Microvascular decompression for hemifacial spasm

Restricted access

✓ The authors report the results of 782 microvascular decompression procedures for hemifacial spasm in 703 patients (705 sides), with follow-up study from 1 to 20 years (mean 8 years). Of 648 patients who had not undergone prior intracranial procedures for hemifacial spasm, 65% were women; their mean age was 52 years, and the mean preoperative duration of symptoms was 7 years. The onset of symptoms was typical in 92% and atypical in 8%. An additional 57 patients who had undergone prior microvascular decompression elsewhere were analyzed as a separate group. Patients were followed prospectively with annual questionnaires.

Kaplan-Meier methods showed that among patients without prior microvascular decompression elsewhere, 84% had excellent results and 7% had partial success 10 years postoperatively. Subgroup analyses (Cox proportional hazards model) showed that men had better results than women, and patients with typical onset of symptoms had better results than those with atypical onset. Nearly all failures occurred within 24 months of operation; 9% of patients underwent reoperation for recurrent symptoms. Second microvascular decompression procedures were less successful, whether the first procedure was performed at Presbyterian-University Hospital or elsewhere, unless the procedure was performed within 30 days after the first microvascular decompression. Patient age, side and preoperative duration of symptoms, history of Bell's palsy, preoperative presence of facial weakness or synkinesis, and implant material used had no influence on postoperative results.

Complications after the first microvascular decompression for hemifacial spasm included ipsilateral deaf ear in 2.6% and ipsilateral permanent, severe facial weakness in 0.9% of patients. Complications were more frequent in reoperated patients. In all, one operative death (0.1%) and two brainstem infarctions (0.3%) occurred. Microvascular decompression is a safe and definitive treatment for hemifacial spasm with proven long-term efficacy.

Article Information

Address for Dr. Barker: UCSF Brain Tumor Research Center, HSE-722, 505 Parnassus Avenue, San Francisco, California 94143–0520.Address reprint requests to: Peter J. Jannetta, M.D., Presbyterian-University Hospital, Room B-400, 230 Lothrop Street, Pittsburgh, Pennsylvania 15213.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Graph showing operative success for all patients (male and female, typical and atypical, first operation only). The dotted line represents chances of excellent relief of hemifacial spasm after first microvascular decompression; solid line, chances of a good or excellent result. See text for grading of success.

  • View in gallery

    Graph showing results of reoperation for recurrent hemifacial spasm. Only patients whose first microvascular decompression for hemifacial spasm was performed at Presbyterian-University Hospital and whose second operation was more than 30 days after their first are included. Results reflect all subsequent operations. Dashed line, chance of excellent result; solid line, chance of good or excellent result.

  • View in gallery

    Graph showing operative success for all patients (excluding those referred to Presbyterian-University Hospital after prior microvascular decompression elsewhere). Results of reoperations are included. Dotted line, chance of excellent result; solid line, chance of good or excellent result.

  • View in gallery

    Graph showing success of microvascular decompression by subgroup. Solid line, chance of excellent result for patients with typical onset of symptoms; dashed line, chance of excellent result for patients with atypical onset of symptoms. Results of reoperations are included. The difference in results is statistically significant (log rank p < 1 × 10−6).

  • View in gallery

    Graph showing success of microvascular decompression by subgroup. Solid line, chance of excellent result for male patients with typical hemifacial spasm; dashed line, chance of excellent result for female patients with typical hemifacial spasm. Results of reoperations are included. The difference in results is statistically significant (log rank p = 0.002).

  • View in gallery

    Graph showing success of reoperation for recurrent hemifacial spasm after a previous microvascular decompression. Solid line, probability of excellent result after an immediate second operation (< 30 days after first microvascular decompression at Presbyterian-University Hospital); dotted line, probability of excellent result after a delayed second operation (recurrence of spasm > 30 days after first microvascular decompression at Presbyterian-University Hospital). The dashed line represents the probability of excellent result for a second microvascular decompression when the first operation was not performed at Presbyterian-University Hospital. Reoperations more than 30 days after first operation at Presbyterian-University Hospital yielded worse results than immediate reoperations (log rank p < 0.01). Reoperations on patients whose first operations were performed elsewhere gave significantly better results than did reoperations on patients with delayed recurrence after a first microvascular decompression at Presbyterian-University Hospital (log rank p = 0.014).

References

  • 1.

    Adams CBT: Microvascular compression: an alternative view and hypothesis. J Neurosurg 70:1121989Adams CBT: Microvascular compression: an alternative view and hypothesis. J Neurosurg 70:1–12 1989

  • 2.

