pain recurrence were similar for patients followed and those not followed for 15 years ( Fig. 2 ). Fig. 1. Graph showing Kaplan—Meier analysis of the pain-free survival rate of 154 consecutive patients with complete and incomplete follow up who were treated by percutaneous

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Gautam U. Mehta, Jason P. Sheehan and Mary Lee Vance

) corresponding with elevated ACTH levels. After targeted GK SRS for the lesion (25 Gy, 5 isocenters) and initiation of cabergoline therapy, the tumor was no longer appreciated on pituitary imaging obtained during 8.5 years of follow-up (right) . By Kaplan-Meier analysis, progression-free survival rates at 1, 3, and 7 years were each 94.7% (number of patients at risk: 18, 12, and 5, respectively) ( Fig. 2 ). Using univariate analysis, clinical factors were evaluated for their effect on tumor growth. Age, sex, time from radiosurgery to adrenalectomy, length of follow

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Michael E. Sughrue, Nader Sanai, Gopal Shangari, Andrew T. Parsa, Mitchel S. Berger and Michael W. McDermott

-checked against the Social Security Death Index. All data were compiled in an electronic database and crosschecked for accuracy before being subject to any statistical analysis. Statistical Analysis Survival and progression analysis was performed using Kaplan-Meier analysis, with between-group differences being analyzed using the log-rank test. Statistically significant between-group differences were subsequently analyzed using Cox regression analysis, in which the covariates of age and KPS score, which we hypothesized might be potential confounders, were forced into the

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Michael E. Sughrue, Rajwant Kaur, Martin J. Rutkowski, Ari J. Kane, Gurvinder Kaur, Isaac Yang, Lawrence H. Pitts and Andrew T. Parsa

patient age for each extent of resection group are provided in Table 2 . F ig . 1. Kaplan-Meier analysis comparing the rate of tumor recurrence between extent of resection (GTR vs NTR vs STR) (A) , a subgroup analysis of STR patients divided by size of the lesion on postoperative imaging (B) , surgical approaches (middle cranial fossa [MCF] vs retrosigmoid craniotomy [RS] vs translabyrinthine craniotomy [TL]) (C) , patient age (≤ 55 years vs those 56–70 years vs those > 70 years of age) (D) , and preoperative tumor size (≤ 1.5 cm vs 1.6–3.0 cm vs > 3.0 cm

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Aaron J. Clark, Michael E. Ivan, Michael E. Sughrue, Isaac Yang, Derick Aranda, Seunggu J. Han, Ari J. Kane and Andrew T. Parsa

performed. All references that contained disaggregated data specifically addressing tumor control or reporting progression with adequate follow-up in patients who had undergone surgery (biopsy procedure or resection) of histologically confirmed pineocytoma were included in our analysis. Any paper that did not provide some follow-up data on these patients with follow-up imaging was excluded, as these studies would not facilitate Kaplan-Meier analysis. Data Extraction The median largest tumor dimension and median tumor volume were not reportable or analyzable in our

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Stephen T. Magill, David S. Lee, Adam J. Yen, Calixto-Hope G. Lucas, David R. Raleigh, Manish K. Aghi, Philip V. Theodosopoulos and Michael W. McDermott

were very good, with 5- and 10-year rates after the first reoperation reaching 88% and 76%, respectively, based on Kaplan-Meier analysis. In our series, the strongest predictor of complication was posterior fossa tumor location. This is perhaps unsurprising, as meningiomas within the posterior fossa are frequently adherent to critical structures, and Simpson grade I resection is often not possible, even in the most capable hands. Thus, the complication rates reported here may inform surgeons as they discuss treatment options with patients who experience recurrent