Elsevier

World Neurosurgery

Volume 109, January 2018, Pages e778-e782
World Neurosurgery

Original Article
Long-Term Efficacy of Initial Microvascular Decompression Versus Subsequent Microvascular Decompression for Idiopathic Hemifacial Spasm

https://doi.org/10.1016/j.wneu.2017.10.079Get rights and content

Objective

Hemifacial spasm (HFS) is a disorder characterized by intermittent, involuntary facial muscle contractions. Microvascular decompression (MVD) is the gold treatment for HFS. The aim of this research was to discuss whether patients undergoing MVD as their initial surgical intervention experience greater spasm control than patients experiencing an MVD performed as a subsequent surgical intervention.

Methods

The study included 976 patients with HFS, 452 of whom (group A) underwent MVD as their initial surgical intervention and 524 of whom (group B) underwent subsequent MVD. Relevant clinical data including outcome of MVD, operative findings, complications, and so on were collected immediately after MVD operation and at follow-up.

Results

The follow-up period was 7–9 years (mean, 7.96 ± 0.87 years). The mean age at intervention was 53.14 years and 55.43 years in the 2 groups, respectively. The long-term postoperative relief rate of patients in the 2 groups was 98.23% and 87.21%, respectively. There was a significant difference in long-term postoperative relief rate of patients between the 2 groups (P < 0.05).

Conclusions

Patients undergoing MVD for HFS as the primary treatment experience better long-term efficacy than patients first treated with botulinum neurotoxin type A.

Introduction

Hemifacial spasm (HFS) is a disorder characterized by intermittent, involuntary facial muscle contractions, leading to impaired quality of life. Compression of the facial nerve by offend vessel is the most common identifiable reason of HFS.1, 2, 3 With a high curative rate from 50% to 98%, microvascular decompression (MVD) has been regarded as the gold standard treatment for HFS.4, 5 However, some patients choose to undergo less-invasive procedures before MVD, such as botulinum neurotoxin type A (BtNtA).6, 7 BtNtA exerts its effect by preventing the liberation of acetylcholine into the synaptic cleft, leading first to functional and then to physical muscle denervation.8 However, the long-term efficacy and safety of subsequent MVD have not been established. In the present study, we retrospectively investigated the characteristics, immediate and long-term outcomes, complications, and vascular decompression in patients experiencing an MVD performed as their first surgical intervention and patients experiencing an MVD performed as a subsequent surgical intervention.

Section snippets

Patient Population

This study and the technique of MVD were approved by Xinhua Hospital Ethics Institutional Committee. Each patient involved in this study signed an informed consent form. All methods were carried out in accordance with approved institutional guidelines and regulations. From January 2008 to October 2010, our department treated 1029 patients with primary HFS via MVD. We identified and excluded 12 patients with bilateral HFS, and 41 patients were lost to follow-up, leaving 976 patients for

Demographics

Table 1 presents the patient demographics. The mean age at intervention was 68.24 years for patients in group A and 67.43 years in group B (P = 0.75). The mean HFS symptom duration was 5.25 years for patients in group A and 6.43 years for patients in group B (P = 0.47). There were not significant differences in mean age at MVD and HFS symptom duration between the 2 groups. In addition, the number of female patients and side of HFS were well matched between the 2 groups. Table 2 presents the

Discussion

MVD has been reported to be the only surgical therapy that directly treats the proposed etiology of HFS. Many studies10, 11 have been published regarding the high efficacy of MVD for patients with HFS, with cure rates ranging anywhere from 50% to 98%, and excellent long-term results 10 years after MVD in 84% of patients. However, it is an invasive procedure and not without certain risks. Some patients are inclined to receive multiple noninvasive local injections of BtNtA or radiosurgery before

Conclusions

The low complication rate and excellent outcome suggest that MVD is an effective and safe treatment for patients with HFS. In addition, patients undergoing MVD for HFS as the primary treatment experience better long-term efficacy than patients who were first treated with BtNtA.

References (20)

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Cited by (5)

Conflict of interest statement: This study was supported by the Shanghai Xinhua Hospital Foundation (grants 15LC21 and 15YJ05), Shanghai Jiao Tong University Medical and Engineering Cross Fund (grants YG2016ZD11 and YG2016QN68), and the Natural Science Foundation of China (grants 81401033 and 81671205).

Hua Zhao, Guang-feng Li, Xin Zhang, Yin-da Tang, Ping Zhou, and Jin Zhu are co–first authors.

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