    Adams CBT: The physiology and pathophysiology of posterior fossa cranial nerve dysfunction syndromes: nonmicrovascular perspective in Barrow DL (ed): Surgery of the Cranial Nerves of the Posterior Fossa. Park Ridge, Ill: American Association of Neurological Surgeons1993 pp 131154Adams CBT: The physiology and pathophysiology of posterior fossa cranial nerve dysfunction syndromes: nonmicrovascular perspective in Barrow DL (ed): Surgery of the Cranial Nerves of the Posterior Fossa. Park Ridge Ill: American Association of Neurological Surgeons 1993 pp 131–154

  • 3.

    Alexander GEMoses H III: Carbamazepine for hemifacial spasm. Neurology 32:2862871982Alexander GE Moses H III: Carbamazepine for hemifacial spasm. Neurology 32:286–287 1982

  • 4.

    Auger RGPiepgras DGLaws ER Jr: Hemifacial spasm: results of microvascular decompression of the facial nerve in 54 patients. Mayo Clin Proc 61:6406441986Auger RG Piepgras DG Laws ER Jr: Hemifacial spasm: results of microvascular decompression of the facial nerve in 54 patients. Mayo Clin Proc 61:640–644 1986

  • 5.

    Auger RGWhisnant JP: Hemifacial spasm in Rochester and Olmstead County, Minnesota, 1960 to 1984. Arch Neurol 47:123312341990Auger RG Whisnant JP: Hemifacial spasm in Rochester and Olmstead County Minnesota 1960 to 1984. Arch Neurol 47:1233–1234 1990

  • 6.

    Cox DR: Regression models and life tables. J R Stat Soc (B) 34:1872201972Cox DR: Regression models and life tables. J R Stat Soc (B) 34:187–220 1972

  • 7.

    Dobie RAFisch U: Primary and revision surgery (selective neurectomy) for facial hyperkinesia. Arch Otolaryngol Head Neck Surg 112:1541631986Dobie RA Fisch U: Primary and revision surgery (selective neurectomy) for facial hyperkinesia. Arch Otolaryngol Head Neck Surg 112:154–163 1986

  • 8.

    Dutton JJBuckley EG: Long-term results and complications of botulinum A toxin in the treatment of blepharospasm. Ophthalmology 95:152915341988Dutton JJ Buckley EG: Long-term results and complications of botulinum A toxin in the treatment of blepharospasm. Ophthalmology 95:1529–1534 1988

  • 9.

    Ehni GWoltman HW: Hemifacial spasm: review of 106 cases. Arch Neurol Psychiatry 53:2052111945Ehni G Woltman HW: Hemifacial spasm: review of 106 cases. Arch Neurol Psychiatry 53:205–211 1945

  • 10.

    Elmqvist DToremalm NGElner Ået al: Hemifacial spasm: electrophysiological findings and the therapeutic effect of facial nerve block. Muscle Nerve 5:S89S941982Elmqvist D Toremalm NG Elner Å et al: Hemifacial spasm: electrophysiological findings and the therapeutic effect of facial nerve block. Muscle Nerve 5:S89–S94 1982

  • 11.

    Felber SBirbamer GAichner Fet al: Magnetic resonance imaging and angiography in hemifacial spasm. Neuroradiology 34:4134161992Felber S Birbamer G Aichner F et al: Magnetic resonance imaging and angiography in hemifacial spasm. Neuroradiology 34:413–416 1992

  • 12.

    Frueh BRPreston RAMusch DC: Facial nerve injury and hemifacial spasm. Am J Ophthalmol 110:4214321990Frueh BR Preston RA Musch DC: Facial nerve injury and hemifacial spasm. Am J Ophthalmol 110:421–432 1990

  • 13.

    Gardner WJ: Concerning the mechanism of trigeminal neuralgia and hemifacial spasm. J Neurosurg 19:9479581962Gardner WJ: Concerning the mechanism of trigeminal neuralgia and hemifacial spasm. J Neurosurg 19:947–958 1962

  • 14.

    Gardner WJSava GA: Hemifacial spasm—a reversible pathophysiologic state. J Neurosurg 19:2402471962Gardner WJ Sava GA: Hemifacial spasm—a reversible pathophysiologic state. J Neurosurg 19:240–247 1962

  • 15.

