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Repeat microvascular decompression for hemifacial spasm.

J A Engh·M Horowitz·L Burkhart·Y-F Chang·A Kassam
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Abstract

OBJECTIVE: To report our experience with repeat microvascular decompression (MVD) for hemifacial spasm (HFS) in patients who have failed their first operation. METHODS: The authors describe 41 redo MVDs for HFS in 36 patients performed over a 3 year period. Seven patients underwent early re-operation after an aborted seventh nerve decompression. Eight patients underwent early re-operation for clinical failure. Eighteen patients underwent late re-operation for spasm recurrence long after their original MVD. Eight MVDs were performed on patients who had already undergone at least two prior operations. RESULTS: Twenty four patients experienced complete spasm resolution (70.6%), eight patients had near total resolution (23.5%), and two patients failed re-operation (5.9%). Two patients were lost to follow up (5.6%). A favourable outcome was reported by 82.4% of patients at a mean follow up interval of 18 months. A total of 91.7% of patients 50 years of age or younger were cured at follow up versus 59.1% of patients older than 50 (p = 0.04). Patients undergoing early re-operation were significantly more likely to be cured or improved than patients undergoing late re-operation (p = 0.03). CONCLUSIONS: Repeat MVD for HFS is effective in experienced hands. Younger patients respond better to repeat MVD. Late repeat MVD for HFS is a reasonable treatment option, although results are less favourable than for early re-operation.

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AdultAgedDecompression, SurgicalFemaleHemifacial SpasmHumansMaleMicrosurgeryMiddle AgedQuality of LifeReoperationSurveys and QuestionnairesTreatment OutcomeJournal Article

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J A Engh, M Horowitz, L Burkhart, Y-F Chang, A Kassam. 2005. Repeat microvascular decompression for hemifacial spasm.. https://doi.org/10.1136/jnnp.2004.056861

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