    Geller BDHallett MRavits J: Botulinum toxin therapy in hemifacial spasm: clinical and electrophysiologic studies. Muscle Nerve 12:7167221989Geller BD Hallett M Ravits J: Botulinum toxin therapy in hemifacial spasm: clinical and electrophysiologic studies. Muscle Nerve 12:716–722 1989

  • 16.

    Harris EKAlbert A: Survivorship Analysis for Clinical Studies. New York: Marcel Dekker1991Harris EK Albert A: Survivorship Analysis for Clinical Studies. New York: Marcel Dekker 1991

  • 17.

    Herzberg L: Management of hemifacial spasm with clonazepam. Neurology 35:167616771985 (Ltr)Herzberg L: Management of hemifacial spasm with clonazepam. Neurology 35:1676–1677 1985 (Ltr)

  • 18.

    Higashi SYamashita JYamamoto Yet al: Hemifacial spasm associated with a cerebellopontine angle arachnoid cyst in a young adult. Surg Neurol 37:2892921992Higashi S Yamashita J Yamamoto Y et al: Hemifacial spasm associated with a cerebellopontine angle arachnoid cyst in a young adult. Surg Neurol 37:289–292 1992

  • 19.

    Hori TFukushima TTerao Het al: Percutaneous radiofrequency facial nerve coagulation in the management of facial spasm. J Neurosurg 54:6556581981Hori T Fukushima T Terao H et al: Percutaneous radiofrequency facial nerve coagulation in the management of facial spasm. J Neurosurg 54:655–658 1981

  • 20.

    Huang C-IChen I-HLee L-S: Microvascular decompression for hemifacial spasm: analyses of operative findings and results in 310 patients. Neurosurgery 30:53561992Huang C-I Chen I-H Lee L-S: Microvascular decompression for hemifacial spasm: analyses of operative findings and results in 310 patients. Neurosurgery 30:53–56 1992

  • 21.

    Iansek RHarrison MJAndrew J: Hypoglossal-facial nerve anastomosis: a clinical and electrophysiological follow-up. J Neurol Neurosurg Psychiatry 49:5885901986Iansek R Harrison MJ Andrew J: Hypoglossal-facial nerve anastomosis: a clinical and electrophysiological follow-up. J Neurol Neurosurg Psychiatry 49:588–590 1986

  • 22.

    Jannetta PJ: Hemifacial spasm caused by a venule: case report. Neurosurgery 14:89921984Jannetta PJ: Hemifacial spasm caused by a venule: case report. Neurosurgery 14:89–92 1984

  • 23.

    Jannetta PJ: Microsurgical exploration and decompression of the facial nerve in hemifacial spasm. Curr Top Surg Res 2:2172201970Jannetta PJ: Microsurgical exploration and decompression of the facial nerve in hemifacial spasm. Curr Top Surg Res 2:217–220 1970

  • 24.

    Jannetta PJ: Microvascular decompression of the facial nerve for hemifacial spasm in Wilson CB (ed): Neurosurgical Procedures: Personal Approaches to Classic Operations. Baltimore: Williams & Wilkins1992 pp 154162Jannetta PJ: Microvascular decompression of the facial nerve for hemifacial spasm in Wilson CB (ed): Neurosurgical Procedures: Personal Approaches to Classic Operations. Baltimore: Williams & Wilkins 1992 pp 154–162

  • 25.

    Lee ET: Statistical Methods for Survival Data Analysised 2. New York: John Wiley & Sons1992Lee ET: Statistical Methods for Survival Data Analysis ed 2. New York: John Wiley & Sons 1992

  • 26.

    Loeser JDChen J: Hemifacial spasm: treatment by microsurgical facial nerve decompression. Neurosurgery 13:1411461983Loeser JD Chen J: Hemifacial spasm: treatment by microsurgical facial nerve decompression. Neurosurgery 13:141–146 1983

  • 27.

    Ludman HChoa DI: Hemifacial spasm: operative treatment. J Laryngol Otol 99:2392451985Ludman H Choa DI: Hemifacial spasm: operative treatment. J Laryngol Otol 99:239–245 1985

  • 28.

    Mauriello JAAljian J: Natural history of treatment of facial dyskinesias with botulinum toxin: a study of 50 consecutive patients over seven years. Br J Ophthalmol 75:7377391991Mauriello JA Aljian J: Natural history of treatment of facial dyskinesias with botulinum toxin: a study of 50 consecutive patients over seven years. Br J Ophthalmol 75:737–739 1991

  • 29.

    Nagaseki YHorikoshi TOmata Tet al: Oblique sagittal magnetic resonance imaging visualizing vascular compression of the trigeminal or facial nerve. J Neurosurg 77:3793861992Nagaseki Y Horikoshi T Omata T et al: Oblique sagittal magnetic resonance imaging visualizing vascular compression of the trigeminal or facial nerve. J Neurosurg 77:379–386 1992

  • 30.

    Nagata SMatsushima TFujii Ket al: Hemifacial spasm due to tumor, aneurysm, or arteriovenous malformation. Surg Neurol 38:2042091992Nagata S Matsushima T Fujii K et al: Hemifacial spasm due to tumor aneurysm or arteriovenous malformation. Surg Neurol 38:204–209 1992

  • 31.

    Sandyk RGillman MA: Baclofen in hemifacial spasm. Int J Neurosci 33:2612641987Sandyk R Gillman MA: Baclofen in hemifacial spasm. Int J Neurosci 33:261–264 1987

  • 32.

    Sprik CWirtschafter JD: Hemifacial spasm due to intracranial tumor. An international survey of botulinum toxin investigators. Ophthalmology 95:104210451988Sprik C Wirtschafter JD: Hemifacial spasm due to intracranial tumor. An international survey of botulinum toxin investigators. Ophthalmology 95:1042–1045 1988

  • 33.

    Steinberg DColla P: SURVIVAL: A Supplementary Module for SYSTAT. Evanston, Ill: SYSTAT, Inc.1988Steinberg D Colla P: SURVIVAL: A Supplementary Module for SYSTAT. Evanston Ill: SYSTAT Inc. 1988

  • 34.

    Taylor JDNKraft SPKazdan MSet al: Treatment of blepharospasm and hemifacial spasm with botulinum A toxin: a Canadian multicentre study. Can J Ophthalmol 26:1331381991Taylor JDN Kraft SP Kazdan MS et al: Treatment of blepharospasm and hemifacial spasm with botulinum A toxin: a Canadian multicentre study. Can J Ophthalmol 26:133–138 1991

  • 35.

    Telischi FFGrobman LRSheremata WAet al: Hemifacial spasm: occurrence in multiple sclerosis. Arch Otolaryngol Head Neck Surg 117:5545561991Telischi FF Grobman LR Sheremata WA et al: Hemifacial spasm: occurrence in multiple sclerosis. Arch Otolaryngol Head Neck Surg 117:554–556 1991

  • 36.

    Tien RDWilkins RH: MRA delineation of the vertebral-basilar system in patients with hemifacial spasm and trigeminal neuralgia. AJNR 14:34361993Tien RD Wilkins RH: MRA delineation of the vertebral-basilar system in patients with hemifacial spasm and trigeminal neuralgia. AJNR 14:34–36 1993

  • 37.

    Turnbull BW: The empirical distribution function with arbitrarily grouped, censored and truncated data. J R Stat Soc (B) 38:2902951976Turnbull BW: The empirical distribution function with arbitrarily grouped censored and truncated data. J R Stat Soc (B) 38:290–295 1976

  • 38.

    Vermersch PPetit HMarion MHet al: Hemifacial spasm due to pontine infarction. J Neurol Neurosurg Psychiatry 54:10181991 (Ltr)Vermersch P Petit H Marion MH et al: Hemifacial spasm due to pontine infarction. J Neurol Neurosurg Psychiatry 54:1018 1991 (Ltr)

  • 39.

    Vital Statistics of the United States 1987. Volume II. Part A. Mortality. Hyattsville, MD: U.S. Department of Health and Human Services1990Vital Statistics of the United States 1987. Volume II. Part A. Mortality. Hyattsville MD: U.S. Department of Health and Human Services 1990

  • 40.

    Westra IDrummond GT: Occult pontine glioma in a patient with hemifacial spasm. Can J Ophthalmol 26:1481511991Westra I Drummond GT: Occult pontine glioma in a patient with hemifacial spasm. Can J Ophthalmol 26:148–151 1991

  • 41.

    Wilkins RH: Facial nerve decompression for hemifacial spasm in Apuzzo MLJ (ed): Brain Surgery: Complication Avoiddance and Management. New York: Churchill Livingstone1993 Vol 2 pp 21152143Wilkins RH: Facial nerve decompression for hemifacial spasm in Apuzzo MLJ (ed): Brain Surgery: Complication Avoiddance and Management. New York: Churchill Livingstone 1993 Vol 2 pp 2115–2143

TrendMD

Cited By

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 350 350 28
Full Text Views 314 314 13
PDF Downloads 140 140 15
EPUB Downloads 0 0 0

PubMed

Google Scholar